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State of California - Department of Fish and Wildlife <br />2019 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />DFW 753.5a (Rev. 01/01/18) Previously DFG 753.5a <br />RECEIPT NUMBER: <br />30-2019 0097 <br />STATE CLEARINGH <br />men] +VMI vnaienracevecee eAory N/A <br />LEADAGENCY EMAIL <br />CITY OF SANTA ANA 02/05/2019 <br />COUNTY/STATE AGENCY OF FILING DOCUMENT NUMBER <br />Francis 201985000101 <br />THORNTON PARK PARKING LOT IMPROVEMENTS 18-7630 <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />ARMANDO FERNANDEZ, CITY OF SANTA ANA <br />(714) 647-3318 <br />PROJECTAPPLICANTADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />20 CIVIC CENTER PLAZA, M36 <br />SANTA ANA <br />CA <br />92702 <br />PROJECT APPLICANT (Check appropriate box) <br />❑✓ Local Public Agency ❑ School District ❑ Other Special District ❑ State Agency ❑ Private <br />Entity <br />CHECK APPLICABLE PEES: <br />❑ Environmental Impact Report (EIR) $3,271.00 $ <br />0,00 <br />❑ Mitigated/Negative Declaration (MND)(ND) $2,354.75 $ <br />0.00 <br />❑ Certified Regulatory Program document (CRP) $1.112.00 $ <br />0.00 <br />[] Exempt from fee <br />El Notice of Exemptlon (attach) <br />❑ CDFW No Effect Determination (attach) <br />❑ Fee previously paid (attach previously Issued cash receipt copy) <br />❑ Water Right Application or Petition Fee (Stale Water Resources Control Board only) $860.00 $ <br />0.00 <br />❑ County documentary handling fee $ <br />0.00 <br />❑ Other $ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ <br />0,00 <br />SIGNA URE 11% <br />X <br />AGENCY OF FILING PRINTED NAME AND TITLE <br />NADIA AL OBAI DI, DEPUTY CLERK <br />ORIGINAL- PROJECT APPLICANT COPY -CDFW/ASB COPY - LEAD AGENCY COPY -COUNTY CLERK OFW763.6a(Rev. 20161216) <br />