HomeMy WebLinkAboutSAM-11-2021-161826.TIF I
A1.11A1
catawba county
public health
AUTHORIZATION OF REFUND
Date: 9/13/22
Case#: SAM-11-2021-161826
Applicant: Stacey&John Goslin
Refund Amount: S186.00
Refund Reason: Samples should have been taken on WELL case,
Authorizing Signature: A k,"t 4
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Received By Staff: Qt4t&i k
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Date: I I,'1I ))
catawbacountync.gov
Environmental Health
Cetcwhc County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8210
MAKING. LIVING. s" 5 ,
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Catawba County, North Carolina - Disbursement Voucher
Vendor No. Date: 9/13/2022
Make Payment To: ��wCp Voucher No(s)
Stacey and John Goslin 1 #
8486 Monbo Rd v 111 dqp
Catawba, NC 28609
-18 42
ATTACHMENT
Prepared by: Julia English
Description Amount
Samples should have been taken on WELL case $186.00
Sub-Total
Food Tax
Sales Tax
Total $ 186.00
For Accounting Use
Fund Cost Center Object Project Amount Only
110 580200 663000
Total
The undersigned hereby certifies that the goods or services specified above have been received
or performed. Payment has not been previously authorized and this expenditure is a proper
charge to the appropriation indicated. The above charge is certified to you for payment.
(SIGNATURE-APPROPRIATE OFFICIAL)
CA CATAWBA COUNTY
100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
O /,5, PI IONE:828.465.8399
Tuesday,September 13,2022
842 5mI www.catawbacountync.gov
PAYOR:
Goslin,Stacey and John
PAYMENTS
TRANSACTION NUMBER: TRC-47132871-13-09-2022
PAYMENT DATE: 09/13/2022
PAYMENT TYPE: DV
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
11-21-399841 110-580200-663000 Inorganic Chemical Sample Fee ($128.00)
11-21-399841 110-580200-663000 Bacteriological Sample Fee (S58.00)
TOTAL PAYMENTS: ($186.00)
SAM-1 1-2021-1 6 1 826
CASE TYPE: Water Sample WORK CLASS: Bacterial
SITE ADDRESS: 8486 MONBO RD,CATAWBA NC 28609
Owner STACEY AND JOHN GOSLIN,8486 MONBO RD,CAIAW l3A NC 28609
11:8052310678C:805-210-1306
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 09/13/2022 10:30 Page 1 of 1