HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Housing & Homeless Services; 2024-01-25CORODATA 1/25/2024
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DocuSign Envelope ID: 658E7E76-BDF0-41 F2-975F-BE34E65D6AC8
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: JAN. 22, 2024 -----------'------
REQUESTING DEPARTMENT: HHS REQUESTER: LEAH SORENSEN
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.
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DEPT. HEAD/DIVISION MANAGER DATE RECORDS MANAGEMENT DATE DATE
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
S8/HCV: Program Applications-
510 Disqualified, Ineligible, Dropped 2018-2020 HS-045 3 years N/A
from Wait List
*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
Page /1
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.
Account #(s)SD012455
Certificate #103065
Date Issued Friday, January 26, 2024
Service Locations 5815 EL CAMINO REAL
Date Range of Service Jan-25-2024 thru Jan-25-2024
Work Ticket(s)1261435
Quantity/Item 73 -73 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).
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