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City of Santa Ana <br />Clerk of the Council -corc oft -ce use <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement andel ")CT 73 r <br />p Y 9 — .a• . r <br />amendments (if any) are no longer in effect. <br />(j4 � $ P r <br />Note: If your agreement is grant related, please ensure that all grant retention requirements ;-:r ,� <br />have been satisfied prior to signing the termination form. <br />Is the agreement(s) 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 />- agreement with SQL. . 10i._ ca. .._. �1 /�� <br />C IM0 <br />No. WM6-151 <br />was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: FW -19-04 <br />Phone/Ext,: 5 <br />Signature: Vi) kwao <br />Date: o0i L9 [ (� <br />Revised 10.18-16 <br />