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*ENVIRONMENTAL DECLARATION <br />(CALIFORNIA FISH AND GAME CODE SEC. 711.4) <br />F�I'CLj��USE ONLY <br />NAME AND ADDRESS OF APPLICANT OR LEAD AGENCY E <br />ALAMEDA COUNITY <br />City of San Leandro <br />City Clerk <br />835 East 14th Street <br />San Leandro, CA 94577 <br />JUN <br />'PXfl9!1vK Ci'GrJNN!H:' , v0_tl j C'et, <br />FILING NO. <br />CLERK'S <br />CLASSIFICATION OF ENVIRONMENTAL DOCUMENT: USE ONLY <br />1. NOTICE OF EXEMPTION/STATEMENT OF EXEMPTION PLU 117 <br />[X] A- STATUTORILY OR CATEGORICALLY EXEMPT <br />$25.00 (Twenty-five Dollars) - CLERK'S FEE <br />[ ] B - DE MINIMUS ROPACT - CERTIFICATE OF FEE EXEMPTION REQUIRED PLU 117 <br />$25.00 (Twenty-five Dollars) - CLERK'S FEE <br />2. NOTICE OF DETERMINATION - FEE REQUIRED PLU 116 <br />[ ] A - 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 PLU 115 <br />$850.00 (Eight Hundred Fifty Dollars) - STATE FILING FEE <br />$25.00 (Twenty-five Dollars) - CLERKS FEE <br />3. [ ] OTHER (Specify) PLU 117 <br />$25.00 (Twenty-five Dollars) - CLERK'S FEE <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 <br />WITH THE ALAMEDA COUNTY CLERK'S OFFICE. <br />MAKE CHECK PAYABLE TO: ALAMEDA COUNTY CLERK <br />Rev. 1/15/91-1056C <br />gAa-forms\cega\f'ihng.cvr <br />