JUL 1 1 2008STATE OF ILLINOISPol/ution Control Board102595-02-M-1540 iCOMPLETE THIS SECTION ON DELIVERYA.
Sign
AgentAddresseeB.
Receiv by ( Printed Name)
./7D.
Is delivery address different from hem ? Yes
If YES, enter delivery address below: q NoCOMPLETE THIS SECTION ON DELIVERYB.
teceeZted
D.
Is delivery address different from item 1? q Yes
If YES, enter delivery address below: q No 3. Service Typertified Mallq Registeredq Insured Mail q Express Mailq Return Receipt for Merchandi:q C.O.D.SENDER: COMPLETE THIS SECTION ■ Complete items 1, 2, and 3. Also Completeitem 4 if Restricted ...
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