HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Records Management; 2018-03-01L' ·-·•-'--,_,._ '-~-=----:~'..J
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: 02/26/2018
REQUESTING DEPARTMENT: RECORDS MANAGEMENT REQUESTER: PAT DOWNIE
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.
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DEPARTMENT HEAD DATE RECORDS MANAGEMENT DATE CITY ATTORNEY DATE
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TABBARCODE
PERIOD (if applicable)
1-75 INITIATIVE PETITION 08/18/2015 0725-20 CL+ .75
1-15 REFERENDUM PETITION 11/2/2015 0725-30 CL+ .75
"If more spaces are needed, click in the last box In right hand corner of table and hit "tab". This wfll create more fields in the table.
To be filled out once records hove been destroyed.
RECORD DESTRUCTION COMPLETED BY: ~t}~ DATE:
CERTIFICATE OF DESTRUCTION? ~ D NO
TAB BARCODES DELETED BY:-----------
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
<.~>' cm o, Revised: 2016
·~ CARLSBAD P o g e / 1
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t•Jcorodata
Shredding, Inc.
Sl,N DlfOO • DRANO£ COUNTYf\.A
-TH BAY/BAN FRA=SCO , SAN JOIIEIIIILICON VALLEY
Thu Mar 1, 2018 I next:Tue 3/20/18!
CITY OF CARLSBAD -RECORDS
MANAGEMENT DIVISION
5815 EL CAMINO REAL
CARLSBAD, CA 92008
Contacts
PAT DOWNIE (760)602-2738
MARIAEMERY/cell# (760)271-6841
Room De~crintion
Corodata Shredding, Inc.
12375 Kerran Street · Poway, CA 92064
(858) 748-1100 Fax (858) 726-6085
First Available
Directions
********CALL MARIA (20) PRIOR TO ARRIVAL.:
760.602.2482 office#****'**
*****GOOD WILL BINS ONL Y****PAD LOCKS****
*****•*******"' .. *****************Ir*********************************
*******"****H*****»•******•********H******°"**************** '--~~~~~~~~~~~~~--'
Special Instructions
11111111111111111 IIIII IIIII IIIII IIII IIII
Ticket# 468161
Routine Instructions
**'ENTER ON FARADAY OR
PRIESTLY***
CALL MARIA (20) PRIOR TO
ARRIVAL -MARIA NEEDS TO
MEET YOU AT
WAREHOUSE/BLDG.
Container Seniice Ttew Ob, Actual
90 Boxes for Destruction (standard) Boxes for Destruction (standard) 90.00 !
I Time In: II Time Out: 11 Driver: I IQuantity: +I-
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 Shreddin i Inc. the aforementioned materials for confidential destruction and hereby
acknowledges an 'ccepts the terms and conditions on the reverse side.
X
SD ST2 Stop 99 BC SD012455 Pagel
1,#L/
I
Account #(s)SD012455
Certificate #108056
Date Issued Thursday, March 01, 2018
Service Locations 5815 EL CAMINO REAL
Date Range of Service Mar-01-2018 thru Mar-01-2018
Work Ticket(s)468161
Quantity/Item 90 -90 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).
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.