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f%r v nr i s •- I W a &,nen *ENVIRONMENTAL DECLARATION (CALIFORNIA FISH AND GAME CODE SEC. 711.4) 4E AND ADDRESS OF APPLICANT OR LEAD AGENCY: FILING REQUESTED BY: City of San Leandro Development Services Department 835 East 14`' Street San Leandro, CA 94577 WHEN FILED RETURN TO: City of San Leandro City Clerk 835 East 14th Street San Leandro, CA 94577 CLASSIFICATION OF ENVIRONMENTAL DOCUMENT: 1. NOTICE OF EXEMPTION/STATEMENT OF EXEMPTION [ ] A- STATUTORILY OR CATEGORICALLY EXEMPT $25.00 (Twenty-five Dollars) - CLERK'S FEE [ ] B - DE MINIMUS IMPACT (GOVERNMENT 3 27383) CERTIFICATE OF FEE EXEMPTION REQUIRED $25.00 (Twenty-five Dollars) - CLERK'S FEE OCT 2 3 2001 LM VLthK''vrrj(.& FOR COURT USE ONLY FILED ALAMEDA COUNTY SEP 21 2001 PATRICK 0'C0M- 7LL: County Clerk : c .� D*4 j )L MC) � 001- 75 07-17-01 C1022/Ig7�j 2. NOTICE OF DETERMINATION - FEE REQUIRED [ ] A - NEGATIVE DECLARATION $1,250.00 (Twelve Hundred Fifty Dollars) - STATE FILING FEE $25.00 (Twenty-five Dollars) - CLERK'S FEE [ ] B - ENVIRONMENTAL IMPACT REPORT $850.00 (Eight Hundred Fifty Dollars) - STATE FILING FEE $25.00 (Twenty-five Dollars) - CLERKS FEE CLERK'S USE ONLY PLU 117 PLU 116 PLU 115 3. )< OTHER (Specify) !y 4t tI✓ of Vai-Am { nafIbtl W/ R �fit IWG�S - Jt � S �y- PLU 117 $25.00 (Twenty-five Dollars) - CLERK'S FEE P(, avo — 000L�q , IO & r j () H.h t'GY01J pt-ANIV ED PE\1 *THIS FORM MUST BE COMPLETED AND SUBMITTED WITH ALL ENVIRONMENTAL DOCUMENTS FILED WITH THE ALAMEDA COUNTY CLERK'S OFFICE. FOUR COPIES OF ALL NECESSARY DOCUMENTATION ARE REQUIRED FOR FILING PURPOSES. 'PLICABLE FEES MUST BE PAID AT THE TIME OF FILING AN ENVIRONMENTAL DOCUMENT 'T�ITH THE ALAMEDA COUNTY CLERK'S OFFICE. MAKE CHECK PAYABLE TO: ALAMEDA COUNTY CLERK Rev. 1/15/91-1056C g:\a-fonns\cega\IIling.evr