HomeMy WebLinkAboutDispositions Forms_72-19_1/17/2020_Utilities NO. 7d - a
RECORDS DISPOSITION DOCUMENT
PAGE 1 OF 1 PAGES
1. AGENCY NAME 2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA Number)
Lori McWilliams, MMC
DEPARTMENT: Utilities- Productions (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 0 b. Imaging and Destruction c. Recycle
Qd. Removed from Server Q 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 ha v been fullv iustified, and that further retention is not required for any litigation pending or imminent.
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4
4him
Sig ature Name and Title (Senior 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 yrs 2005-2009 1
CAJ
Chlorine Field Residuals(Rolling Hills Readings)
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.
d letions or modifications are indicated. (Witness to the records disp sition)
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Signature Date
Custodian/Records Liaison Officbr Date
Name and Title
Form Updated: 1/3/17