CLERKS OFFICE001 272005ORIGIN1 STATEQFILLINO:SPollution Control BoardSENDER: COMPLETE THIS SLCTION COMPLETE THIS SECTION ON DEL (VEPY • 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.
Date of Delivery
1~cAt~ /c/CL /O-~2f0iD.
Is delivery address differentfrom itØ I? 0 Yes
If YES, enter delivery address below: 0 No3.
Service Type
ned Mall 0 Express MailRegIstered 0 Return Receipt for MerchaMse0 Insured Mall 0 C.0.D.4. RestrIcted Delivery?
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
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