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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. 01101123) Previously DFG 753.5a <br />RECEIPT NUMBER: <br />30 — 12/12/2024 — 1059 <br />Save <br />STATE CLEARINGHOUSE NUMBER (If applicable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />LEADAGENCY LEADAGENCY EMAIL DATE <br />CITY OF SANTA ANA 12/12/2024 <br />COUNTYISTATE AGENCY OF FILING IDOCUMENTNUMBER <br />Orange 202485001076 <br />PROJECT TITLE <br />BRISTOL-TOLLIVER STREET URBAN GREENING <br />PROJECT APPLICANT NAME. <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />(714 )647-5647 <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 />© Local Public Agency ❑ School District ❑ Other Special District <br />❑ State Agency ❑ Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />$4,051.26 <br />$ <br />0.00 <br />❑ Mitigated/Negative Declaration (MND)(ND) <br />$2,916.75 <br />$ <br />0.00 <br />❑ Certified Regulatory Program (CRP) document - payment due directly to CDFW <br />$1,377.25 <br />$ <br />0.00 <br />F1 Exempt from fee <br />r❑' Notice of Exemption (attach) <br />❑ CDFW No Effect Determination (attach) <br />❑ Fee previously paid (attach previously issued cash receipt copy) <br />o W0 <br />❑ Water Right Application or Petition Fee (State Water Resources Control Board only) $850.00 $ <br />❑ County documentary handling fee $ <br />® Other $ <br />PAYMENT M ETHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ 0.00 <br />SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br />X WMELISSA GOMEZ, DEPUTY <br />ORIGINAL- PROJECT APPLICANT COPY - CDFWIA58 COPY- LEAD AGENCY COPY- COUNTY CLERK DFW 753.5a {Rev. 0110 112023) <br />