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State of California - Department of Fish and Wildlife <br />2021 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />DFW 763.5a (REV.01/01/21) Previously DFG 763.6a <br />LEADAGENCY EMAIL <br />CITY OF SANTA ANA <br />SANTA ANA LIBRARY CHILDREN'S PATIO <br />30 — 06/01/2021 — 0389 <br />ITATE CLEARINGHOUSE NUMBER (h <br />06/01/2021 <br />)OCUMENT NUMBER <br />202185000405 <br />PROJECTAPPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />( ) <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 />Q Local Pubic Agency Q School District 0 Other Special Distncl ❑ Stale Agency <br />0 Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) $3,445.25 $ <br />0.00 <br />❑ MitlgatedlNegative Declafation (MND)(ND) $2.480.26 $ <br />0.00 <br />❑ Certified Regulatory Program (ORP) document - payment due directly to CDFW $1.171.25 $ <br />0.00 <br />m Exempt from fee <br />RI 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 $ <br />0.00 <br />❑ County documentary handling fee $ <br />❑ Other $ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ <br />0.00 <br />SIGNATURE <br />AGENCY OF FILING PRINTED NAME AND TITLE <br />is K <br />I DEPUTY CLERK, CLAUDIA FRANCO <br />ORIGINAL, PROJECT APPLICANT COPY. COPN/ASS COPY - UPADAGENCY COPY. COUNTY CLERK OFW 7535e(Rev. 01012021) <br />