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*ENVIRONMENTAL DECLARATION <br />i (CALIFORNIA FISH AND GAME CODE SEC. 711.4) <br />FOR C�L1R�' IiSE <br />NAME AND ADDRESS OF APPLICANT OR LEAD AGENCY: j"' L, ffb <br />ALAMEDA COUNTY <br />ty of San Leandro <br />F E B 2 8 2000 <br />Development Services Department PAT ICK 'CO EL County Clerk <br />835 East 14th Street 9 D <br />FILING NO. <br />San Leandro CA 94577 <br />CLASSIFICATION OF ENVIRONMENTAL DOCUMENT: <br />1. NOTICE OF EXEMPTION/STATEMENT OF EXEMPTION <br />[ ] A - STATUTORILY OR CATEGORICALLY EXEMPT <br />$25.00 (Twenty-five Dollars) - CLERK'S FEE <br />[ ] B - DE MINIMUS RAPACT - CERTIFICATE OF FEE EXEMPTION REQUIRED <br />$25.00 (Twenty-five Dollars) - CLERK'S FEE <br />C <br />2. NOTICE OF DETERMINATION - FEE REQUIRED <br />[•] - NEGATIVE DECLARATION <br />$1,250.00 (Twelve Hundred Fifty Dollars) - STATE FILING FEE <br />$25.00 (Twenty-five Dollars) - CLERK'S FEE <br />[ ] B - ENVIRONMENTAL IMPACT REPORT <br />$850.00 (Eight Hundred Fifty Dollars) - STATE FILING FEE <br />$25.00 (Twenty-five Dollars) - CLERKS FEE <br />3. [X] OTHER (Specify) Notice of Determination with De Minimis Impact <br />$25.00 (Twenty-five Dollars) - CLERK'S FEE <br />PLU 117 <br />CLERK'S <br />USE ONLY <br />PLU 117 <br />PLU 117 <br />PLU 116 <br />PLU 115 <br />*THIS FORM MUST BE COMPLETED AND SUBMITTED WITH ALL ENVIRONMENTAL DOCUMENTS <br />FILED WITH THE ALAMEDA COUNTY CLERK'S OFFICE. <br />FOUR COPIES OF ALL NECESSARY DOCUMENTATION ARE REQUIRED FOR FILING PURPOSES. <br />APPLICABLE FEES MUST BE PAID AT THE TIME OF FILING AN ENVIRONMENTAL DOCUMENT WITH <br />THE ALAMEDA COUNTY CLERK'S OFFICE. <br />MAKE CHECK PAYABLE TO: ALAMEDA COUNTY CLERK <br />Rev. 1/15/91-1056C <br />nms\cega\filing.cvr <br />