HomeMy WebLinkAboutDisposition Forms_54-18_11/14/2018_WP RECORDS DISPOSITION DOCUMENT NO.
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1. AGENCY NAME 2. AGENCY CONTACT(Name and Telephone
VILLAGE OF TEQUESTA Number)
Lori McWilliams, MMC
DEPARTMENT: Utilities - Pumping and Storage (561) 768-0443
3. NOTICE OF INTENTION: The scheduled records listed in Item 5 are to be disposed of in the manner checked
below (specify only one).
0 a. Shred O b. Imaging and Destruction c. Recycle
0 d. Removed from Server 0 e. Other
4. SUBMITTED BY:
I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the
records have been Ily justified, and that further retention is not required for any litigation pending or imminent.
'
Sign ture Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
6.
a. b. C. d. e. f. g.
Schedule Item Title Retention Inclusive Volume Disposition
No. No. Dates in Action and
Cubic Date
Feet Completed
After
Authorization
GS 14 82 Public Water Records: Bacteriological Analysis 5 Years 2012
TOTAL CUBIC FEET THIS PAGE: �
7. DISPOSAL AUTHORIZATION: Disposal for 8. DISPOSAL CERTIFICATE: The above and below listed records have
the above listed records is authorized. Any been disposed of in the manner and on the date shown in column g.
eletions or modifications are indicated. (Witness to the records disposition)
lliAAA
Signaturi Date
Custodian/Records Liaison Officer Date �{
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Name and Title
Form Updated: 1/3/17