Fillable REQUEST FOR REFUND Air Quality Management (AQM)

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REQUEST FOR REFUND Air Quality Management (AQM)

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The REQUEST FOR REFUND Air Quality Management (AQM) form is 1 page long and contains:

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  • 4 check-boxes
  • 15 other fields

Country of origin: US
File type: PDF

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Make Check Payable to:
Air Quality Management (AQM)
REQUEST FOR REFUND
Date:
Business Name:
Mailing Address:
City State Zip
Contact Name:
Phone Number:
EMAIL Address:
Permit Number:
Original Payment:
$ made via:
Cash
Check
Debit Card
Credit Card
Refund Requested:
$
Reason for Refund:
Signature Date
Mail or fax the completed form (see information at bottom of page), or submit via email to: aqmdadmin@washoecounty.us
FOR INTERNAL USE ONLY
Air Quality Specialist Supervisor Approval
Administrative Secretary Approval
Division Director Approval
FCO Approval AHSO Signature:
Final Refund Amount: $ (FCO calculates) Cash or Check requires Voucher
Notes:
AIR QUALITY MANAGEMENT
1001 East 9th Street, Building B171 I Reno, Nevada 89512
775-784-7200 I Fax: 775-784-7225 I OurCleanAir.com
Serving Reno, Sparks and all of Washoe County, Nevada | Washoe County is an Equal Opportunity Employer
Revised June 2021
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REQUEST FOR REFUND Air Quality Management (AQM)

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Completed 22 September 2021

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