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State of California - Department of Fish and Wildlife <br />2023 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5a (REV. 01/01/23) Previously DFG 753.5a <br />AC RECEIPT #: 3401877 <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />F."i'l-"R <br />• <br />RECEIPT NUMBER: <br />01-03/07/2023- 061 <br />STATE CLEARINGHOUSE NUMBER (If applicable) <br />LLAUAULN UY LEADAGENCY EMAIL DATE <br />CITY OF SAN LEANDRO ENGINEERING & TRANSPORTATION 03/07/2023 <br />I;OUNTY/STATE AGENCY OF FILING DOCUMENT NUMBER <br />'ALAMEDA 23 - 061 <br />PROJECT TITLE <br />SANITARY SEWER POINT REPAIRS 2022-23; PROJECT NO. 2022-0120 <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />ROBERT MAGNO <br />(510) 577-3373 <br />PROJECT APPLICANT ADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />85 EAST 14TH STREET <br />SAN LEANDRO <br />CA <br />94577 <br />PROJECT APPLICANT (Check appropriate box) <br />✓0 Local Public Agency School District Other Special District <br />State Agency <br />Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />$3,839.25 $ <br />0.00 <br />❑ Mitigated/Negative Declaration (MND)(ND) <br />$2,764.00 $ <br />0.00 <br />❑ Certified Regulatory Program (CRP) document - payment due directly to CDFW <br />$1,305.25 $ <br />0.00 <br />El Exempt from fee <br />E] Notice of Exemption (attach) <br />❑ CDFW No Effect Determination (attach) <br />❑ Fee previously paid (attach previously issued cash receipt copy) <br />❑ Water Right Application or Petition Fee (State Water Resources Control Board only) <br />$850.00 $ <br />0.00 <br />0 County documentary handling fee <br />$ <br />50.00 <br />❑ Other <br />$ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit ❑ Check 0 Other TOTAL RECEIVED $ <br />50.00 <br />SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br />X CL-) CBACA , DEPUTY CLERK <br />