HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Library & Cultural Arts; 2006-11-27 (2)City Clerk/Records Management
Page 1 of 2
RECORDS DESTRUCTION REQUEST
Department Requesting Destruction: Volunteer Services - Cole Library
Approvals for Destruction
Department V[ead Date
Records Manager Date
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: Janice Jeray-Mohney
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
RECORDS DESCRIPTION
Volunteer Application (application missing)
Volunteer Application (folder missing)
Volunteer Application (folder missing
Volunteer Application (folder missing)
Volunteer Application (folder missing)
Volunteer Application (folder missing)
Volunteer Application
Volunteer Application
Volunteer Application
Volunteer Application
Volunteer Application (folder missing)
Volunteer Application (folder missing)
Volunteer Application (folder missi««i|
^/
Volunteer Application (folder missing)
DATED
2002
2001
2002
2002
2002
2001
2001
2001
2001
2001
2002
2002
2002
2001
BOX
No.
£0<=t»-
-u>V:T
T
RRS No.
0860-80
0860-80
0860-80
0860-80
0860-80
0860-80
0860-80
0860-80
0860-80
0860-80
0860-80
0860-80
0860-80
0860-80
RRS
Period
CL+3
CL+3
CL+3
CL+3
CL+3
CL+3
CL+3
CL+3
CL+3
CL+3
CL+3
CL+3
CL+3
CL+3
BARCODE
LC000025
LC000027
LC000035
LC000041
LC000046
LC000071
LC000072
LC000069
LC000073
LC000074
LC000090
LC000093
LC000095
LC000105
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 of2
Person(s) Completing Form: Janice Jeray-Mohney
No.
15
16
17
18
19
RECORDS DESCRIPTION
Volunteer Application (folder missing)
Volunteer Application (folder missing)
Volunteer Application (folder missing)
Volunteer Application (folder missipA)
Volunteer Application (folder missing )
DATED
2001
2002
2002
2001
2002
BOX
No.
£0=* (=,-
T>xS~
T
RRS No.
0860-80
0860-80
0860-80
0860-80
0860-80
RRS
Period
CL+3
CL+3
CL+3
CL+3
CL+3
BARCODE
LC000114
LC000119
LC000122
LC000141
LC000145
APPROVED By
City Attorney
H=HOLD
RECORD DESTRUCTION COMPLETED BY ;
CERTIFICATE OF DESTRUCTION? Yes No D
DATE
SMEADLINK BARCODES DELETED BY;DATE:
This form documents the destruction of City records in accordance with the California Public Records Act
Revised 08/25/2005
SECURE DOCUMENT DESTRUCTION
Client materials are to be destroyed off-site. Client will
receive official Certificate of Destruction upon completion
of service.
ti^This CERTIFICATE OF DESTRUCTION certifies the complete
destruction of all material contained as described below on the
date and at the time recorded herewith.
Date / Time of Pick up:__AM PM
Billing Address
Date / Time of Destruction/A 27-0JL
Service Address
AM
Contact:Phone Number: C7 40 )
Type
Quantity
Service
Rate
Total
File Boxes
(Lie
^&**
Bankers
Boxes
ShredForce
Executive
100
ShredForce
250
Other
^^Hfe^
7r^
//^
^*y
Other Other
SHREDFOffCEID*:.
Balance Due: $.
SHREDFOffCE Signature:
Please Invoice Client
Amount Paid:$
Authorized Representative:
Comments:
IB:Hours:Other:
SHREDFORCE D PO Box 891 D San Marcos, CA 92079 D (800) 444-6209
09/05