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Ir <br />■ Complete items 1, 2, and 3. Also complete A. Signature <br />item 4 if Restricted Delivery is desired. <br />■ Print y r (V drdrKsVn e reverse <br />so that e _ r the ardrto ou. c . <br />■ Attach t ti baeC d>�tfie mailpiece, <br />or on the ront if space permits. <br />1. Article Addressed to: <br />(Vr4A� L,iA0.1 0A1eev <br />C. <br />s delivery address dif &erit frbm'iteffS 1? <br />If YES, egterl G li 1 ryG d 2,154 <br />A elow: <br />II LNVIRONMENT HEALTH <br />PERMIT/SERVICFS <br />❑ Agent <br />❑ Addressee <br />❑ Yes <br />❑ No <br />3. Service Type <br />Certified Mail ❑ Express Mail <br />Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) ❑ Yes <br />2. Article Number 7002 2030 0001 7624 6020 <br />(transfer from service label) tR � <br />PS Form 3811, August 2001 Domestic Return Receipt 102595-01-M-2509 <br />i <br />r <br />Postal <br />oCERTIFIED <br />MAILm <br />RECEIPT <br />ru <br />M(Domestic <br />Mail Only, No Insurance <br />Coverage Provided) <br />ru <br />Postage $ <br />C3 <br />O <br />Certified Fee <br />�Return <br />Reclept Fee <br />(Endorsement Required) <br />Postmark <br />e <br />O <br />ITl <br />Restricted Delivery Fee <br />(Endorsement Required) <br />O <br />fU <br />Total Postage & Fees <br />IlJ <br />E3IZI <br />• I` <br />ent To c1 ,j��I <br />i^'_ <br />b4reet <br />d / 1 <br />---- P-4-0-4 <br />Aldi-:---- <br />PO Box No. Z Ef 2 W <br />G _ _ _ /1 ` <br />---------------------------- ------------------�--r <br />City, State, 2f <br />-T A AAw A <br />----------------P,- <br />^ <br />/ LA 0) % 1 <br />i <br />r <br />