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~Corrple~e lama t enaor x rot edditlonal urvicea. I also wish to receive the <br />• Complete ilem9 3. 4a, and Ib. fOlloWing SefVICe3 (ter 0n <br />• P <br />n Q; our name end etltlrese on the reverse of this tone ao that we can velum tNa extra fee): <br />i <br />ro o <br />~ <br />•Attach t <br />ts ronn to the boot of Iha meilpied, ar on the beck if apace dose not <br />it 1. ^ Addressee's Address ~ <br />perm <br />• Wdte'Rerum ReCai R uesfed'on the meilpiece below Ne article number, <br />m aq <br />2. ^ Restricted Delivery d <br />to <br />•The Retum Receipt will show to wrgm ttte artice was delivered end the tlate n . <br />delivered. , Consult posbnaster for fee. <br /> ~ <br />3. ANcle Addressed W: 4a. ANde Number <br />~ f ~ <br />"`-" " ' v' W~ """ <br /> <br />~[, 4b. Service Type <br />~ ~~ <br />i <br />^ R <br />t <br />d <br />tifi <br />'C <br />d ° <br />t+ <br />. s <br />ere <br />eg <br />et <br />e <br />G3 <br /> <br />`~ <br />7 <br />I <br />~ <br />^ Express Mail ^ Insured a <br />5 <br />~ <br />~ <br />~ ~ <br />" <br />Il <br />n <br />^ Retum Receipt for Merchartdse ^ COD p <br />In <br />r r / n~ lJ <br />-1 <br />ll 7. Date of Delivery <br /> i <br /> . <br />5. Received By: (Pdnt Name) B. Addressee's Ad re s (Only it requested ~ <br /> and lee is pald) ~ <br />XY~9,~~ ~~gv I 1 <br />PS Form 3811, December fss Domestic Return Receipt i• <br />+. <br />m <br />m <br />,_ <br />C <br />O <br />E <br />`o <br />LL <br />OJ <br />a <br />(BS)OVERS[1PRDfiN/DHV. WASTE . <br />(AT)ACID OR TOXIC MATERIALS <br />Y = LtR«ted and Found in Compliance <br />WHITE - PUBLIC FILE <br />Z 416 942'72 <br />receipt for <br />Certified MaiP ~ c <br />No Insur~~r~ov oy <br />Do not r Interr(~t 4r <br />ISee Reversal '(` ' ¢ <br />se <br />.~ l <br />P O sale aid IP C /~, <br />CCJ <br />Pos~age F <br />P <br />Geru6ed Fee <br />$peaal Delwerv Fee <br />I ~ <br />Pesucud 04~Ya'Y fee J - - -~ - ~ - <br />Pewrn Peceiot Snowing <br />so Wnom a Daie Delwere0 <br />Peiwn Receipt Snowing io Whom <br />Dale, and A00~essee's AD <br />TOTA1 Postage , <br />a Fees J.\~' _\ <br />Postmark or Dale 11.. ~ .~ <br />~a>\a\\~~ ~O~ <br />`~ .~ <br />U <br />C <br />1.17 <br />rN-- <br />C <br />rrrT3 <br />C <br />L <br />T <br />Cr <br />6 <br />0 <br />Nwr (SC) EROSION/SEDII~NTATION N (RS) RfiCL PLAN/COMP ~N~ <br />~i A~ (OD)OFF-SITE DAMAGE i!I (ST)STI P(JI.ATIONS NL~ <br />«t•d and Problems Noted <br />PV = Wp«ted and Poeaible Violations Noted PB = trt•P <br />N =Not Irup«ted NA =Not Applicable <br />YELLOW - OPERATOR PINK - CORRESPONDENCE FILfi <br />