HomeMy WebLinkAboutDispositions Forms_69-19_1/17/2020_Utilities RECORDS DISPOSITION DOCUMENT NO.
PAGE 1 OF 1 PAGES
1. AGENCY NAME 2. AGENCY CONTACT(Name and Telephone
VILLAGE OF TEQUESTA Number)
Lori McWilliams, MMC
DEPARTMENT: Utilities- Production (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 Q b. Imaging and Destruction Q c. Recycle
Qd. Removed from Server Qe. Other
4. SUBMITTED BY:
I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the
record ha been fully justified, and that fu her retention is not required for any litigation pending or imminent.
Signature Name and Title (96nior Staff only) Date
6. 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 83 Public Water System Records: Chemical Analysis 10 years 2007 - 2009 1
TTHM - HAA5 to - p
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)
hk ( aa
Molt.- 7 Signature Date
Custodian/Records Liaison Offic r Date ,I r
M,U 111 f-ft
Name and Title
Form Updated: 1/3/17