HomeMy WebLinkAboutDispositions Forms_45-19_10/7/2019_UtilitiesRECORDS DISPOSITION DOCUMENT
NO. _
PAGE 1 OF 4 PAGES
1. AGENCY NAME
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
DEPARTMENT: Utilities - Production
Lori McWilliams, MMC
(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).
�a. Shred Ob. Imaging and Destruction �c. Recycle
d. Removed from Server �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 fully ustified, and that further retention is not required for any litigation pending or imminent.
j C ,1 �i�
Sig ature Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
6.
a.
Schedule
No.
b.
Item
No.
C.
Title
d.
Retention
e.
Inclusive
Dates
f.
Volume
in
Cubic
9-
Disposition
Action and
Date
Feet
Completed
After
Authorization
GS1-SL
340
Disbursement Records - Detail
5 FY
5/5/09-9/24/13
1
eclu c/>'
vendor invoices
TOTAL CUBIC FEET THIS PAGE:
1
7. DISPOSAL AUTHORIZATION: Disposal for
the above listed records is authorized. Any
deletions or modifications are indicated.
8. DISPOSAL CERTIFICATE: The above and below listed records have
been disposed of in the manner and on the date shown in column g.
(Witness to the records disposition)
/ I c,-e I �,�_ \ 1 I i Z) ( gr
Signature Date
l
Custodian/Records Liaison Officer Date
Name and Title
Form Updated: 1/3/17
RECORDS DISPOSITION DOCUMENT
NO. qS` /PAGE
a of y PAGES
1. AGENCY NAME
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
Lori McWilliams, MMC
DEPARTMENT: Utilities - Water Pumping & Storage
(561) 768-0443
Li
3. NOTICE OF INTENTION: The scheduled records listed in Item 5 are to be disposed of in the manner checked
below (specify only one).
Oa. Shred 0b. Imaging and Destruction Oc. Recycle
0 d. Removed from Server Oe. 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 fully justified, and that further retention is not required for any litigation pending or imminent.
Sig ature v Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
6.
a.
Schedule
No.
b.
Item
No.
C.
Title
d.
Retention
e.
Inclusive
Dates
f.
Volume
in
Cubic
g.
Disposition
Action and
Date
Feet
Completed
After
Authorization
GS14
129
Public Water System Records:
3 Yrs.
2000-2014
1
R&O Jej
L
Consumer Confidence Reports
zoo
TOTAL CUBIC FEET THIS PAGE:
1
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.
deletions or modifications are indicated.
(Witness to the records disposition)
►roa ���� f 421711 q
l a�l
Custodian/Records Liaison Officer Date—
Signature Date
!'LL
Name and Title
Form Updated: 1/3/17
NO. LIS- /q
RECORDS DISPOSITION DOCUMENT
PAGE OF L1 PAGES
1. AGENCY NAME
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
Lori McWilliams, MMC
DEPARTMENT: Utilities
(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).
Qa. Shred 0b. Imaging and Destruction Qc. Recycle
Od. Removed from Server 0e. 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 fully justified, and that further retention is not required for any litigation pending or imminent.
4'E�- W.1' OL± S" 1 x
Sign ture Name and Title (Senior Staff only) ate
5. LIST OF RECORD SERIES
6.
a.
Schedule
b.
Item
C.
Title
d.
Retention
e.
Inclusive
f.
Volume
g.
Disposition
No.
No.
Dates
in
Cubic
Action and
Date
Feet
Completed
After
Authorization
GS14
133
Utility Records: Management and Monitoring
10 years
2005 - 2008
1
�ec
Disinfectant Reporting
q zlZell
TOTAL CUBIC FEET THIS PAGE:
1
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.
deletions or modifications are indicated.
(Witness to the records disposition)
q`) q t 9
Signature Date
-�— / n
c:l1,P�l eI('�i� i arl�'� /-tf[ Vl/.i Ili sfrct�'iu� /'ts-c +-,
Custodian/Records Liaison Officer Date
Name and Title
Form Updated: 1/3/17
RECORDS DISPOSITION DOCUMENT
NO. � F-/ J
PAGE j� OF 4- PAGES
1. AGENCY NAME
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
Lori McWilliams, MMC
DEPARTMENT:
(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).
0a. Shred Ob. Imaging and Destruction Qc. Recycle
0d. Removed from Server oe. 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 fully justified, and that further retention is not required for any litigation pending or imminent.
Y�67AW ( C- eL."'� � nL i 8
Sig ature Name and Title (Senior Staff only) Date
5. LIST OF RECORD SERIES
6.
a.
Schedule
b.
Item
C.
Title
d.
Retention
e.
Inclusive
f.
Volume
g.
Disposition
No.
No.
Dates
in
Cubic
Action and
Date
Feet
Completed
After
Authorization
GS14
135
Utility Records: Reporting Compliance
5 years
2013
1
Rey Ae�
Bacteriological Reports
)r1J2o(
TOTAL CUBIC FEET THIS PAGE:
1
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.
deletionsor modifications are indicated.
the records disposition)
�"M
6)3,30
1 I(Wiitnnes�sdtto�
114 Q�
Signature Date �—
M 1 �:�ic��l � �irn`� `>rl-�, f�rir2ci � � �����i � �5�•
Custodian/Records Liaison Officer Date
Name and Title
Form Updated: 1/3/17