HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Parks & Recreation; 2017-08-08RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: 4/1/2017
REQUESTING
DEPARTMENT: PARKS & RECREATION
DESTRUCTION APPROVALS:
REQUESTER:
We certify that the records listed below.hove 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.
RECORDS MANAGEMENT:
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
LCR-2013-1 FACILITIES USE PERMITS 2013 GC 34090 CL+2
*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: __ ti_tJ._h_V_�------
CERTIFICATE OF DESTRUCTION? N YES D NO
SMEADSOFT BARCODES DELETED BY:------------
DATE:
DATE: ------
«� CITY OJ
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management
Program. w CARLSBAD Revised: 4/2/2017
(RANCHO CARRILLO)
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 certificate shall be deemed to modify the terms of the parties' Service Agreement(s) or Work Ticket(s).
E-Jcorodata i/SSAE16 Type II Aodll Cornpleled HIPAfA