HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Fire; 2021-12-3011-16-2021 11/24/21
Corodata 12/30/2021
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RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: 10/29/21
REQUESTING DEPARTMENT: FIRE ADMINISTRATION REQUESTER: CAROL CAMPAGNA
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.
RECORDS MANAGEMENT DATE CITY ATTORNEY DATE
RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE BOX NO. PERIOD (if applicable)
FD028 Ride-Along Waivers Jan 2014 -FR-035 2 years Dec 2018
FD028 Subpoena to Appear Jan 2013 -CC-250 2 years Dec 2018
FD028 Subpoenas for Records Jan 2015 -CC-250 2 years Dec 2018
FD028 Records Request Jan 2017 -CC-210 2 years June 2019
FD028 Internal Records Request Jan 2015 -CC-210 2 years Dec 2018
FD029 Medical Inventory Cards by Unit Jan 2015 -FR-050 3 years Oct 2018
FD029 Controlled Drug Sheets by STA July 2015-FR-050 3 years Oct 2018
FD029 Medical Inventory Cards by Unit Jan 2007 FR-050 3 years
FD030 EMS Surveys Jan 2015 -CW-285 2 years Sept 2019
*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
TAB BARCODES DELETED BY: ______________ _ DATE: _____ _
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
( City of
Carlsbad Revised: 2021
P ag e /1
Account #(s)SD012455
Certificate #101376
Date Issued Monday, January 03, 2022
Service Locations 5815 EL CAMINO REAL
Date Range of Service Dec-30-2021 thru Dec-30-2021
Work Ticket(s)912008
Quantity/Item
1 -CALL 20 MINUTES RPIOR TO
ARRIVAL - 760-271-6841
50 -50 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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