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" State of California - Department of Fish and Wildlife <br />2017 ENVIRONMENTAL FILING FEE CASH RECEIPT <br />t <br />DFW 753.5a (Rev. 01/01117) Previously DFG 753,5a <br />r. <br />30.2017 0525 <br />LEADAGENCY EMAIL <br />(If <br />CITY OF SANTA ANA <br />05/25/2017 <br />COUNTY/STATE AGENCY OF FILING <br />DOCUMENT NUMBER <br />Orange <br />201785000562 <br />PROJECT TITLE <br />LOCAL STREET SLURRY SEAL 2016-17 <br />PROJECT APPLICANT NAME <br />PROJECT APPLICANT <br />EMAIL <br />PHONE NUMBER <br />CITY OF SANTA ANA PUBLIC WORKS AGENCY <br />(714) 647-5632 <br />PROJECT APPLICANT ADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />ROSS ANNEX, 20 CIVIC CENTER PLAZA, 3RD FL M-36 <br />SANTA ANA <br />CA <br />92702 <br />PROJECT APPLICANT (Check appropriate box) <br />E]d Local Publlc Agency E] School District E] Other Spatial District <br />[] State Agency []✓ Private <br />Entity <br />CHECK APPLICABLE FEES: <br />❑ Environmental Impact Report (EIR) <br />$3,075.26 <br />It <br />0.00 <br />© MltlgatedlNegative Daclaratfon (MND)(ND) <br />$2,216,25 <br />$ <br />0.00 <br />[] Certified Regulatory Program document (GRP) <br />$1,045.50 <br />$ <br />0.00 <br />El Exempt from fee <br />Q 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 />$850.00 <br />$ <br />0.00 <br />County documentary handling fee <br />$ <br />❑ Other <br />$ <br />PAYMENT METHOD: <br />❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL <br />RECEIVED <br />$ <br />0,00 <br />HAZEL L. BENNETT, DEPUTY CLERK <br />ORIGINAL- PROJECT APPLICANT COPY •COFWIA8a COPY• LEAD AGENCY COPY -COUNTY CLERK DFW 753.5.(R4v. 2015121.9) <br />