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2002-11-18_REVISION - M1983176
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2002-11-18_REVISION - M1983176
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Entry Properties
Last modified
6/15/2021 2:45:25 PM
Creation date
11/21/2007 12:11:14 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1983176
IBM Index Class Name
Revision
Doc Date
11/18/2002
Doc Name
Submittal of Proof of Notification
From
Asphalt Specialties Co Inc
To
DMG
Type & Sequence
AM1
Media Type
D
Archive
No
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^ Complete Items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />AdamsCocm~y $ogrrl o-f~ <br />L'ommi~loner-5 <br />950 ~. 4~ Ave. <br />~rigFrton, CA . ~~x <br />2. Artie <br />7~ <br />PS Foy <br />A. Received by (Please Pnnt Clearly) ~ B. Date of Delivery <br />C. Sig/na~Y~re~ ~°xr r VIJYd/(jr(~t' <br />X ~-G.C-1~'~'Y Age <br />D. Is delivery address di even m~~ ite~~1 ^Ves <br />If YES, enter delivery address below: ^ No <br />3. Service Type <br />f~ Certified Mail ^ Express Mail <br />^ Registered ~ Return Receipt for Merchandise <br />^ Insured Mail ^ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ^Ves <br />2595-99-M-1789 <br />i <br />f <br />^ Complete items 1, 2, and 3. Also complete <br />item 4 if Restricted Delivery is desired. <br />^ Print your name and address on the reverse <br />so that we can return the card to you. <br />^ Attach this card to the back of the mailpiece, <br />or on the front if space permits. <br />1. Article Addressed to: <br />A. Received 6y (Please Print Cleary) ~ B. Date of Delivery <br />G. <br />^ Agent <br />Is tlelivery adc f~ss different from item 17 L1 Yes <br />It YES, enter tlelivery atldress below: ^ No <br />2Z 1 ~. ~'q I /1Ve ~ 3. Service Type <br />{,.~-;,~ rrr"` 1~Gedified Mail ^ Express Mail <br />r~ ni t w7 CO ^ Registered ~ Return Receipt for Merchandise <br />702 2030 0000 1348 7203 <br />2. Anicle Number (Copy /rom service label) <br />PS Form 3811, July 1999 Domestic Return Receipt 102595-99-M-1799 <br />
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