WQ0014306_Returned Green Card NOV-2021-LV-0744_20211018

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• Complete items 1, 2, and 3.
ENDER: COMPLETE THIS SECTION
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• Print your name and address on t e rev- rs=
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.
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COMPLETE THIS SECTION ON DELIVERY
A. Signa;{Ire�
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❑ Agent
❑ AddresseE
B. Reca ved y (Printed Name)
Name) C. Date of Deliver)
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1. Article Addressed to: D. Is cellvery address different from Item 1?
"— — ICY S Tater delivery address below:
Sandler Utilities at Mill Run LLC nn OCT 1;8 2021
448 Viking Drive, Suite 200
Virginia Beach, VA 23452-7331
Raymond Gottlieb
Larcric
1111111111111111111111111111111111111111111111
9590 9402 7050 1225 0080 02
2. ,Article Number (Transfer from service label)
• 7021 d95�] df701 =10281 $050
Water Quality
Regional Operations Section
3. serv_ig9byype'Rt"' ` ileg,ona1 O IiO=
0 Registered Mail "
I Mall Restricted Delivery
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❑ Yes
❑ No
0 Priority Mail Express®Adult Signature Restricted Delivery 0 Registered Mail Restrict
0 Adult
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USPS TRACKING #
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9590 9402 7050 1225 0080 02
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*
Division of Water Resources
943 Washington Square Mall
Washington, NC 27889
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