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Stale of California - Department of Fish and Wildlife <br />3; 2024 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5a (REV. 01 /01 /23) Previously DFG 753.5a <br />LEADAGENCY EMAIL <br />r—_ <br />1Eelrit Startl]ver Save <br />RECEIPT NUMBER: <br />30— 11/27/2024 — 1034 <br />CITY OF SANTA ANA 11/27/2024 <br />COUNTY)STATE AGENCY OF FILING DOCUMENT NUMBER <br />manna "+ 202485001048 <br />TRAFFIC SIGNAL INSTALL AT SEGERSTROM AND ROSEWOOD <br />PROJECTAPPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />(714 )647-5626 <br />PROJECTAPPLICANT ADDRESS <br />CITY STATE <br />ZIP CODE <br />20 CIVIC CENTER PLAZA (M-36) <br />SANTA ANA CA <br />92702 <br />PROJECT APPLICANT (Check appropriate box) <br />s❑ Local Public Agency ❑ School District ❑ Other Special District ❑ Stale Agency ❑ Private Entity' <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) $4,061.26 $ <br />0.00 <br />❑ Mitigated/Negative Declaration (MND)(ND) $2,916.75 $ <br />0.00 <br />❑ Certified Regulatory Program(CRP)document - payment due directly to CDFW $1,377.25 $ <br />0.00 <br />0 Exempt from fee <br />❑+ 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) $850.00 $ <br />0.00 <br />❑ County documentary handling fee $ <br />❑ Other $ <br />PAYMENT METHOD: <br />0.00 <br />❑ Cash [I Credit El Check _ ❑ Other TOTAL RECEIVED $ <br />SIGNATURE <br />AGENCY OF FILING PRINTED NAME AND TITLE <br />X <br />MELISSA GOMEZ, DEPUTY <br />ORIGINAL- PROJECT APPLICANT COPY-CDFWIA813 COPY -LEAD AGENCY COPY-COUNTYCLERK DPW 753an(Rw. 01/01/2023) <br />