HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Parks & Recreation; 2017-08-08 (2)RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: 7-21-17
REQUESTING PARKS S� REC. REQUESTER:
DEPARTMENT: �HARDING� MARK OLSON
DESTRUCTION APPROVALS:
We certify that the records tisted 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 Yo exist.
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RECORDS MANAGEMENT:
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BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
� Class Registration, Medical Release
HRD032 forms (camps), Incident reports, 2005-2009 (130.55 CL +' Z
class rosters
Class Registration, Medical Release
HRD033 forms (camps), Incident reports, 2010-2012 �J30-5S �,� f 2
class rosters
Class Registration, Medical Release
HRD034 forms (camps), Incident reports, 2012-2013 1130-5s C�+Z
class rosters
HRD035 Instructor payment requests, 2001-2013
instructor agreements 1130-OS CG�f 2
HRD036 Instructor payment requests, 2012-2013
instructor agreements /l3U -05 CLt Z
*!f more spaces are needed, click in the last box in right hand corner of table and hit 'Yab". This will create more fietds in the table.
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY: ��G���
CERTIFICATE OF DESTRUCTION? � YES � NO
SMEADSOFT BARCODES DELETED BY:
DATE: B� %U�
DATE: �
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� CARLSBAD
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management
Program.
Revised: 7/21/2017
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
107135
Wednesday, August 09, 2017
5815 EL CAMINO REAL
Aug-08-2017 thru Aug-08-2017
416042
' Nothing in this certifcate shall be deemed fo modify the terms of ihe paRies' Service Agreemen((s) or Work Ticket(s).
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