HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Housing Services; 2007-06-04RECORDS DESTRUCTION REQUEST
City Clerk/Records Management
Page 1 of 1
Department Requesting Destruction: Housing and Redevelopment
x Approvals for Destruction
\ JU-.
Department Head
Lab.
Date
H-U-01
Records Manager Date
_ U -V?-
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:
DP$<ZA Do&cFt&^
No.
1
2
3
5
RECORDS DESCRIPTION
CDBG - Subrecipient Files: Catholic Charities;
Fraternity House; Lifeline Comm Serves; No Cty
Health Srvcs; CofC Admin; Heartland Human
Relations; Women's Res Ctr Boys & Girls Club,
Hospice of No Caost; Join Hands Save a Life;
Meals on Wheels; No Cty Council on Aging; CofC
Yes to Art; Comm Care for Adults; Comm Res Ctr;
Brother Benno Found; Casa De Amparo Shelter;
Stay and Play
Inactive Applicants: Lachance to Zuniga
CDBG Selection
CDBG Program files
DATED
1999
2003
1996-
1999
1999
BOX
No.
29
66
13067571
95
13067612
97
13067614
vfc
RRS No.
0565-
30
0550-
23
0565-
20
0565-
20
RRS
Period
TE + 5
TE+3
TE+5
TE+5
BARCODE APPROVED By
City Attorney
H=HOLD
RECORD DESTRUCTION COMPLETED BY :
CERTIFICATE OF DESTRUCTION? YeUZ] No
DATE
SMEADLINK BARCODES DELETED BY:n DATE:
This form documents fne 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.
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 Date / Time of Destruction:iJ.
Billing Address Service Address
. c/
Contact:Phone Number: (
Type
Quantity
Service
Rate
Total
File Boxes
{<&>%iJ-&% "^
aO
n^ls
Bankers
Boxes
Shred Force
Executive
100
ShredForce
250
Qther^
yfSeJ^Z^fcX
I
0O
/£* - —
&<**
Other Other
•
SHREDFO^CE ID#:.
Balance Due: $.
Amount Paid: $.
/ 00-T'SHREDFOffCE Signature:
Please Invoice Client
Check Number:
Credit Card
' * 1 ~ J £^'lf'™5.' ~~3.")"^^r?**"?^ "l „""' " •"»:«"'- ~T
~4 ~*'" " "~~ ' "' ~^ "^^ ^ ^^t-^ *>*
, "''•"">•-*' •!- O% . "V- -^4^ ^ ,', ~ i
-
~~* ~ ff ' " I /fn>* -
*""*"" * "~ i ' ~<? " $*S™* 4^ * ' *"~' !i£2«skSg3^£^i?'vf*f<
Authorized Representative:
Comments:
TB: Hours:
Authorized Signature^.
Other:
SHREDEORCE • PO Box 891 • San Marcos, CA 92079 • (800) 444-6209
09/05