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DW State of Califomia - Department of Fish and Wildlife <br />HE 2024 ENVIRONMENTAL DOCUMENT FILING FEE <br />1*7 CASH RECEIPT <br />DPW 753.5a (RF-V. WOWS) Previously DFG 753.6a <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />Print $terl0>rer Save <br />RECEIPT NUMBER: <br />30 — 07/03/2024 0572 <br />STATE CLEARINGHOUSE NUMBER (ffapplioabfe) <br />LEAD AGENCY LFADAGENCY EMAIL DATE <br />OCPW, DEVELOPMENT SERVICES 07/03/2024 <br />COUNTYISTATE AGENCY OF FILING DOCUMENT NUMBER <br />Clrnnna 12D2485000579 <br />PROJECT <br />ROUSSELLE STREET FLOOD PROTECTION PROJECT <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CRAIG FOSTER, NPDES MANAGER, CITY OF SANTA <br />(714 ) 647 5659 <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 appropdate box) <br />[a Local Public Agency School District Other Special District <br />State Agency [] Private Entity <br />CHECK APPLICABLE FEES; <br />0.00 <br />[IEnAronmental Impact Report (EIR) <br />$4,051.26 $ <br />❑ MitlgaledlNegative Declaration (MND)(ND) <br />$2,918.75 $ <br />0.00 <br />❑ Certified Regulatory Program (CRP) document - payment due directly to CDFW <br />$1,377.26 $ <br />0,00 <br />El Exempt from Fee <br />R 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 (State Water Resources Control Board only) <br />$850.00 $ <br />0.00 <br />❑ County documentary handling fee <br />$ <br />❑ Other <br />$ <br />PAYMENT METHOD: <br />0.00 <br />El Cash ❑ Credit ❑ Check El Other TOTAL RECEIVED $ <br />SIGNATURE _ <br />AGENCY OF FILING PRINTED NAME AND TITLE <br />IA <br />NA HERRERA, DEPUTY <br />ORIGINAL- PROJECT APPLICANT COPY-MMAGG COPY-LEADA09NCY COPY -COUNTY CLERK DFW753.5a(Rov.M10112023) <br />