WQCS00328_NOV-2021-DV-0182 GC_20210326

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■ 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. Signature
X
❑/k§ent
Addresse
B. Received by (Printed Name) C. Date of Deliver
1—Article_Addreneartp:o 1_14c3r'r'IsCturg
Attn: Mike Rose, Administrator
Post Office Box 100
Harrisburg, North Carolina 28075
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9590 9402 5027 9063 9504 75
D. Is delivery address different from item 1? ❑ Ye
If YES, enter delivery address below: ❑ No
2 Article_Number flraasfecifom_sefyiceJabeD r,
70191 i 4n Li001113313 k 72734•i
3. Service Type
❑ Adult Signature
Stricted Delivery
Certified Ma
Ma
❑ /
Bert ail Restricted Delivery rf`
❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
❑}Insuredl
❑ Insured Mail Restricted Delivery
(over $500)
❑ Priority Mail Express®
0 Registered MaliTM
0 Registered Mail Restrict
Delivery
LI-Return Receipt for
Merclband
0 Signature Confirmation'
• ❑ Signature Confirmation
{ Restricted Delivery
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USPS TRACKING #
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9590 9402 i027 9063 9504 75
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First -Class Mail
Postage & Fees -Paid
LISPS
Permit No. G-10
° Sender please rintyour name, address, and ZIP+4® in this box*
I( North Ca`ro►Ina State Department
of Environmental Quality
Mooresville Regional Offi e — WQ/Meilinger
610 East Center Avenue, ui
Mooresville, North Carolina 28115
+i11+1111,1,11411111111'111111111111

1. . ' ostk ervice '
CERTIFItD MAIL° RECEIPT,
Domestic Mail Only .
For delivery information, visit our website at www.usps.como.
OF
Certified Mall Fee
Extra Services & Fees (checkb
❑ Retum Receipt (hardccpy)
❑ Retum Receipt (electronic) $
❑ Certified Mali Restricted Delivery $
['Adult Signature Required $
['Adult Signature Restricted Delivery $
add fee es
Pilate)
Postage
$
Total Postag
$
Sent To
Street and Af
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Postmark
Here
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Attn: Mike Rose, Administrator
Post Office Box 100
Harrisburg, North Carolina 28075
City,, State, Z 3.21 . ml MA q r v0 1. Q` o V

;ertniea maii service proviaes
A receipt (this portion of the Certified Mail label).
A unique identifier for your mailpiece.
Electronic verification of delivery or attempted
delivery.
A record of delivery (including the recipient's
signature) that Is retained by the Postal Service'
for a specified period.
nportant Reminders:
You may purchase Certified Mail service with
First -Class Mail°, First -Class Package Servicee,
or Priority Mail® service.
Certified Mall service is not available for
international mall.
Insurance coverage Is not available for purchase
with Certified Mall service. However, the purchase
of Certified Mall service does not change the ■
insurance coverage automatically included with
certain Priority Mail items.
For an additional fee, and with a proper
endorsement on the mailplece, you may request
the following services:
- Return receipt service, which provides a record
of delivery (including the recipient's signature).
You can request a hardcopy retum receipt or an
electronic version. For a hardcopy return receipt,
complete PS Form 3811, Domestic Return
Receipt. attach PS Form 3811 to your mailplece;
the following nenetits:
for an electronic re&um receipt, see a retail
associate for assistance.To rece 'e a duplicate
return receipt for no additignal fee, present this
USPS®-postmarked Certified Mail receipt to the
retail associate.
- Restricted delivery service, which provides
delivery to the addressee specified by name, or
to the addressee's authorized agent.
- Adult signature service, which requires the
signee to be at least 21 years of age (not
available at retail).
- Adult signature restricted delivery service, which
requires the signee to be at least 21 years of agi
and provides delivery to the addressee specified
by name, or to the addressee's authorized agent
(not available at retail).
To ensure that your Certified Mail receipt is
accepted as legal proof of mailing, It should bear a
USPS postmark If you would like a postmark on
this Certified Mail receipt, please present your
Certified Mail item at a Post Office' for
postmarking. If you don't need a postmark on this
Certified Mali receipt, detach the barcoded portion
of this label, affix it to the mailpiece, apply
appropriate postage, and deposit the mailpiece.
IMPORTANT: Save this receipt for your records.