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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: OVER PAYMENT OF 8112. AUGUST 27. 1992.CHECK #2351. FOR UNDERGROUND <br /> STORAGE TANK SURCHARGE FEE FEES WERE PREVIOUSLY PAID BY CONTRACTOR ON AUGUST 13. 1992. <br /> IRENE PLUMMER- 13285 COPPERPOLIS RD <br /> IRENEI3 <br /> RECEIPT I OTHER IDENTIFICATION # <br /> DEPOSIT PERMIT # DATE OF DEPOSIT PERMIT: <br /> AMOUNT OF REFUND: $ 112 <br /> REFUND PAYABLE TO: IRENE PLUMMER <br /> ADDRESS: C/O ENVIRONMENTAL HEALTH <br /> 445 N SAN JOAQUIN <br /> J ; I <br /> DEPARTMENT APPROVAL /_ 1 LV •r - i "I <br /> Amt rize Sigmture <br /> EXPENDITURES AUTHORIZED BY: <br /> AWnortrW Sleneture Date <br /> ABATE TO 415 ljn ( SSC-) C�CDeD- <br /> Claims examined and <br /> approved pursuant to Govt <br /> Code Sep. 29741 <br /> ADRIAN J VAN HOUTEN <br /> j/ County Auditor <br /> �( by <br /> Deputy <br /> ENTITY NO FUND DEPT NO EXP CODE AMOUNT t <br /> VENDOR NO <br /> ud-Cont a3l i <br /> R <br /> J <br />