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HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Public Works; 2016-06-30Rrconos DEsrRUcnoN AurHoRlzATloN Fonvl Dare:11-03-2015 Reeurslne Pueltc Wonrs Drpenrurrur: CorurRacrAorulru Desrnucrroru AppRovns: lile cerlify thctt tne r*ccrd:; listed beiow hi:'te beert tc*ipleted, cncj :tc penri!ng ar cngaiilij liiigaiicn r-tr ret*;nsa f*! titE sc'n<tauied !'et€nf:!)i1 pericd, reqtiire* *uciits ltct't c€ett w:d4aEn:--+rlFtxt"ir€1:qj+:dli+daisja-.==:Fj ==e-F5E:Ba*?=<i:#ffi33:!3#tJ6!iE1#+j$.]1a:+ra=::i$!+ja*:!'+ir:E-l;atr=5€ c$iY\R? woy, ,A v This lorm documents the destruction of City records in occordance with the City of Carlsbad Records Manogement Progrom. Revised: 7/11/2076 BOX NO.RECORDS DESCRIPTION DATED RRS NO.RRS PERIOD TAB BARCODE (if applicable) General lnformation 1986- 1990 1000-05 CU +2 lnspection Requests 1986- 1988 1000-76 CL+2 lnspection Logs 1_986- 1988 1000-77 CL+ 2 *lf more spaces are needed, click in the last box in right hond corner of table ond hit'tob'. This will create more lields in the toble. To be filled out once records hove been destroyed. RECORD DESTRUCTION COMPLETED BY: CERTI FICATE OF DESTRUCTION? PRM Folder Records DELETED BY; DATE: DATE: CARLSBAD \r,=d-it SERVICE RECORD CERTIFICATE OF DESTRUCTION (THIS IS NOT AN INVOICE) Customer: 11889293 City Of Carlsbad-Records Management 5a15 EI Camino Real CARLSBAD CA 92008-8801 USA Page: 1 of 1 Order #: 8024860953 Order Date: OGI30/2016 This year your firm has $aved 42.8La trees through recycling shredded paper. QrYServiced, a7A: Bankers/Archive Box Equipment Maintenance: Service Type: Customer Signature: Customer Print Name: Received on Account: $ NA = Not Accessible E an"ou" / check No.: Additional Charges: Autmomatic TotalContainerlnventory:service: Extra Material: Container Type: Purge Service: Requested Type: NF = Not Found at Location QTY: 1.000 QTY: Actual QTY: QTY: NA NF Container Type Serlal No.Loeataon