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RECORDS DISPOSITION DOCUMENT
NO. S Ic , /lq
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).
0 a. Shred Q b. Imaging and Destruction c. Recycle
Qd. 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.
I� v7 yn
Signature Y Name and Ti le (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
GS 14
133
Utility Records: Management & Monitoring
10 yrs
2007-2008
1
QeC4C(fC(
-a?-a
(Monthly Well Analysis)
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)
Q&W � L �G .�i
Signatur Date
0�/1 oL iwec
Custodian/Records Liaison Officer Date
Named Title
Form Updated: 1/3/17