Prepared by: Stan Cowen Air Quality Engineer 

Print Name 

Signature: __9~ 

~ 

Print Title 

11 /12/2013 

Date 

805/645-1408 

Phone # 

CALIFORNIA DEPARTMENT OF FISH AND WILDLIFE 

2013 ENVIRONMENTAL FILING FEE CASH RECEIPT 

Complete the information and submit with each set of documents 

presented for filing. Please provide an original set and (3) three sets 

of copies for filing. 

Project Title: Ventura County APCD Rule 74.31 and Amendments to VCAPCD Rule 23 

Name of Agency filing attached document: Ventura County Air Pollution Control District 

The above named agency is filing as: Q Lead Agency Q Responsible Agency Q Trustee Agency 

Address of Filing Agency: 669 County Square Drive, Ventura, CA 93003 

DOcument Type (check one): Q Environmental Impact Report 0 Negative Declaration 

0 Mitigated Neg. Declaration Q Exemption 

Project Applicant: Ventura County Air Pollution Control District 

Project Applicant Address: 669 County Sguare Drive , Ventura, CA 93003 

Project Applicant Phone Number: (805) 645-1408 

Project Applicant is (check one): 0 Local Public Agency Q School District Q Other Special District 

0 State Agency OPrivate Entity 

If the agency presenting this document is filing as the responsible agency, provide a copy of the Lead 

Agency's filed documents and complete the following: 

Lead Agency: 

Lead Agency's Project Title: _ 

Lead Agency's State Receipt #: 

Lead Agency's Document #:T 

Check Applicable Fees (check all that apply): 

0 Negative Declaration ($2,156.25) (D Categorically Exempt 

0 Environmental Impact Report ($2,995.25) QStatutorily Exempt 

(D County Administrative Fee ($50.00) © No Effect Determination Form 

Q Filed by responsible agency; fees paid by lead agency (Attach a copy of Lead Agency's filing & receipt). 

Q Fees have already been paid (Attach a copy of the prior filing and proof of payment). 

DO NOT WRITE BELOW THIS LINE 

The following will be completed by the Ventura County Clerk's Office. 

Signature of person receiving payment: , Total Received: $ 

Deputy County Clerk 

Posted: through 

(FW2013) 
VENTURA COUNTY CLERK AND RECORDER 

Hall of Administration, Main Plaza 

800 South Victoria Avenue 

Ventura, CA 93009 

805-654-2295 http://recorder.countyofventura.org 

MARK A. LUNN 

CLERK AND RECORDER Receipt for Services 

Cashier QUELLR Batch # 771733 

Customer VENTURA COUNTY AIR POLUTION CONTROL DIST. 

Date: 11/19/2013 Time: 10:41:43AM 

Doc. Type Instrument No GF Number Rec Fees PCOR Sin-vey Fees Taxes Total 

CEIRE 20131119-10017435-0 50.00 0.00 0.00 0.00 50.00 

Total Fee: 50.00 

CHECK 1163 50.00 

Payment Total: 50.00 

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