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COUNTY OF SAN JOAQUIN <br /> REFUND REQUEST FORM <br /> DATE: April 15 1992 — <br /> DEPARTMENT: PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH <br /> REASON(S)FOR THE REFUND: PAID ACTIVE FEES FOR UNDERGROUND STORAGE TANK. TANKS WERE REMOVED PRIOR TO BILLING <br /> DATE, CHIECK #3974603 ON FEBRUARY 26 1988. <br /> 455 GR N LINE RD,TRACY <br /> SEVEN01 <br /> RECEIPT ► OTHER IDENTIFICATION ✓t <br /> DEPOSIT PERMIT B DATE OF DEPOSIT PERMIT: <br /> AMAUkfb <br /> q!'RM-FAiA7L B�tJ�F1CYiNfS�ifd�6RAtION <br /> ADDRESS: C/O ENVIRONMENTAL HEALTH <br /> 446 N SAN JOAQUIN <br /> DEPARTMENT APPROVAL I •� - <br /> Arrtlgl ed elonature <br /> EXPENDITURES AUTHORIZED By: <br /> Authetlne <br /> xed 9letme Dete <br /> ABATE•TO-1000.01-041 OU v 8140'_r._ <br /> Claims examined and <br /> approved pursuant to Govt <br /> Code Sao. 29741 <br /> ADRIAN J VAN HOUTEN <br /> County Auditor <br /> by <br /> Deputy <br /> ENTITY NO FUND DEPT NO EXP CODE AMOUNT VENDOR NO <br /> lx� <br /> AIMCont2816/701 & 5-��d 7 Copy <br /> \willf <br />