HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Fire Prevention; 2023-10-25RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: 1/17/2024
REQUESTING DEPARTMENT: FIRE PREVENTION REQUESTER: AMBER RESSMER
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. f!:!!£,1!, I (z:!/7¥ RECORDS MANAGEMENT DATE CllY ATTORNEY DATE
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
VIATRON BACK-FILE SCANNING OF FIRE PREVENTION DOCUMENTS
51 BOXES (FIRE PREVENTION PLANS/PERMITS SEE ATTACHED) PJ8174 FP PLANS -34 BOXES; PJ8153 FP PERMITS -17 BOXES
TAB BARCODE
(if applicable)
**ORIGINAL SCANNED
DOCUMENTS UPLOADED
INTO LASERFICHE AND HARD
COPIES DESTROYED PER
RECORDS MANAGEMENT
PROCEDURES
*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: PAPER RECYCLING SHREDDING SPECIALISTS
CERTIFICATE OF DESTRUCTION? (]] YES O NO
TAB BARCODES DELETED BY: _____________ _
DATE: 10/25/2023
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
01-25-2024 1/31/24
Certificate ofDestruction
Paper Recycling .Shredding Specialisl6, Inc.
1391 E. Mission Blvd. Pomona. CA. 91766
Receipt of this Certificate guarantees that all records documents received from:
CITY OF CARLSBAD -FIRE MAPS
located at:
18233 S. Hoover St.
Gardena, CA 90248
by Paper Recycling .Shredding Specialists, Inc. was shredded at the address noted on this certificate.
In addition. the Customer aclatuwledges thaJ they were given the opporhmily to witnu.s
the destruction of their paper, by the on-site shredding process.
Authorized Signalure
Castomer Acknowledgement ________ Date ____ _
Customer Printed Name
Arrival time:. _____ Departure time:. ___ _
Date
Item description of products shredded
_ ____ Security Containers
34
Boxes Project NO.# PJ8174 (1-34)
______ Executive Sealrity C.Onsolea
______ Weight (wlren opplkobl,J
Paper .&:t:ydtng SlumJ1ng Sp«iallsll. Inc. ,. NAID«nljlalfer&ad, ,m.sllc and ojf..rfle damtt:rlrm ofJIIIIIUand ptnHd tttllUnlJJ£ Wcate lltll HAID «nffled/arattJOlhuf#of..iia latluall/fl.
Certificate of Destruction
Paper R ecycling _shredding Specialists, Inc.
1391 E. Mission Blvd. Pomona, CA 91766
Receipt of this Certificate guarantees that all records documents received.from:
CITY OF CARLSBAD -FIRE PERMITS
located at:
18233 S. Hoover St
Gardena, CA 90248
by Paper Recycling .Shredding Specialists, Inc. was shredded at the address noted on this certificate.
In addition, the Customer acknowledges that they were given the opportunity to witness
the destruction of their paper, by the on-site shredding process.
A'llthorized Signature
Customer Acknowledgement ________ Date ____ _
Customer Printed Name
Arrival time: ________ Departure time:. ____ _
Date
Item description of products shredded
______ Sec:urey Containers
17 -----Boxes Project NO.# PJ81 53 (1 -17)
______ Executive Security Consoles
_ _____ Weight (wltm applicable)
Pape, R«ydlng SltrafdlnK $pedal,_ Inc. ls NA/Dc:utljlolfor 6olh 01Nll.e and~ ddr.4iaa of paper and pt1nled-auz&. We Ol'e nat NAID aztiflet/fa,-anyolhu typuf,-J/adOllrralon.