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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Return form to the Clerk of the Council Office (M -30). <br />Call 647 -6520 if you have any questions. <br />The agreement with Antech Diagnostics <br />G 200 <br />COTC Office Use Only _ <br />No. N- 2005 -055 was completed on 6/30/05 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />fltnandlnent Department: PRCSA <br />fl- 20ps °I10 <br />Phone /Ext.: 5254 <br />Signature: NLxWCAV-0 <br />Date: 717114 <br />Revised 0 8-2310 <br />