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State of Califomia - Department of Fish and Wildlife <br />2024 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW 753.5a (REV. 01101123) Previously DFG 753.5a�...-- <br />t�r'int <br />5tartOvar =?Save <br />RECEIPT NUMBER: <br />30 -- 12/19/2024 -- 1085 <br />STATE CLEARINGHOUSE; NUMBER (Itapplicable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE ORPRINTCLEARLY. <br />LEAD AGENCY <br />LEADAGENCY EMAIL <br />DATE <br />CITY OF SANTA ANA <br />12/19/2024 <br />COUNTYISTATE AGENCY OF FILING <br />DOCUMENT NUMBER <br />Orarige <br />202485001102 <br />PROJECT TITLE <br />CIVIC CENTER REHABILITATION SHELTON TO FLOWER <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY <br />(714 )647-5665 <br />PROJECT APPLICANTADDRESS <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 />[a Local Public Agency ❑ School District E] Other Special DWrict <br />❑ State Agency Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />$4,051.26 $ <br />0.00 <br />❑ Mitigated/Negative Declaration (MND)(ND) <br />$2,916.75 $ <br />0.00 <br />❑ Certified Regulatory Program (CRP) document - payment due directly to CDFW <br />$1,377.25 $ <br />0.00 <br />0 Exempt from fee <br />21 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 Petltion 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 />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL <br />RECEIVED $ <br />0.00 <br />SIGNATURE <br />AGENCY OF FILING PRINTED NAME AND TITLE <br />MELISSA GOMEZ, DEPUTY <br />ORIGINAL - PROJECT srw HIN601 {Rev. OM1I2023) <br />City Council 11 — 64 3/18/2025 <br />