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� V <br /> COUNTY OF SAN JOAQUIN <br /> REFUND REQUEST FORM <br /> DATE: September 13 1993 <br /> DEPARTMENT: PUBLIC HEALTH SERVICESIENVIRONMENTAL HEALTH - <br /> REASON(S)FOR THE REFUND: OVER PAYMENT OF $234 DECEMBER 3 1992 CHECK /19977 FOR UNDERGROUND <br /> STORAGE TANK REMOVAL FEES THIS IS AN EXEMPT FARM TANK AND HAS WITHDRAWN THE APPLICATION FOR <br /> REMOVAL <br /> HERBST ENGINEERING INC <br /> 5980- 12TH STREET <br /> (SITE INFORMATION 17398 DEVIRES RD) <br /> RECEIPT / OTHER IDENTIFICATION i <br /> DEPOSIT PERMIT / DATE OF DEPOSIT PERMIT: <br /> AMOUNT OF REFUND: 4 234 <br /> REFUND PAYABLE TO: HERBST ENGINEERING INC <br /> ADDRESS: C/O ENVIRONMENTAL HEALTH <br /> 445 N SAN JOAQUIN <br /> DEPARTMENT APPROVAL G .� <br /> Au�horha8 810.etrxe <br /> EXPENDITURES AUTHORIZED By: <br /> ABATE TO 1000-01 04100 - 6140 0006 <br /> Claims examined and <br /> approved pursuant to Govt <br /> Code Seo. 29741 <br /> ADRIAN J VAN HOUTEN <br /> r County Auditor <br /> by <br /> Deputy <br /> ENTITY NO FUND DEPT NO EXP CODE AMOUNT VENDOR NO <br /> ASM Cont 28161701 <br /> >i <br />