HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Human Resources; 2019-04-18~
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RECORDS DESTRUCTION AUTHORI-ZATION FORM
DATE: 03/26/2019
REQUESTING DEPARTMENT: HUMAN RESOURCES REQUESTER: KIM STANKAVICH
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and o pending or ongoing litigation or investigation involving these records is known to exist.
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DEPARTMENT HEAD: DATE RECORDS MANAGEMENT: DATE CITY ATTORNEY: DATE
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
v 2 BOXES PATRICK PRESTON 1995 0840-50 TE+5 N/A GRIEVANCES-COMPLAINTS (SAFETY)
V BRENDA BUNNELL N/A 1 BOX GRIEVANCES-COMPLAINTS (NON-SAFETY) 2005 0840-55 TE+5
J 1 BOX ANITA RAMOS HOZMILLER 2001 0840-55 TE+5 N/A GRIEVANCES-COMPLAINTS (NON-SAFETY)
..,I DANNY ROY N/A 1 BOX GRIEVANCES-COMPLAINTS (NON-SAFETY) 2002 0840-55 TE+5
*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: ?;-vo t(,dv
CERTIFICATE OF DESTRUCTION? lfa7 YES O NO
SMEADS0FT BARCODES DELETED BY: __________ _
DATE:
DATE: ------
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
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Carlsbad Revised: 3/27/2019
CERTIFICATE OF DESTRUCTION & RECYCLING
This certificate 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
110232
Monday, April 22, 2019
5815 EL CAMINO REAL
Apr-18-2019 thru Apr-18-2019
577291
41 -41 Boxes for Destruction ( standard)
• Nothing in this certificate shall be deemed to modify the terms of the parties' Service Agreement(s) or Work Ticket(s).
t:1corodata i/SSAE16
Type II Audit Completed HIP£