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State of California - Department of Fish and Wildlife <br />2024 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5a (REV. 01/01123) Previously 0FG 753.5a <br />Prlrit. <br />RECEIPT NUMBER; <br />30 -- 10123/2024 — 0934 <br />STATE CLEARINGHOUSE NUMBER (!f appNcabla) <br />SEE INSTRUCTIONS ON I;;EVERSE. TYPE OR PRINT CLEARLY. <br />LEADAGENCY LBADAGENCY EMAIL DATE <br />CITY OF SANTA ANA 10/2312024 <br />COUNTYISTATE AGENCY OF FILING DOCUMENT NUMBER <br />Orange 202485000947 <br />PROJECT TITLE <br />SIDEWALK REPLACEMENT PROJECT FY 24/26 <br />PROJECT APPLtCANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />(714 )647-5033 <br />PROJECT APPLICANT ADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />20 CIVIC CENTER PLAZA M-36 <br />SANTA ANA <br />CA <br />92702 <br />PROJECT APPLICANT (Check appropriate box) <br />Q Local Pub[IC Agency ❑ School District Other Special District <br />State Agency Private Entity <br />CHECK APPLICABLE FEES: <br />© Environmental Impact Report (EIR) <br />$4,061.25 $ <br />0.00 <br />❑ MltlgatodlNegattve Declaration (MND)(ND) <br />$2,916.76 $ <br />_ . ^ _ _ ___ <br />0.00 <br />❑ Certified Regulatory Program (CRP) document - payment due directly to CDFW <br />$1,377.25 $ <br />0.00 <br />(] Exempt from fee <br />0 Notice of Exemption (attach) <br />❑ CDFW No Effeot Determination (attach) <br />d Fee previously paid (attach previously Issued cash receipt copy) <br />❑ Water Right Appf[cation or Petition Fee (State Water Resources Control Board only) <br />$850.00 $ <br />0.00 <br />❑ County documentary handling fee <br />$ <br />Other <br />$ <br />PAYMENT M ETHOD: <br />Q Cash ❑ Credit © Check [I Other TOTAL RECEIVED $ 0•00 <br />SIGNATURE AGENCY OF PILING PRINTED NAME AND TITLE <br />X MELISSA GOMEZ, DEPUTY <br />DRIMNAL-PROJECTAPPLICANT COPY-COFWIASS COPY -LUA0AGENCY COPY -COUNTY CLERK 0FW753.5a(Roy.01/01/2023) <br />