HomeMy WebLinkAboutDisposition Forms_15-15_01/22/2015_Utilities RECORDS DISPOSITION DOCUMENT No. 15 _ j
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 imminent. manner checked below (specify only one):
J f
Signature Date K__1a. Destruction b. Microfilming and Destruction
a.1 Shred Lo Recycle
Michelle Terriault Adm. Assist. 0 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 109 Treatment Plant Reports: Water 4 years 2002-2007 ,� 6
(Daily) — Well Field #1 High Service
Motor Clock Hour Readings
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.
(Witness to the Records Disposition)
C I
Signature: M `� ✓� Date: Signature: k /� >/ Date:
Print Name: Lori McWilliams Print Name:
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, �► { 1 �C tt�
Print Title: Village Clerk Print Title: u e&
NOTE Upon disposition retain this form for your records