HomeMy WebLinkAboutDisposition Forms_09-17_01/02/2017_Utilities Revised : 1/22/14 PAGE 1 OF PAGES
1. AGENCY 2. DEPARTMENT Water Plant 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 -0440
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 r imminent. manner checked below (specify only one):
Only the Depart r , the authority to sign off on Item 6.
Recycle
Signature Date /
Name
Title Samuel Heady, Deputy Director Utilities
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
GS1 -SL 17 Correspondence - Boil Water Notifications 3 FY's 2009 - 9/30/13 1 )' all i
-
9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have been
authorized. An deletions or modifications are indicated disposed of in the manner and on the date shown in column g.
(Witness to the Records Disposition)
Signature f 1 1 n/ i Date ' I ��I /t Signature Date
Print Name: Lori McWilliams, MMC Print Name
Print Title: Village Clerk Print Title I �'(�
NOTE. Upon disposition retain this form for your records
Print Form
Revised : 1/22/14 PAGE `d- OF3 PAGES
1.AGENCY 2. DEPARTMENT 3. BUREAU
Village of Tequesta Water Plant 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 - 0440
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 imminent. manner checked below (specify only one):
Only the Depart n nt Head has the uthority to sign off on Item 6.
Recycle
Signature Date Z
Name
Title Samuel Heady, Deputy Director Utilities
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 25 Environmental Reports: Discharge Monitoring Rep. 7 Years 2009 2 jhAg1 in
rem
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.
j�' �I /Il (Witness to the Records Disposition)
Signature IVY �' ►W"` v Date I � Signature !1 : Date
Print Name: Lori McWilliams, MMC Print Name Lor W `� oS
Print Title: Village Clerk Print Title Lo
NOTE: Upon disposition retain this form for your records
Print Form
Revised : 1/22/14 PAGE I OF 3 PAGES
1. AGENCY 2. DEPARTMENT Water Plant 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 -0440
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 i imminent. manner checked below (specify only one):
Only the Departm Head has the authority to sign off on Item 6.
Recycle
Signature Date
Name
Title Samuel Heady, Deputy Director Utilities
& 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
GS1 -SL 94 Complaints: Citizens /Consumer /Employees 1 Annv. Yr. 2011 -2015 1 1 1aylt/1
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) n
Signature (�t w� ' Date Signature Date p(l('
Print Name: Lori McWilliams, MMC Print Name
Print Title: Village Clerk Print Title V , 1� - 0(4 (LL-
NOTE: Upon disposition retain this form for Your records
Print Form
