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° SEND <br /> D 7Compl a items anNor 21or adtlilional services. I 0 wish to receive the <br /> Z ii Complete items 3,4a,and 4b. to in services(for an <br /> •RdM your name and address on a reyer9e'gfjhJs or s t o can r eMfa f A 49 90 <br /> card to ou. ;e (t»�jtii�6j 2 e7 rvW <br /> •Attach this form to the front oft e m pi ac pace does not 1, ❑ Addressee's Address 5. <br /> m permit. <br /> m -•Wdte'Return Receipt Requested'on the mailpiece below the article number. 2, ❑ Restricted Delivery fD <br /> •The Return Receipt will show to whom the article was delivered and the date <br /> 5 <br /> delivered. Consult postmaster for fee. <br /> c y <br /> a i;EPT OF TOXIC SUBSTANCEb CVNTHVL 4 . rficle Number <br /> - <br /> m JAMES TJOSVOLD CHIEF CENTRAL CA c <br /> E CLFAMP OPERATIONS BRANCH 4b.Service Type w <br /> 10151 CROYDON WAY STE 3 ❑ Registered (Certified <br /> to ySACRAMENTO CA 95827-2107 ❑ Express Mail Insured .cw r <br /> ¢ ❑ Return Receipt for Merchandise ❑ COD <br /> p " 7.Date of Delivery ° <br /> z ' o - 3J -97 0 <br /> 0 <br /> 5. Received By: (Print Name) 8.Addressee's Address( my if requested c 1 <br /> cc <br /> and fee is paid)cci <br /> c <br /> g 6.Signature: (Ad essee o(Agent) <br /> PSR 3811, December 1994 mmestid Return Receipt <br /> O U <br /> Ln <br /> Min U r <br /> SIS 6�1 U U 0 T 64 <br /> �• E W iY1 N � o �. <br /> O8 in M N un as " <br /> Q'c%z . N U H 3 MLL � � LL <br /> QP LL d <br /> C7 Z <br /> pi <br /> • � 8 �b �� a � W <br /> g A <br /> ! E O C a r7f j! It 'Ia � � <br /> p U 966L I!Jdtl-0080 WJo=l Sd <br /> in in <br /> O iC <br /> h r-I N <br />