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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />._ <br />nrvl� 3' i <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amendments (if any) are no longer in effect.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 Le, Choc <br />ail <br />f<1. <br />COTC Office Use Only <br />No. A-2004-122 (�2&)' was completed on 6/30/09 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />/p� Czf) (29) <br />A-2005-149, A-2006-145, A-2004-122-03,011) ' Department: PRCSA <br />f-A-2004-122-04,tA-2004-122-05 t2f) <br />t2j) - Phone/Ext.: 5254 <br />0-2000-(WbC2.) core '+A•2003.WC20 <br />+N-2001-101Jc24)' 4A•2003-197 <br />t N-ISO 2.-047 CZb)' <br />Signature: S1A��(i� P��+imtly� <br />Date: <br />Revised 08-23-10 <br />