HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Fire; 2009-01-06City Clerk/Records Management
Pagel of 3
RECORDS DESTRUCTION REQUEST
Department Requesting Destruction: Fire Administration
Appro^aTs^for Destruction
\z-
Date
.ecords Manager Date
t 7
Attorney Date
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.
Person(s) Completing Form:
Shannon Snell
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
RECORDS DESCRIPTION
EMS Documents 2000/2001
EMS Documents 2001
EMS Documents 2000-2001
EMS Documents 1999
EMS Documents 2001
EMS Documents 1997
EMS Documents 1999-2000
EMS Documents 2001
EMS Documents 1999-1999
EMS Documents 1999
EMS Documents 2000
EMS Documents 1997
EMS Documents 1998
DATED
3-4/2001
1-2/2000
4-6/2001
2/2001
1-5/2000
1-2/2001
6 - 7/'99
10-11/'99
8-10/2001
3-6/1997
9-11/1997
5-7/2000
8/1999
6-8/2001
1-2/1999
1-2/1998
2-4/'99
11-12/'99
10-11/'00
8/'00
11-12/'00
1-4/1997
6-11/1997
8-11/1998
BOX
No.
1
RRS No.
0610-65
0610-65
0610-65
0610-65
0610-65
0610-65
0610-65
0610-65
0610-65
0610-65
0610-65
0610-65
0610-65
RRS
Period
7
years
7
years
7
years
7
years
7
years
7
years
7
years
7
years
7
years
7
years
7
years
7
years
7
years
BARCODE APPROVED By
City Attorney
H=HOLD
This form documents the destruction of City records in accordance with the California Public Records Act
Revised 08/25/2005
City Clerk/Records Management
Page 2 of 3
Person(s) Completing Form:
Shannon Snell
No.
14
15
16
17
18
19
RECORDS DESCRIPTION
EMS Documents 1997
EMS Documents 1998
Ems Documents 1997/2000
EMS Documents 1998
EMS Documents 1998
EMS Documents 2000-2001
DATED
5-12/1997
2-5/1998
1 0-127-00
7-10/'97
5-8/1998
9-10/1998
4-6/1998
1/2001
4/2000
7-9/2000
BOX
No.
RRS No.
0610-65
0610-65
0610-65
0610-65
0610-65
0610-65
RRS
Period
7
years
7
years
7
years
7
years
7
years
7
years
BARCODE APPROVED By
City Attorney
H=HOLD
Records Management Use Only
RECORD DESTRUCTION COMPLETED BY ;DATE
This form documents the destruction of City records in accordance with the California Public Records Act
Revised 08/25/2005
City Clerk/Records Management
Page 3 of3
CERTIFICATE OF DESTRUCTION? Yes [3 No D
SMEADLINK BARCODES DELETED BY: ^VAv> orVL.DATE:
r/j/s form documents the destruction of City records in accordance with the California Public Records Act
Revised 08/25/2005
CERTIFICATE OF DESTRUCTION
DOCUMENT MANAGEMENT
SERVICE PERFORMED
175 Gallon Wheeled Container
95 Gallon Wheeled Container
64 Gallon Wheeled Container
32 Gallon Wheeled Container
16 Gallon Wheeled Container
40" Executive Console
27" Executive Console
24" Executive Console
Deskside Container
Secured Cart
Unsecured Cart
SVC ' D ADD ' L
SERVICE TICKET #:
DATE:
CUSTOMER #!
DEPARTMENT:
SERVICE PERFORMED
Outside Steel Container
Gaylord
Pallet
Recycling Container
Bag
Pounds
Minutes
Lock(s) Present/Operable:
Clasp(s) Present/Operable:
Service NAID Certified:
OOG3J3 - 46658
SVC ' D ADD ' L
Yes No
Yes No
Yes No
COMMENTS:
This certificate is to certify that Cintas Document Management will shred confidential data per customer's instructions and according 10 HIPAA & GLBA
regulations for the above-mentioned company. Non-paper destruction services are not NAID certified.
CUSTOMER SIGNATURE:
SERVICE REP SIGNATURE:
DATE: /
DATE:
9455 WAPLES ST • STE. 110 • SAN DIEGO, CA 921213924 • Phone: (858)678-0460 • Fax: (858)678-0894