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COUNTY OF SAN JOAQUIN <br /> REFUND REQUEST FORM <br /> DATE: April 14, 1992 <br /> DEPARTMENT: PUBLIC HEALTH EJERVICEWENVIRONMENTAL HEALTH <br /> REASON(S)FOR THE REFUND: PAID TWICE FOR 1992 UNDERGROUND STORAGE TANK PERMIT. ON FEBRUARY 12 1992 <br /> FROM DARRELL EPPLER,OWNER. CHECK #16376 AND AGAIN ON FEBRUARY 18 1992 CHECK 0653639 FROM UNOCAL <br /> UNION OIL SS#15886 <br /> UNION27 <br /> 7� <br /> RECEIPT A OTHER IDENTIFICATION ad <br /> DEPOSIT PERMIT X DATE OF DEPOSIT PERMIT: <br /> AMOUNT OF REFUND: 3 C10 }` <br /> REFUND PAYABLE TO:_PARRU EPPLER <br /> ADDRESS: C/O ENVIRONMENTAL HEALTH <br /> 446 N SAN JOAQUIN <br /> DEPARTMENT APPROV L (/ <br /> uthorized Signature <br /> EXPENDITURES AUTHORIZED BY: <br /> Authorized Signature Dote <br /> Claim examined and <br /> approved pursuant to Govt <br /> Code Seo,29741 <br /> ADRIAN J VAN HOUTEN <br /> County Auditor <br /> by <br /> ENTITY NO FUND DEPT NO EXP CODE AMOUNT VENDOR NO <br /> r o .. <br />