CLERK’S OFFICEAPR 25 2005STATE OF ILLINOISPollution Control BoardSENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY • Complete items 1, 2, and 3.
Also complete
it~~4if Restricted Delivery is desired.
N Attach this card to the back of the mailpiece,
or on the front if space permits.
240 North Road
Fairbury, IL 61739 / A Signature ~ ~ ‘Received by (Printed Name) C.
Date~DeI~ve
~ D.
Isdelivery address different fromltem 1? (0 Yk
if YES, enter delivery address below: 0 No3. S~yiceType,.~..P...
Allowed
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