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City of Santa 'a <br />Clerk of the Council <br />1 A�rt TERMINATION FORM <br />Please complete this form in its entirety when the attached project and FE all$ _ 6' <br />amendments (if any) are no longer in effect. Nltl PN 4: ?2 <br />t CITY OF SNTA ANA <br />CLERK OF COUNCIL <br />Is the project a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-30) <br />Call 647-1520 if you have any questions. <br />The project with NA 0 SAA0d c,Ln "'1,L &UM'A-A-ShAQ,, <br />No. N-2017-178 was completed on and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: WL6A <br />Phone/Ext.: 14 al�Q <br />Signature: Ah*,, 9 <br />Date: a I� /30IA <br />Revised: 08-14-17 <br />