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State of California - Department of Fish and Wildlife <br />2024 ENVIRONMENTAL. DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5a (REV, 01101/23) Previously DFG 753.6a <br />RECEIPT NUMBER: <br />30 — 09/05/2024 — 0771 <br />CLEARINGHOUSE NUMBER (If applicable) <br />EINSTRUCTIONSONREVERSE. TYPE ORPRINTCLEARLY. <br />LEADAGENCY LaOAOENCY EMAIL DATE <br />CITY OF SANTA ANA 1 1 09/05/2024 <br />COUNTY/STATE AGENCY OF FILING DOCUMENT NUMBER <br />Orange PF 202486000782 <br />PROJECT TITLE; <br />MEMORIAL PARK AQUATICS CENTER <br />PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PRONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY (714 )571-4241 <br />PROJECTAPPLICANTADDRESS CITY STATE ZIP CODE <br />20 CIVIC CENTER PLAZA (M-36) SANTA ANA CA 92702 <br />PROJECT APPLICANT (Check appropriate box) <br />d Local Public Agency ❑ School District ❑ Other Special District ❑ State Agency ❑ Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />❑ MillgatedlNegalive Declaration (MND)(ND) <br />❑ Certified Regulatory Program (CRP) document - payment due directly to COFW <br />I] Exempt from fee <br />r❑ Notice of Exemption (attach) <br />❑ CDFW No Effect Determination (attach) <br />❑ Fes previously paid (attach previously Issued cash recetpt copy) <br />❑ Water Right Application or Petition Fee (Stale Water Resources Control Board only) <br />❑ County documentaryhandling fee <br />❑ Other <br />PAYMENT METHOD: <br />$4,051.25 $ <br />0.00 <br />$2,916.75 $ <br />0.00 <br />$1,377.26 $ <br />.__ 0.00 <br />$850.00 $ <br />0.00 <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ 0.00 <br />OF FILING PRINTED NAME AND TITLE <br />�[ 1CARINA HERRERA, DEPUTY <br />ORIGINAL -PriOJP-CT APPLICANT COPY-CIJF'1MIAM CoFY-LEAOAGENCY COPY -COUNTY CLERK DPW 703-Ba(Rev.0110112023) <br />