HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Public Works; 2016-03-14RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: 06/25/14
REQUESTING UTILITIES,
DEPARTMENT: WASTEWATER
DESTRUCTION APPROVALS:
_;'Yt7tY <hlJ i` the record.s listed below
comploteci, and oo pending r or -going rrii{ICt duo or in
DEPARTMErhIT HEAD
(0/J0 elkink
DATE R CORDS MANAGEMENT
REQUESTER:
MARCIA LONG
flf' schedu ;E ' retention period, requ, ._ d audits hot,e been
diving these records is kn_ ,,r.:G
DATE
5-
DATE
BOX NO.
RECORDS DESCRIPTION
DATED
RRS NO.
RRS
PERIOD
TAB BARCODE
(if applicable)
M
13067499
CMWD — General Information
(Safety meeting attendance Togs)
1992-
1994
1210-10
CU+2
PWUTILWW 2
General Information - Sewer System
Cleaning Records
July 2007
June 2008
1210-10
CU+2
/ PWUTILWW 3
General Information - Sewer System
Assessments
2007-
2008
1210-10
CU+2
*If more spaces are 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:
CERTIFICATE OF DESTRUCTION? YES AS6A/A/Ob
NO
TAB BARCODES DELETED BY:
DATE:
DATE: 3
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 4/21/2015
CARLSBAD p a q 11
Shred- it
3801 Ocean Ranch Blvd
Suite 101
Oceanside CA
92056
Phone: 760- 598- 5700
SERVICE RE( k ) 1, I) SUMMARY
CERTIFICATE OF DESTRUCTION
PLEASE KEEP THIS FO It YOUR RECORDS
IIISISNOTANIN�ci1C�?;
Customer: 00118ti'.2
CITY OF CARLSBAD- I;I.l u11)SMANAGEMENT
5815 El. CA !WINO REAL
CARLSBAD CA 92008- 8801
Order #: 8022396527
Order Date: 03.14.2016
Service Type: ON- SITE PURGE
Contact.
Time In: 10:17 AM
Y ? �bVvnr�
Material Collected
BANKERS/ARCHIVE BOX
Total:
Customer Signature; PAT
CSR Signature: DAVID SCHULTZ
157
157
Shred- it is committed to the secure destruction of its customers'
confidential information. This certification will affirm that
Shred- it destroys the customer confidential material, pursuant to
ow- customers request and instructions.
The following services are NAID certified:
Hard Drive Destruction
Mobile Destruction
Offsite Destruction
The following services are not NAID certified:
Non- Paper Destruction