ORIGiNAL DEC 2 2 2004STATE OF ILL1NO~SPollution Contro’ BoardSENDER COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERYM Complete items 1, 2, and 3.
Also complete
item 4 if Restricted Delivery is desired.
• Attach this card to the back of the mailpiece,
or on the front if space permits.
(Extra Fee)
2.
Article Number
(rransferfrornseniicelabel) 7004 0750 0004 3960 1888PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-15403.
S,rviceType
fl.Pertified Mail 0 Express Mailo Registered 0 Return Receipt for Merchandise0 Insured Mail 0 C.O.D. 0 Yes
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
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