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COUNTY OF SAN JOAQUIN <br /> REFUND REQUEST FORM <br /> DATE: April 15 1992 <br /> DEPARTMENT: PUBLIC HEALTH SERVICES ENVIRONMEINTAL HEALTH <br /> REASON(S)FOR THE REFUND: PAID TWICE SURCHARGE TAX FOR UNDERGROUND STORAGE TANK. <br /> PAID CHECK 916845 ON FEBRUARY 12 1989 AND CHECK #55577 ON FEBRUARY 19 1989. <br /> 733 S VA BUREN ST STOCKTON <br /> WESTE73 <br /> RECEIPT i OTHER IDENTIFICATION # <br /> DEPOSIT PERMIT # DATE OF DEPOSIT PERMIT: <br /> . . _.. 617r .._ <br /> AMouNtbF pEFUN1"1 <br /> pEFUNIi OAYANLr.1WiMfkp'pUI�dIN� I:j�1YRIAL9 CO <br /> ADDRESS: C/O ENVIRONMENTAL HEALTH <br /> 446 N SAN JOAOUIN <br /> i <br /> DEPARTMENT APPROVAL' <br /> 1 Author zed tllg wture <br /> EXPENDITURES AUTHORIZED BY: <br /> ABATE*TO'1 60909•$909T+Oti�CJ'OObb Au bo l sd 6lp ulun pas <br /> Claime examined and <br /> approved pursuant to Govt <br /> � <br /> / Code Seo. 29741 <br /> r( .(b� ADRIAN J VAN HOUTEN <br /> County Auditor <br /> 6y <br /> Deputy <br /> ENTITY NO FUND DEPT NO EXP CODE AMOUNT VENDOR NO <br /> ArwConoaa(sne) C,00 <br /> -�.—.� _- �ronaac^mx nnu riaammwrann�n ur w.no as-.,.. <br />