HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Fire; 2016-06-30,:t'.u&a.:4,:?:.;a;,t,..,8r-*:a,a-,'a::a4=z*.?ra€2;.:a:a?..,:ara,..:,?a:t.r;;;=:
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DesrRucnoru Appnovas:
We certify that the records listed below hsve been retained for the scheduled retentian period, required audits have been
completed, and no pending or ongoing litigatian or investigation involving these records is knawn to exist.
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This form documents the destruction of City records in qccordonce with the City of Corlsbdd Records Mqndgement program.
.o&t^",.,.r,^-.- Revised:12/11/201sV CARLSBAD
BOX NO.RECORDS DESCRIPTION DATED RRS NO.RRS
PERIOD
TAB BARCODE
(if applicable)
{D OL3 Patient Surveys Jan-Dec
2412 GC 34090 CU+2 0630-05
*lf more spoces are needed, click in the last box in right hand corner of table and hit "tab". This will creote more fietds in the tsbte.
To be filled out once recbrds have been destroyed.
RECORD DESTRUCflON COMPLETED BY:
CERTI FICATE O F DESTRUCTION ?
SMEADSOFT BARCODES DELETED BY:
DArE: bS O'/+
DATE:
\r,=d-it SERVICE RECORD
CERTIFICATE OF DESTRUCTION
(THIS IS NOT AN INVOICE)
Customer: 11889293
City Of Carlsbad-Records Management
5a15 EI Camino Real
CARLSBAD CA 92008-8801
USA
Page: 1 of 1
Order #: 8024860953
Order Date: OGI30/2016
This year your firm has $aved 42.8La trees through recycling shredded paper.
QrYServiced, a7A:
Bankers/Archive
Box
Equipment
Maintenance:
Service Type:
Customer Signature:
Customer Print Name:
Received on Account: $
NA = Not Accessible
E an"ou" / check No.:
Additional Charges:
Autmomatic TotalContainerlnventory:service:
Extra Material: Container Type:
Purge Service: Requested Type:
NF = Not Found at Location
QTY: 1.000
QTY:
Actual
QTY:
QTY:
NA NF Container Type Serlal No.Loeataon