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State of California - Department of Fish and Wildlife <br />2022 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5a (REV.01/01/22) Previously DFG 753.5a <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY <br />� Prlgt save <br />RECEIPT NUMBER: <br />30 — 03/07/2022 — 0179 <br />LEADAGENCY <br />LEADAGENCY EMAIL <br />DATE <br />CITY OF SANTA ANA <br />03/07/2022 <br />COUNTYISTATE AGENCY OF FILING <br />DOCUMENT NUMBER <br />orange <br />202285000184 <br />PROJECT TITLE <br />CABRILLO PARK IRRIGATION RENOVATION <br />PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PHONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY (714)647-5665 <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 />E Local Public Agency 0 School District Other Special District ❑ Stale Agency Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />$3,539.25 <br />$ <br />0.00 <br />❑ Mitigated/Negative Declaration (MND)(ND) <br />$2.548.00 <br />$ <br />0.00 <br />❑ Certified Regulatory Program (CRP) document- payment due directly to CDFW <br />$1,203,25 <br />$ <br />0.00 <br />Exempt from fee <br />® 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 (Stale 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 RECEIVED <br />$ <br />0.00 <br />SIGNATURE AGENCY OF FILING PRINTED NAME AND TITLE <br />X DEPUTY CLERK, CLAUDIA FRANCO <br />ORIGINAL- PROJECT APPLICANT COPY -CDMIASB COPY -LEAD AGENCY COPY -COU NTY CLERK DM 75M (Ray. 01012022) <br />