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JAN-17-2008 04:27 PM TIPTON'S STATIONERY 2092390141 P. 2 <br /> SAN JOAQUIN COUNTY DEPARTMENT OF PUBLIC WORKS <br /> SOLID WASTE DIVISION <br /> LOYELACE MATERIAL RECQVERY FACrLLRY&TRANSFER STATION <br /> NORTH COUNT RECYCLIN CENTER&SANITARY LANDFM <br /> CASH-REFUND FORM <br /> L01 Ut0 <br /> TOD,LYi DATE <br /> l202r)D 4 . <br /> RECEIPT NUMBER " <br /> d � e <br /> DE O RECEIPT <br /> A <br /> TOTAL CHARGES ON RECEIPT <br /> �N �DW <br /> S ✓w — <br /> AMOUNT OF REFUND CAS R CLERK'S SIGNATURE <br /> REASON FOR REFUND: <br /> ZF <br /> AM,toTFC,4 Com . <br /> CUSTOMER'S ADDRESS: <br /> .;m <br /> +lith <br /> CUSTOMER'S PHONE# <br /> CUSTOMER'S SIGNAT �ERYL4OR'S SIGNATURE <br /> (Acknowledging receipt of refund) (§upervisor giving refund) <br /> White copy- 5ebmit with daily paperwork to <br /> SoDd Waste Adm1xUdmmt1oa <br /> m:lnceelformjwteslgenerslbcaiehoust rtfund form.wpd <br /> 03/13/01 Yellow copy- Costomer's copy. <br /> PuMk WO*f 160(BIO <br />