20071685 Ver 1_Certified Return Receipt_20071006

^ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
^ Print your name and address on the reverse
so that we can return the card to you.
^ Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
Scott Bergsma
6313 Sparking Brook Drive
Raleigh,NC 27616
DWQ#07-1685-Wake
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A. S na ure
X Agent
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B. Rece Printed Name) C. Date of Delivery
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every a dress different from item 1? ^ Yes
YES, enter delivery address bet~nr: ~'No
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k' S~F~cpress Mail
^ Registered ~eturn Receipt for Merchandise
^ Insured Mail /LJ C.O.D.
4. Restricted Delivery? (Extra Feel ^ Yes
2. Article Number 7pp7 p710 0004 674 2173
(transfer from sen
PS Form 3811, February 2004 Domestic Return Receipt 102595-o2-M-1540

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UNITED STATES POSTAL JERVICE ~ ~: ~~
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• Sender: Please print your name, address, and ZIP+4 in this box •
NC DENR Division of Water Quality
401 Oversight/Express Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604
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