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SENDER: <br />9 <br />~ •Complae items 1 and/or 2 tar additional services. <br />•Complete items 3 <br />48 <br />arM Ib I also wish t0 receive the <br /> <br />~ , <br />, <br />. <br />•Pdnt your name end address on the nverae of this farm eo tha <br />card to wu <br />t we can return this 10110WIng SBrVIC9a (for 8n <br /> <br />extra tea): <br />S <br />~ . <br />•Adach thin form to the Nora d the mailpixa, or on tla beck it apace does nd <br />permit. <br />1. ^ Addressee's Address o <br />i' <br />~ <br />~ •Wdle'Refum Reaeipr Rpuesred' an tM mailpiece baow the anx~e number. <br />•The Return Receipt will show to whom the enida wee tlekveretl arW tM date <br />2. ~ Restdcted Delivery i <br />y <br />a dowered' Consult posbnaster for fee. <br /> <br />n 3. Article Addressed to: V,, C ,, <br />~~`~ ~K <br />' A ~cl b r <br />u31 ~b <br />Qr <br />-+~` c <br />O ~D <br />`- <br />~ 4b. Service Type c <br /> l <br />[ ^ Registeretl Certified <br /> C~~ _ ^ <br />~ ~~, 1, 1 L <br />U yl'l <br />~ <br />r 1 <br />o ^ Express Mail F sured <br />~ <br /> ~ <br />l <br />F <br />+' ^ Return Receipt fo p <br /> 7. Date of Delive ~ <br /> [O <br />C c i rte. L' { <br />~~~ p <br />i. <br /> 5. Received By: (Print Neme) B. Addressee's A Only r re ed <br /> and !ee is paid <br /> 6. Signature: (Addressee orA enf <br />9 ) <br />O ht's ~ <br />a°. X <br /> <br /> PS form 381 , Decwnber 1994 DOII'IeS1iiC Relum Rarnint <br />31" 406 <br />D <br />ge or Certified Mail ~ <br />once Coverage Provided. <br /> <br /> <br /> <br /> <br /> <br /> 0 of use for International Mail See reverse r <br /> tto Cr] <br />.... <br /> u <br />v ~I `1 W <br /> im, State, Z P ode ,1 <br />r l~ <br />~ <br /> <br /> Postage <br /> CeNfed Fee ~ <br /> Spedal Delivery Fee _ ' <br /> n <br /> s <br /> <br />N Restricted Delivery Fe sI U <br />~ Raum Receipt Sh ~t ~ <br /> Whom 8 Date Dai red s: Q <br />_ <br />~ <br />g ReNm Recepl W <br />' ,1 K <br /> s ass <br />Date,60ddressee n ([ <br />S TOTAL Postage 8 es <br />~ Postmark or Date Q <br />o LISPS <br /> <br />LL ¢ <br />a ~ <br /> C <br />(AT)ACID OR TOXIC MATERIALS ~L~J (OD)OFF-SITE DAMAGE ~ (ST)STIPULATIONS !v <br />Y =Inspected and Found in Compliance PV =Inspected end Passible Violations Noted PB =Inspected end Problems Noted <br />N = NM Inspected NA = Not Applicable <br />WHITE - PUBLIC FILE PINK - OPERATOR YELLOW - CORRESPONDENCE FILE <br />