HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Transportation Engineering; 2019-07-11RECO~DS DESTRUCTION AUTHORIZATION, FORM
DATE: 5/13/19
REQUESTING DEPARTMENT: PW TRAFFIC ENG REQUESTER: LEAH SORENSEN
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.
CITY ATTORNEY: DATE
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
Various
N/A Signal Service Requests 1988-1040-07 CL+ 5 N/A
1995
*If more spaces are needed, click in the last box in right hand corner of table and hit "tab". This will create mare fields in the table.
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY: . r!trYCJ d!/v
CERTIFICATE OF DESTRUCTION? ~ YES O NO
DATE:
SMEADSOFT BARCODES DELETED BY: DATE: -
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
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Carlsbad Revised: 5/13/2019
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
SD012455
110465
Tuesday, July 16, 2019
5815 EL CAMINO REAL
Jul-11-2019 thru Jul-11-2019
601563
41 -41 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).
tJcorodata itSSAE16
Type II Audit Completed HIPAA.