HomeMy WebLinkAboutDisposition Forms_50-14_02/28/2014_Utilities RECORDS DISPOSITION DOCUMENT NO.
Revised: 12/20/11 PAGE 1 OF 1 PAGES
1. AGENCY 2. DEPARTMENT Utilities 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
litigation pending or i tr})nent. manner checked below (specify only one):
Signa ure Da (e Da. Destruction 0 b. Microfilming and Destruction
a.1 Shred 0 a.2 Recycle
Nathan Litteral, Water Plant Superintendent F c. Imaging and Destruction
Name and Title LL] 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 107 Treatment Plant Logs: Daily 4 years:
Plant Master Water Meter 1996-1999
Plant Domestic Water Meter 1996-1999
(daily meter readings)
9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have been
authorized. Apy deletions or modifications are indicated disposed of in the manner and on the date shown in column g.
(Witness to the,Records Disposition)
Signature: Date: Signatur i ,�,�y - Date:
Print Name: Lori McWilliams Print Name:
Print Title: Village Clerk Print Title:
NOTE: Upon disposition retain this form for your records