HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Library & Cultural Arts; 2016-09-06RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: 3/4/2013
REQUESTING DEPARTMENT: LIBRARY & CULTURAL ARTS REQUESTER: CISSIE SEXTON
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 · t.
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RECORDS MANAGEMENT:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS SMEADSOFT BARCODE
PERIOD (if applicable)
Part-time recruitment files and 2012 0850-25 CL+3 LIBOt4 application forms
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY: ,u_ndd-U
CERTIFICATE OF DESTRUCTION? (i217 YES 0 NO
DATE: ~~Jk
SMEADSOFT BARCODES DELETED BY:------------DATE: __________ __
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
,~;~'em o• Revised: 3/4/2013 ~CARLSBAD
CERTIFICATE OF DESTRUCTION & RECYCLING
This certificate is presented to: CITY OF CARLSBAD -RECORDS MGMT DEPT.
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
104525
Tuesday, September 13, 2016
5815 EL CAMINO REAL
Sep-06-2016 thru Sep-06-2016
340714
4 -4 64 Gallon Bin
*Nothing in this certificate shall be deemed to modify the terms of the parties' Service Agreement(s) or Work Ticket(s).
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iJcorodata
Shredding, Inc.
SAN DIEGO -ORANGE COUNTY/LA
NORTH BAY/SAN FRANCISCO· SAN JOSE/SILICON VALLEY
Tue Sep 6 2016 ' next: 10/4/20161
CITY OF CARLSBAD -RECORDS
MGMTDEPT.
5815 EL CAMINO REAL
CARLSBAD, CA 92008
Contacts
PAT DOWNIE (760)602-2738
MARIA EMERY (760)271-6841
Room Description
1 64 Gallon Bin
1 64 Gallon Bin
1 64 Gallon Bin
1 64 Gallon Bin
Corodata Shredding, Inc.
12375 Kerran Street· Poway, CA 92064
(858) 7 48-1100 Fax (858) 726-6085
\, I/,
1111111111111111111111111111111111111111 First Available Ticket # 340714
Directions Routine Instructions
********CALL MARIA (20) PRIOR TO ARRIVAL********** ***ENTER ON FARADAY OR
******************************************************************* PRIESTLY***
************************************************************** CALL MARIA (20) PRIOR TO
!ARRIVAL -MARIA NEEDS TO
MEET YOU AT
Special Instructions WAREHOUSE/BLDG.
Container Service Item Qty Actual
64 Gallon Bin 1.00 1
64 Gallon Bin 1.00 I
64 Gallon Bin 1.00
64 Gallon Bin 1.00
1 Minimum Service Ticket Amount
Service I Comments
Corodata Shredding, Inc. represents that it received the aforementioned materials for confidential
destruction and hereby certifies such materials will be confidentially handled and destroyed and
that the shredded materials will be recycled. Client represents that it has authority to provide to
Corodata Shredding, Inc. the aforementioned materials for confidential destruction and hereby
acknowledges and accepts the terms and conditions on the reverse side.
SO BT Stop 99 BC SD012455 Page 1