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State of California - Department of Fish and Wildlife <br />2025 ENVIRONMENTAL DOCUMENT FILING FEE <br />CASH RECEIPT <br />DFW753.5a (REV. 01101/25) Previously DFG 753.5a <br />RECEIPT NUMBER: <br />30-0711012025-0515 <br />CLEARINGHOUSE. NUMBER (if applicable) <br />SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARLY. <br />LEADAGENCY LEAD AGENCY EMAIL DATE <br />CITY OF SANTA ANA 07/10/2026 <br />COUNTYISTATE AGENCY OF FILING DOCUMENT NUMBER <br />ORANGE COUNTY 202685000663 <br />PROJECT TITLE <br />SEGERSTROM & RAITT AND SEGERSTROM & FLOW <br />PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PHONE NUMBER <br />CITY OF SANTA ANA (714) 647-5626 <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 />Q Local Public Agency ❑ School District ❑ Other Special District ❑ State Agency ❑ Private Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />$ 4,123.50 $ <br />❑ Mitigated/Negative Declaratidn (MND)(ND) <br />$ 2,968.75 $ <br />❑ Certified Regulatory Program (CRP) document - payment due directly to CDFW <br />$ 1,401.75 $ <br />x❑ Exempt from fee <br />M 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 Control Board only) <br />$ 850.00 $ <br />❑ County documentary handling fee <br />$ 50.00 $ <br />❑ Other <br />$ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit © Check ❑ Other TOTAL RECEIVED $ 0.00 <br />SIGNATURE <br />AGENCY OF FILING PRINTED NAME AND TITLE <br />X <br />Sarah Luna Deputy Clerk <br />ORIGINAL -PROJECT APPLICANT COPY -CDFWIASB COPY - LEADAGENCY COPY -COUNTY CLERK DFW753.5a(Rev.01012025) <br />