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