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State of California - Department of Fish and Wildlife <br />2018 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />DFW 753.5a (Rev. 01/03/18) Previously DFG 753.5a <br />Print Finalize&Email <br />RECEIPT NUMBER: <br />AC RECEIPT #: 2477857 01 —11/02/2018-411 <br />STATE CLEARINGHOUSE NUMBER (If applicable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />LEAD AGENCY LEADAGENCY EMAIL DATE <br />CITY OF SAN LEANDRO 11/02/2018 <br />COUNTY/STATE AGENCY OF FILING DOCUMENT NUMBER <br />Alameda18-411 <br />PROJECT TITLE <br />FARRELLY POOL <br />PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PHONE NUMBER <br />CITY OF SAN LEANDRO (510) 577-3329 <br />PROJECT APPLICANT ADDRESS CITYSTATE ZIP CODE <br />835 E. 14TH STREET SAN LEANDRO CA 94577 <br />PROJECT APPLICANT (Check appropriate box) <br />0 Local Public Agency E] School District Other Special District State Agency Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />$3,168.00 $ <br />0.00 <br />❑ Mitigated/Negative Declaration (MND)(ND) <br />$2,280.75 $ <br />0.00 <br />❑ Certified Regulatory Program document (CRP) <br />$1,077.00 $ <br />0.00 <br />ED Exempt from fee <br />El 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 />❑✓ County documentary handling fee <br />$ <br />50.00 <br />❑ Other <br />$ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit El Check ❑ Other TOTAL RECEIVED $ <br />50.00 <br />SIGNATURE <br />AGENCY OF FILING PRINTED NAME AND TITLE <br />X <br />T.CLAFTON , DEPUTY CLERK <br />