250047_Returned Green Card NOV-2021-PC-0071_20210212

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USPS TRACKING #
II
1111
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9590 9402 6321 0296 8917 88
United States
Postal. Service
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4® in this box*
NCDEQ
DIVISION OF WATER RESOURCES
WATER QUALITY OPERATIONS SECTION
943 WASHINGTON SQUARE MALL
WASHINGTON, NC 27889

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N�V - Zo,- ► -
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HHs
SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
• Complete items 1, 2, and 3.
• 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.
a Adirlc Lt irlrr.RRed to:
Sammy Lane
10705 Hwy 55 W
Dove! NC 28526
1111
1111111111111
III
III
1 III I II
11
II
9590 9402 6321 0296 8917 88
B. Received bq'' f finfed Name)
2
D. Is delivery address dt
If YES, enter delivery a
rb
I. /19/ `2r�oi
/bb* :04/
❑ Agent
❑ Addressee
C. Date of Delivery
nt from item 1? ❑ Yes
sss below: 0 No
440
2. Article Number (Transfer from service label)
7019 2970 0001 3139 9999
3. Service Typ10G; `c, ❑ Priority Mail Express®
❑ Adult Signature C ''t . ❑ Registered MaiITM
❑ Adult Signature Restricted Delivery 0 Registered Mall Restricted
iftertified Mail® Delivery
❑ Certified Mail Restricted Delivery 0 Signature ConfirmationTM
0 Collect on Delivery 0 Signature Confirmation
0 Collect on Delivery Restricted Delivery Restricted Delivery
❑ Insured Mail
Insured Mail Restricted Delivery
(over $500)
PS Form 3811, July 2020 PSN 7530-02-000-9053
Domestic Return Receipt