HomeMy WebLinkAboutDisposition Forms_37-15_05/22/2015_Utilities RECORDS DISPOSITION DOCUMENT No. �7 _ 15
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 represe d below, that any audit requirements for the records
have been fully j tified, an at further retention is not required for any The scheduled records listed in Item 8 are to be disposed of in the
litigation pe r' J manner checked below (specify only one): : Z �4
Signature Date K---Ia. Destruction E:] b. Microfilming and Destruction
a.1 Shred � a.2 Recycle
Samuel Heady, Deputy Director, Utilities 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 118 Water Analysis Records: ✓10 years 2003-2004 .320 1
Daily Water Analysis
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)
Signature ,1 / ` Date: �j t� Signature: l� Date: J
Print Name: Lori McWilliams Print Name:
Print Title: Village Clerk Print Title: �� >� - I -r , /1-1
NOTE: Upon disposition retain this form for your records