HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Fire; 2021-10-07 (4)RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: OCTOBER 1, 2021 ----------"--------
REQUESTING
DEPARTMENT: FIRE 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.
DATE RECORDS MANAGEMENT: DATE CITY ATTORNEY: DATE
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
1 box
3 of 3
Volunteer applications 2017 HR-170 SEP+3(Volunteer Program)
*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: __________ _ DATE: -------CERTIFICATE OF DESTRUCTION? 0 YES 0 NO
SMEADSOFT BARCODES DELETED BY: ___________ _ DATE: -------
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
("'rnyof Carlsbad Revised: 10/1/2021
10-05-2021 10/6/2021
Corodata 10/07/2021
x
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ENT HEAD:
11
Account #(s)SD012455
Certificate #101273
Date Issued Friday, October 08, 2021
Service Locations 5815 EL CAMINO REAL
Date Range of Service Oct-07-2021 thru Oct-07-2021
Work Ticket(s)873043
Quantity/Item
1 -CALL 20 MINUTES RPIOR TO
ARRIVAL - 760-271-6841
67 -67 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).
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.
E•Jcoro data SSAE16
Type II Audit Completed • HIPA'A
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