HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Housing Services; 2019-09-05RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: Aug. 27, 2019
REQUESTING DEPARTMENT: CED/HNS REQUESTER: Marie Jones-Kirk -----------
DESTRUCTION APPROVALS:
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.
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CITY ATTORNEY: DATE
RRS TAB BARCODE
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BOX NO. RECORDS DESCRIPTION DATED RRS NO. PERIOD (if applicable) r, 1 pack Volunteer applications 8/27/19 860-8D CL+3 ( '51..t,, ~ttttciud) (Volunteer Programs)
*If more spaces ore 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: DATE: t:/ I s/.2.-t:J19
CERTIFICATE OF DESTRUCTION? ~ikli~-Y-ES---□--N-0 __ _
SMEADSOFT BARCODES DELETED BY: ___________ _ DATE: _____ _
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
(Cityof
Carlsbad Revised: 8/27/2019
last Name
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Endrizzi ~fA~rr··
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Ragland
Rodriguez
Sauber
Sherzai
Tague
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Records Destruction Authorizaton: August 27, 2019
First Name
!iArthur .
Verona
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Rich
Jesse
Jenna
Jamal
Thaddeus
![Emily
VO Date
. l! _ 19/l!i/2014
10/20/2015
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8/28/2009
3/12/2014
7/17/2014
7/16/2014
5/19/2015
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Archive Date Purge Date
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7/26/2016 7/26/2019
. -zti1~0~¥; .... ·.1 7/1/2019
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6/14/2016 6/14/2019
7/1/2014 7/1/2017
5/27/2016 5/27/2019
12/1/2014 12/1/2017
2/5/2016 2/5/2019 .. 3/22.Jipi,f C . l 3/2/2019
Page 1
CERTIFICATE OF DESTRUCTION & RECYCLING
This certificate is presented to: CITY OF CARLSBAD -RECORDS MANAGEMENT DIVISION
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
80012455
110640
Monday, September 09, 2019
5815 EL CAMINO REAL
Sep-05-2019 thru Sep-05-2019
618871
60 -60 Boxes for Destruction (standard)
• Nothing in this certificate shall be deemed to modify the terms of the parties' Service Agreement(s) or Work Ticket(s).
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Type II Audit Completed HIPAl\