HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Parks & Recreation; 2017-04-20RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: ;;.,/ (}_ f /J7
REQUESTING DEPARTMENT: p~~eoo,J~REQUESTER: j:-1icWP f?u'vc:_
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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 ongoin g litigation or investigation involving these records is known to exist.
~HEAD: Qe~ A.TIORNEY:
BOX NO. RECORDS DESCRIPTION . DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
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*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: ___ &ro._,.___W-V---"=-----DATE:
CERTIFICATE OF DESTRUCTION? ~ YES D NO
SMEADSOFT BARCODES DELETED BY:------------DATE:~~~~~-
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
l ~">' con o, Revised: 3/24/2015 ~ CARLSBAD
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RECORDS DESTRUCT ION AUTHORIZATION FORM
. DATE: d /:J--J /} 7 . _ (
REQUESTING DEPARTMENT: Pan ks 'hi Reai.ooio~EQUESTER: )::__lJ, {1)JJ2 p~\Jq
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DESTRUCTION APPROVALS:
We certify that the records listed below have been retained fo r the scheduled re tention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
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~. HEAD: RECORDS MANAGEMENT: ~RNEY:
BOX NO. RECORDS DESCRIPTION . DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
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*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 oncerecords have been destroyed.
RECORD DESTRUCTION COMPLETED BY: -=-~--'&~_'(J_·itfa-, _____ _
CERTIFICATE OF DESTRUCTION? ~ YES O NO
DATE:
SMEADSOFT BARCODES DELETED BY: ____ -_______ _ DATE: ------
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
<<~ CITY or Revised: 3/24/2015 ~ CARLSBAD
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: ;, /JJ ! I]
REQUESTING DEPARTMENT: ?Mks !dY\f'OtO~ REQUESTER: ~l,....._.1'_a&1~=------;E~ru-'_Uc_a..._~---
Ae8-q_ N~e Ari--atic s y
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained Jar the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known
~EAD: RECORDS MANAGEMENT:
RECORDS DESCRIPTION . DATED RRS NO. RRS TAB BARCODE BOX NO. PERIOD (if applicable)
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*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 oncerecords have been destroyed.
RECORD DESTRUCTION COMPLETED BY: ~ ~ DATE:'f///k/7
CERTIFICATE OF DESTRUCTION? (Z}_ 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.
,<~> cm o, Revised: 3/24/2015 ~ CARLSBAD .
CERTIFICATE OF DESTRUCTION & RECYCLING
This certificate is presented to: CITY OF CARLSBAD
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
106786
Monday,April24,2017
5815 EL CAMINO REAL
Apr-20-2017 thru Apr-20-2017
388996
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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SSAE16
Type II Audit Completed • HIPAtA
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