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i <br />ai,'%� <br />.0 SENDER: �i5 p�aj� S ' <br />rn o Complete items 1 and/or 2 for additional services. <br />y Complete items 3, 4a, and 4b <br />0 Print your name and address 6 the reverse of this form so that we can return this <br />at card to you. <br />i❑ Attach this form to the front of the mailpiece, or on the back if space does not <br />y permit. <br />t ❑ Write "Retum Receipt Requested"on the mailpiece below the article number. <br />❑ The Return Receipt will show to whom the article was delivered and the date <br />delivered. <br />t -also wish to receive the follow- <br />ing services (for an extra fee): <br />1. ❑ Addressee's Address <br />2. ❑ Restricted Delivery <br />v3. <br />Y <br />Article Addressed to: <br />4a. Article Number <br />0 9 7, <br />d <br />y3 <br />E <br />0 <br />B I WALLERS ETI, LF ESTS <br />4b. Service Type <br />❑Registered <br />Certified <br />N <br />2 2 8 6 5 S HENRY RD <br />❑Express Mail <br />❑ Insured <br />oWc <br />E S CALON CA 93320 <br />❑ Return Receipt for Merchandise <br />❑ COD <br />0 <br />z <br />a p r.cc <br />e� <br />5. Received By: (Print Name) 8. Addressee's <br />¢ <br />JUL V n 2 Maid) <br />6. Signature (Addressee or Agent) <br />_N VIRONIVI NT HEALTH <br />PS Form 3811, December 1994 PERMIT/SE 99-E <br />(uniy it <br />Domestic Return Hecelpt <br />ai <br />v <br />N <br />to • <br />a. <br />'y <br />v <br />d' <br />c <br />d <br />rn' <br />c <br />.y <br />0 <br />