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State of California -Department of Fish and Wildlife <br />2018 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />DFW 753.5a (Rev. 01/03/18) Previously DFG 753.5a <br />RECEIPT NUMBER: <br />AC RECEIPT#: 2477857 01 -11/02/2018-411 <br />STATE CLEARINGHOUSE NUMBER (If applicable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />LEAD AGENCY LEAD AGENCY EMAIL <br />CITY OF SAN LEANDRO <br />COUNTY/STATE AGENCY OF FILING <br />r~1~ m~9.?t._., ........ -........ ·-···~·~·-·~·~············.J <br />PROJECT TITLE <br />FARRELLY POOL <br />PROJECT APPLICANT NAME <br />CITY OF SAN LEANDRO <br />PROJECT APPLICANT ADDRESS <br />835 E. 14TH STREET <br />PROJECT APPLICANT (Check appropriate box) <br />PROJECT APPLICANT EMAIL <br />CITY <br />SAN LEANDRO ! <br />STATE <br />CA <br />DATE <br />11/02/2018 <br />DOCUMENT NUMBER <br />18-411 <br />PHONE NUMBER <br />(510) 577-3329 <br />ZIP CODE <br />94577 <br />[Z] Local Public Agency 0 Scho.ol District 0 Other Special District 0 State Agency 0 Private Entity <br />CHECK APPLICABLE FEES: <br />0 Environmental Impact Report (EIR) <br />0 Mitigated/Negative Declaration (MND)(ND) <br />0 Certified Regulatory Program document (CRP) <br />0 Exempt from fee <br />0 Notice of Exemption (attach) <br />0 CDFW No Effect Determination (attach) <br />D Fee previously paid (attach previously issued cash receipt copy) <br />0 Water Right Application or Petition Fee (State Water Resources Control Board only) <br />0 County documentary handling fee <br />D Other <br />PAYMENT METHOD: <br />$3,168.00 <br />$2,280.75 <br />$1,077.00 <br />$850.00 $ <br />$ <br />$ <br />0 Cash 0 Credit 0 Check 0 Other TOTAL RECEIVED $ <br />SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br />x T. CLAFTON , DEPUTY CLERK <br />0.00 <br />50.00 <br />50.00