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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. 01/01/23) Previously DFG 753.5a <br />.Print Save. . ..... ... . —L.] <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 />LEAD AGENCY LEADAGENCY EMAIL DATE <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY 08108/2023 <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 <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />(714 )719-0015 <br />PROJECT APPLICANT 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 />r[] Local Public Agency ❑ School District ❑ Other Special District <br />❑ State Agency <br />[] Private Entity <br />CHECK APPLICABLE FEES. <br />❑ Environmental Impact Report (EIR) <br />$3,839.25 <br />$ <br />0.00 <br />❑ Mitlgated/Negative Declaration (MND)(ND) <br />$2,764.00 <br />$ <br />0.00 <br />❑ Certified Regulatory Program (CRP) document - payment due directly to CDFW <br />$1,305.25 <br />$ <br />0.00 <br />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 />❑ 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 />❑ Other <br />$ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL <br />RECEIVED <br />$ <br />0.00 <br />SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br />X DEPUTY CLERK, CARINA CORTES <br />ORIGINAL -PROJECT APPLICANT COPY -CDFWIASB COPY-LP.ADAGENCY COPY -COUNTY CLERK DPW 753.5a(Rev.0110112023) <br />