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HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Library & Cultural Arts; 2009-01-06 (2)RECORDS DESTRUCTION REQUEST City Clerk/Records Management Page 1 of 1 Department Requesting Destruction: Approvals for Destruction Department Head Date Records Manager Attorney Date Date 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. Person^) Completing Form: No. / RECORDS DESCRIPTION frfJTS (SriU^jrrS DATED £003 BOX No. §y°<I RRS No. 04/«-t/7 RRS Period ct.^- BARCODE ** APPROVED By City Attorney H=HOLD RECORD DESTRUCTION COMPLETED BY : ^^c^orca/C\rvVa5 DATE: ov/Ot/AcioQ, CERTIFICATE OF DESTRUCTION? Yes & No D SMEADLINK BARCODES DELETED BY: (\l* DATE: r/?/s form documents the destruction of City records in accordance with the California Public Records Act Revised 08/25/2005 CJNlAS DOCUMENT MANAGEMENT CITY OF CARLSBAD 2351 FARADAY AVE CARLSBAD, CA 920087217 CONTACT: Tanya Bjork - Phone: (760)602-2786 SERVICE PERFORMED Pounds Minutes //?' ,_ADD ' L CERTIFICATE OF DESTRUCTION SERVICE TICKET #: DATE: CUSTOMER #: SERVICE/TYPE: NEXT SERVICE DATE: NEXT SERVICE TYPE: Lock(s) Present/Operable: Clasp(s) Present/Operable: OOG36 - 66715 01/06/2009 10284 Purge/Onsite Not scheduled. Not scheduled. Yes Yes No No COMMENTS: This certificate is to certify that Cintas Document Management will shred confidential data per customer's instructions and according to H1PAA & GLBA regulations for the above-mentioned company. Mobile destruction services are NAID certified. Non-Paper destruction services are not NAID certified. CUSTOMER SIGNATURE: SERVICE REP SIGNATURE: DATE: DATE: 9455 WAPLES ST • STE. 110 • SAN DIEGO, CA 921213924 • Phone: (858)678-0460 • Fax: (858)678-0894