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State of California - Department of Fish and Wildlife <br />_ 2025 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5a (REV. 01101125) Previously DFG 753.5a <br />� � L Save <br />RECEIPT NUMBER: <br />30 — 01/30/2025 — 0054 <br />STATE CLEARINGHOUSE NUMBER (!(applicable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />LEADAGENCY LEADAGENCY EMAIL DATE <br />CITY OF SANTA ANA 1 01/30/2025 <br />COUNTYISTATE AGENCY OF FILING DOCUMENT NUMBER <br />orange 1202585000057 <br />PROJECT TITLE <br />FIRE STATION 70 REMODEL <br />PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PHONE NUMBER <br />CITY OF SANTA ANA (714)571-4241 <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 I] School District [] Other Special District <br />State Agency <br />Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />$4,123.50 <br />$ <br />0.00 <br />❑ Mitigated/Negative Declaration (MND)(ND) <br />$2,968.75 <br />$ <br />0.00 <br />❑ Certified Regulatory Program (CRP) document - payment due directly to CDFW <br />$1,401.75 <br />$ <br />0.00 <br />El Exempt from fee <br />E) 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 />$850.00 <br />$ <br />0.00 <br />❑ County documentary handling fee <br />$ <br />50.00 <br />❑ Other <br />$ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL <br />RECEIVED <br />$ <br />50.00 <br />SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br />X KALCI DO, DEPUTY <br />ORI G INA4 -PROJECT APPLICANT COPY - CDFWIASB COPY - LEAD AGENCY COPY - COUNTY CLERK DFW 753.5a (Rev. 01IM2025) <br />