RECEIVEDCLERKS OFFICEOCT 312005STATE OF ILLINOISPollution Control Board~4PLETETHIS SECTIONms 1, 2, and 3.
Also complete
icted Delivery is desired.
o the back of the mailpiece,
space permits.
Signature
or DeliveryC AgentC Addresseea: 10/20/05 B.M.
4
ter “ ‘1obile Home Park~oute 45—52L 60922 £iL~’d reJTe,~D.
Is delivery address different from item 1? 0 Yes
It YES, enter delivery address below: 0 No /3. Service Typeertilied Mail C Express MailD Registered C Return Receipt tar MerchandiseC Insured Mail C COD. (Ex tra Fee) C yesy ...
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