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State of California-Department of Fish and Wildlife <br /> 2023 ENVIRONMENTAL DOCUMENT FILING FEE <br /> CASH RECEIPT <br /> DFW 753.5a(REV.01101123)Previously DFG 753.5a - <br /> Prmt Saves <br /> RECEIPT NUMBER: <br /> 30— 08/08/2023 — 0682 <br /> STATE CLEARINGHOUSE NUMBER(If applicable) <br /> SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br /> LEADAGENCY LFADAGENCY EMAIL DATE <br /> CITY OF SANTA ANA, PUBLIC WORKS AGENCY 08/08/2023 <br /> COUNTY/STATE AGENCY OF FILING DOCUMENT NUMBER <br /> Orange 202385000693 <br /> PROJECT TITLE <br /> GRAND AVE REHAB FROM EDINGER AVE TO MCFA <br /> PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PHONE NUMBER <br /> CITY OF SANTA ANA, PUBLIC WORKS AGENCY (714 )719-0015 <br /> PROJECT APPLICANT ADDRESS CITY STATE ZIP CODE <br /> 20 CIVIC CENTER PLAZA (M-36) SANTA ANA CA 92702 <br /> PROJECT APPLICANT(Check appropriate box) <br /> 0 Local Public Agency ❑ School District ❑ Other Special District ❑ State Agency []Private Entity <br /> CHECK APPLICABLE FEES: <br /> ❑ Environmental Impact Report(EIR) $3,839.25 $ 0.00 <br /> ❑ Mitigated/Negative Declaration(MND)(ND) $2,764.00 $ 0.00 <br /> ❑ Certified Regulatory Program(CRP)document-payment due directly to CDFW $1,305.25 $ 0.00 <br /> Exempt from fee <br /> El 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 $ 0.00 <br /> ❑ County documentary handling fee $ <br /> ❑ Other $ <br /> PAYMENT METHOD: <br /> ❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ 0.00 <br /> SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br /> X DEPUTY CLERK, CARINA CORTES <br /> ORIGINAL-FCqj T`AP MjI COPY-CDFWlASB COPY-LEAD AGEIC8 _ 38 COPY-COUNTY CLERK N0110112023) <br />