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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A Signature <br /> item 4 if Restricted Delivery is desired. X ❑Agent <br /> ■ Print your name and address on the reverse ❑Addressee <br /> so that we can return the card to you. B. Received by(Pdlnfed Name) C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. <br /> D. Is delivery address different from item 1? Ep Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑ No <br /> APOLINAR LOPEZ <br /> 10900 TfOKAY COLONY ROAD <br /> LODI, CA 95240 r[''IVMONMEN T HEALTH <br /> 3. Service Type <br /> KI 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 7004 25110 0003 3789 41113 <br /> (Transfer from service Iabeo <br /> PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 <br />