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COUNTY OF SAN JOAQUIN <br /> • REFUND REQUEST FORM <br /> DATE: Aril 14 1992 <br /> DEPARTMENT: PUBLIC HEALIH SERVICES ENVI ONMENTAL HEALTH <br /> REASON(S)FOR THE REFUND: PAID 1636 ON FEBRUARY 21 1992 CHECK 06928 FOR WELL&WELL DESTRUCTION <br /> ERIM AT 6806 PACIFIC AVE. ONLY OWED 6149 145M+ 60 <br /> KAPPEALIAN ENGINEERING INC <br /> ,Z� <br /> RECEIPT # OTHER IDENTIFICATION 0 <br /> DEPOSIT PERMIT N DATE OF DEPOSIT PERMIT: <br /> AMbUIYT.6040UN�3!`,A,�,��^--� - <br /> REFUN6/ jA�t1�S'�'kl,Apk'JILIANrNGIN tl C <br /> • ADDRESS: C/O ENVIRONMENTAL HEALTH <br /> 446 N SAN JOAOUIN <br /> DEPARTMENT APPROVAL yt <br /> Av1MFlxed Sleeetbe <br /> EXPENDITURES AUTHORRED BY: Aulnerl:ed 8lyrutme TWO <br /> Claim examined and <br /> approved pursuant to Govt <br /> Code Sec.29741 <br /> ADRIAN J VAN HOUTEN <br /> County Auditor <br /> by <br /> ENTITY NO FUND DEPT NO EXP CODE AMOUNT VENDOR NO <br /> em <br /> 2J DG s s)59P ply <br />