19931059 Ver 1_Certified Return Receipt_20080212

^ 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.
- ,-- -- -
1. Article Addressed to:
Larco Construction
Attn: Mr. Robert Ponton
P.O. Box 16279
Winston-Salem,NC 27115
DWQ# 1993-1059-v2-Guilford
2. Article Number
(Transfer from service labs
4. Restricted Delivery? (Extra Fee)
^ Yes
A. Si ure ~
x ~li~ IJ Agent
lr1.l-/L- ' /'~sY,cG"L t ^ Addressee
g. Received by (Printed Name) C. D' a of Delivery
~ 4 S ~~ l/ ~ /z /)7
S~ v
D. Is delivery address different from item ? ^ Yes
If YES, enter delivery address below: ^ No
3. Service Type
Certified Mail ^ Express Mail
Registered Return Receipt for Merchandise
^ Insured Mail C.O.D.
707 3020 ~0~0 1325 0796
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STAT~S.P4ST~tfr;.~~RgVtC~ ~ ,,,
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Ste'
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• Sender: Please print your name, address;'and Z(P+4 in this box •
NC DENR Division of Water
Quality
401 Oversight/Txpress Unit
2321 Crabtree Boulevard Suite2~0
Raleigh,NC 27604
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