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0 <br /> COUNTY OF SAN JOAQUIN <br /> REFUND REQUEST FORM <br /> DATE: Se tembet 15 1992 <br /> DEPARTMENT: PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH <br /> REASON(S)FOR THE REFUND: ACTIVE FEES PAID FOR 1989 ON JANUARY 30 1989 FOR UNDERGROUND STORAGE <br /> TANK FEES, TANKS WERE REMOVED IN JANUARY 1989. <br /> SUNRISE MARKET & LIQUOR <br /> SUNRI95 <br /> RECEIPT li OTHER IDENTIFICATION # <br /> DEPOSIT PERMIT C 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 <br /> Authorized Signature <br /> EXPENDITURES AUTHORIZED BY: Authorized Signature Date <br /> ABATE TO 1000-01 04100 - 6140 0006 <br /> Claims examined and <br /> approved pursuant to Govt <br /> Code Sec, 29741 <br /> ADRIAN J VAN HOUTEN <br /> County Auditor <br /> by <br /> Deputy <br /> ENTITY NO FUND DEPT NO EXP CODE AMOUNT VENDOR NO <br /> Aud-Cont-MG1791 <br />