HomeMy WebLinkAboutDisposition Forms_22-13_02/22/2013 RECORDS DISPOSITION DOCUMENT NO. a — Ly
Revised: 12/20/11 PAGE i' OF PAGES
1. AGENCY 2. DEPARTMENT Utilities 'k)0L,L„ P bA_4 3. BUREAU
Village of Tequesta N/A
4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number)
345 Tequesta Drive Lori McWilliams, MMC
Tequesta, FL 33469 561- 768 -0443
6. SUBMITTED BY: I hereby certify that the records to be disposed of are 7. NOTICE OF INTENTION
correctly represented below, that any audit requirements for the records
have been fully justified and that further retention is not required for any The scheduled records listed in Item 8 are to be disposed of in the
litigati pe ding o i nt. manner checked below (specify only one):
Signa lre Date K::::]a. Destruction b. Microfilming and Destruction
0 a.1 Shred a.2 Recycle
Nathan Litteral, Water Plant Superintendent c. Imaging and Destruction
Name and Title d. Other
8. LIST OF RECORD SERIES
a. b. C. d. e. f. g.
Schedule Item Title Retention Inclusive Volume Disposition
Item No. Dates in Action and Date
Cubic Completed After
Feet Authorization
GS14 82 Bacteriological Analysis 5 years 2002-
3Jaa G
9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have been
authorized. Any deletions or modifications are indicated disposed of in the manner and on the date shown in column g.
z� I (Witness to the Records Disposition)
Signature: (�/ ✓� �1�3
Signature: Date:
3
4QZ ' 1 gV✓L Date: 0
g Ol.c �� W✓�
Print Name: Lori McWilliams Print Name:
Print Title: Village Clerk Print Title:
NOTE Upon disposition retain this form for your records