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® State of California - Department of Fish and Wildlife <br />2020 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />DFW 753.5a (Rev. 01/01/18) Previously DFG 753.5a <br />RECEIPT NUMBER: <br />30-2020 0410 <br />5IAfE CLEARINGHOUSE NUMBER (i(applicable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. NIA <br />LEAD AGENCY LEADAGENCY EMAIL DATE <br />CITY OF SANTA ANA 06/16/2020 <br />COU NTYISTATE AGENCY OF FILING DOCUMENT NUMBER <br />Orange 202085000424 <br />PROJECT TITLE <br />STANDARD AVENUE PROTECTED BIKE LANES: 3RD TO WARNER (20-6965) <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />(714) 647-5655 <br />PROJECT APPLICANT ADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />20 CIVIC CENTER PALZA M-36 <br />SANTA ANA <br />CA <br />92702 <br />PROJECT APPLICANT (Check appropriate box) <br />2] Local Public Agency School District Other Special District State Agency Private <br />Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) $3,343.25 $ <br />0,00 <br />❑ Mitigated/Negative Declaration (MND)(ND) $2,406.75 $ <br />0.00 <br />❑ Certified Regulatory Program document (CRP) $1,136.50 $ <br />0.00 <br />E Exempt from fee <br />0 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 Contral Board only) $850,00 S <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 />SIGMA IEAGENCY <br />il <br />OF FILING PRINTED NAME AND TITLE <br />G'� P- <br />NADIAAL OBAIDI,DEPUTY CLERK <br />ORIGINAL - PROJECT APPLICANT COPY - CDFWIASB COPY - LEAD AGENCY COPY - COUNTY CLERK DFW 753,5a IRov. 2015M5) <br />