HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Fire; 2023-06-1504-27-2023 5/2/2023
CORODATA 6/15/2023
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RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: 04/24/2023
REQUESTING DEPARTMENT: FIRE ADMINISTRATION REQUESTER: VANESSA MARTINEZ
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.
:14Z3;l;~ION MANArf 5: f:e 3 RECORDS MANAGEMENT DATE CITY ATTORNEY DATE
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BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
FD035 Controlled Drug Inventory Rec. Jan 2019-FR-050 3 years Dec 2019
II II Ambulance Medication Logs Jan 2019 -FR-050 3 years Dec 2019
II II EMS Surveys APR 2019-CW-285 2 years Dec 2020
*If more spaces are needed, click in the last bax 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.
(Cityof
Carlsbad Revised: 2021
Pag e /1
Account #(s)SD012455
Certificate #102455
Date Issued Monday, June 19, 2023
Service Locations 5815 EL CAMINO REAL
Date Range of Service Jun-15-2023 thru Jun-15-2023
Work Ticket(s)1153680
Quantity/Item 116 -116 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.
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