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HomeMy WebLinkAbout; ; Records Destruction Authorization Form - Purchsing; 2020-01-30~ fi,l/ RECORDS DESTRUCTION AUTHORIZATION FORM DATE: I// S/IC/ REQuEsT1NG DEPARTMENT: ~oY'JCl / Rm::viaslnta-: REQUESTER: DESTRUCTION APPROVALS: We certify that the records listed below have been retained for the scheduled retention period, required audits have been completed, and no pending or ongoing litigation or investigation involving these records is known to exist. ~ ~tt/~/t°J DEPARTMENT HEAD: DATE RECORDS MANAGEMENT: DATE !1JL CITY ATTORNEY: DATE BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE PERIOD (if applicable) I ,1oo7 Prv ~ \ ~ ~o7 0'-710-·L/ 5 .Au+1-t N/A- // 'S4r('.)l1..ts G.9u,'P-D\sp%,ct,I Jw4-d.vlt-j oi,,o-uo A0\+Y /I *If more spaces are needed, click in the last box in right hand corner of table and hit "tab". This will create more fields in the table. To be filled out once records have been destroyed. RECORD DESTRUCTION COMPLETED BY: ~~ DATE: CERTIFICATE OF DESTRUCTION? I)(: YES O NO SMEADSOFT BARCODES DELETED BY: DATE: ------------------ This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program. {'Cityof Carlsbad Revised: 10/4/2019 RECORDS DESTRUCTION AUTHORIZATION FORM DATE: REQUESTING DEPARTMENT: __L_J"--------'--"=:::>..£..._+-+--""'---'-(=C'-'-'C!Sc::.=..!...' 1/l~EQUESTER: sk.w1 Sctit.1 "2__ DESTRUCTION APPROVALS: We certify that the records listed below have been retained for the scheduled retention period, required audits have been i;;;I;:d;ng o: ~;;~/1:got~g :;;ms ;s kn;ill DfPARTMENTHEAo: DATE RECORDS MANAGEMENT: DATE CITY ATTORNEY: DATE BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE I PERIOD (if applicable) ~ I JDJ&-da>"1 Dicl,s 4 f{Dpl)Sc,t( s a.oo~ -0, 70--l.( S Au+L-{ r,/°'. .;1eo·1 *If more spaces are needed, click in the last box in right hand corner of table and hit "tab". This will create more fields in the table. To be filled out once records have been destroyed. RECORD DESTRUCTION COMPLETED BY: &-t-a~ CERTIFICATE OF DESTRUCTION? ~YES O NO SMEADSOFT BARCODES DELETED BY: ___________ _ DATE: ------ This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program. Ccityor Carlsbad Revised: 10/4/2019 CERTIFICATE OF DESTRUCTION & RECYCLING This certific~te is presented to: CITY OF CARLSBAD -RECORDS MANAGEMENT DIVISION Per the express request of Client, Corodata has received the Material referred to below and has/will destroy and then recycle said Material in accordance with its standard procedures. As the parties have agreed, Corodata will not inventory, record or track any information contained within or related to the Material. Account #(s) Certificate # Date Issued Service Locations Date Range of Service Work Ticket(s) Quantity/Item SD012455 111346 Thursday, January 30, 2020 5815 EL CAMINO REAL Jan-30-2020 thru Jan-30-2020 666060 * Nothing in this certificate shall be deemed to modify the terms of the parties' Service Agreement(s) or Work Ticket(s). t:1corodata irSSAE16 Type II Audit Compleied HIPAA