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State of California —The: Resources Agency <br />bEFARTMENT OF FISHAND GAME <br />RECEIPT# <br />2012 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />STATE C�LfEAJgIN HOUSE #(xappacsme / <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY <br />/ <br />gAGENC _ <br />^:t Or <br />DA; ;RCS ✓'..G+. <br />COUNTY /STATED NCY' (LING - '- <br />UMENTNUMBER -. <br />PROF.CTTITLE <br />. <br />PRO JECTAPPLICANiNAM r_ <br />PHQNENIJ <br />r� <br />f j <br />PROJECTAPPLjCA ADD E$5 � C <br />ST <br />PROJECT AP LI A Check appro da to box): . <br />' Local Public Agency - ❑ School District ❑ Other Special District <br />❑ State Agency:'.'. . ❑ Prlvate' Entity - <br />CHECKAPPLICABLE' FEES: - <br />❑ Environmental Impact Report (EIR) <br />$2,9]906 $,..; <br />❑ Mitigated /Negative Declaration(ND)(MND) <br />$2,10150 <br />$ <br />C3 - Applioatlon -Fee Water Diversion (State Water Resources Control Board Only) <br />$850.00 <br />$. <br />❑ Protacts Subject to Certified Regulatory Programs (CRP) <br />- .$992.50 <br />$ <br />p CoyntyAdministrative Fee <br />$b0.00 <br />$ <br />�P[¢ect that is exempt from fees <br />A Notice of Exemption <br />. ❑ DEG No Effect Determination (Form Attached) <br />p Other <br />- <br />$ <br />PAYMENTMETHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other <br />TOTALRECEIVED. <br />$ "! <br />OIMIAM IMC <br />YELWW-DFGlASe "-..,_ PINK- IFADAGENCY GOLDENROD, <br />,W <br />