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I <br />.. <br />nwillhimm STATE OF CALIFORNIA -THE RESOURCES AGENCY <br />OREDEPARTMENT OF FISH AND GAME <br />ENVIRONMENTAL FILING FEE CASH RECEIPT <br />DFG 753.5a (6-01) <br />Lead Agency:' <br />County / State Agency of <br />Project Title: <br />Project Applicant Name:, <br />Project Applicant Address: <br />20/0350 <br />Date: <br />Document No.: <br />Phone Number: `5')9 33;1I <br />A_."� 9y5`i1) <br />Project Applicant (check appropriate box): Local Public Agency School District Other Special District El <br />State Agency Private Entity <br />CHECK APPLICABLE FEES: <br />( ) Environmental Impact Report <br />( ) Negative Declaration <br />( ) Application Fee Water Diversion (State Water Resources Control Board Only) <br />( ) P ojects Subject to Certified Regulatory Programs <br />(r County Administrative Fee <br />( ) Project that is exempt from fees <br />Signature and title of person receiving payment; <br />WHITE -PROJECT APPLICANT YELLOW-DFG/FASB <br />$850.00 <br />$ <br />$1,250.00 <br />$ <br />$850.00 <br />$ <br />$850.00 <br />$ <br />$25.00 <br />$ O <br />PINK -LEAD AGENCY " GOLDENROD -STATE AGENCY OF FILING <br />