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1 <br /> COUNTY OF SAN JOAQUIN <br /> REFUNREQUEST FORM <br /> DATE: September 16. 1992 <br /> DEPARTMENT: PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH <br /> REASON(S) FOR THE REFUND: PAID ACTIVE FEES OF $250. MARCH 15, 1990, CHECK #10533, FOR UNDERGROUND <br /> STORAGE TANK FEES. REMOVAL FEES WERE PAID IN DECEMBER 1989. <br /> E Z FOOD, 2537 WATERLOO RD <br /> EZF0025 <br /> RECEIPT# OTHER IDENTIFICATION # <br /> DEPOSIT PERMIT # DATE OF DEPOSIT PERMIT: <br /> AMOUNT OF REFUND: $ 250 , <br /> REFUND PAYABLE TO: E-Z SERVE, INC <br /> ADDRESS: C/O ENVIRONMENTAL HEALTH <br /> 445 N SAN JOAQUIN <br /> DEPARTMENT APPROVAL S��'�)'`��- �'�-- �'-�� <br /> Authorized SIQr tura <br /> EXPENDITURES AUTHORMED BY: <br /> Authorized Sigmture Det. <br /> ABATE TO 100�0y/-01 04100 - 6140 0006 <br /> �� I-- Claims examined and <br /> / approved pursuant to Govt <br /> Code Sec. 29741 <br /> ADRIAN J VAN HOUTEN <br /> T7 �� County Auditor <br /> I/ by <br /> Deputy <br /> ENTITY NO FUND I DEPT NO EXP CODE I AMOUNT I VENDOR NO <br /> AW-Cont- 61 / 1 <br />