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COUNTY OF SAN JOAQUIN <br /> REFUND REQUEST FORM <br /> DATE: September 16, 1992 <br /> DEPARTMENT: PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH <br /> REASON(S) FOR THE REFUND: OVERPAYMENT OF $150 JANUARY 29 1990 CHECK #8421 FOR UNDERGROUND <br /> STORAGE TANK ACTIVE FEES. TANKS WERE REMOVED JANUARY 5 1990. NO FEES WERE DUE. <br /> CELPRIL INDUSTRIES 251 OAK ST- MANTECA <br /> CELPRZi <br /> RECEIPT # OTHER IDENTIFICATION # <br /> DEPOSIT PERMIT # DATE OF DEPOSIT PERMIT: <br /> AMOUNT OF REFUND: $ 150 <br /> REFUND PAYABLE TO: CELPRIL INDUSTRIES <br /> ADDRESS: C/O ENVIRONMENTAL HEALTH <br /> 445 N SAN JOAQUIN n <br /> DEPARTMENT APPROVAL �7-n��C C -�_. AP` go V7 "/u f( Yl 6+) <br /> AutlarizeE Slprutum <br /> EXPENDITURES AUTHORIZED BY: <br /> Authorized Sipneturs Date <br /> ABATE TO 1000-01 04100 6140 0006 <br /> if �. /9' "Z� Claims examined and <br /> approved pursuant to Govt <br /> Code Sec. 29741 <br /> ADRIAN) VAN HOUTEN <br /> County Auditor <br /> by <br /> Deputy <br /> ENTITY NO FUND DEPT NO EXP CODE AMOUNT VENDOR NO <br /> AW-cert-za�snel <br />