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Home My WebLink AboutDisposition Forms_10-17_01/27/2017_Utilities •'� '• • �• NO. ID-119 Revised : 1/22/14 PAGE 1 OF t j PAGES 1. AGENCY 2. DEPARTMENT Water Plant 3. BUREAU Village of Tequesta N/A I 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 cV imminent. manner checked below (specify only one): Only the Depart nt He! has the authority to sign off on Item 6. Signature Date Recycle s ZY 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 I Feet Authorization GS1 -SL 17 Correspondence - Chloride Analysis 3 FY's 2003 - 9/30/13 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) Signature � , Date I��I �� Signature Date �/'-I Print Name: Lori McWilliams, MMC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this form for your records Print Form 1 Revised : 1/22/14 PAGE 9�,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: 1 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 minent. manner checked below (specify only one): Only the Departfne Head has 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 94 Complaints: Citizens /Consumer /Employees 1 Annv. Yr. 2010 1 t e C l a 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. r� (Witness to the Records Disposition) Signature`1r1f Date �p 7'(� Signature (�; (y�, , )� Date Print Name: Lori McWilliams, MMC_ Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this form for your records Print Form •'� '• • �• NO. �OfI Revised : 1/22/14 PAGE S OFr7 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 imminent. manner checked below (specify only one): Oniy the Depart nt Head h;, a authority to sign off on Item 6. / Signature Date - Z' try Recycle Name &:?6A 14vo 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 (Admin.) - Monthly Water Usage 3 FY's 2010 - 9/30/13 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) Signature Date Signature Date Print Name: Lori McWilliams, MMC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this form for your records Print Form Revised : 1/22/14 PAGE `1 OF r7 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 or imminent. manner checked below (specify only one): my the Departure ias the authority to sign off on Item 6. Recycle Signature Q ^ Date 1 `1 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 340 Disbursement Records - Water Plant Meter Bills 5 FY 2007 - 9/30/11 .025 - 7 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 Date I '� �I (� Signature Date ) Z� / Print Name: Lori McWilliams, MMC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this form for your records Light gray shading indicates a field required to be cumpleted by department. Print Form Light blue requires a signature RECORDS DISPOSITION DOCUMENT N O . O Revised: 12/20/11 PAGE OF 11 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. SUBMITT D BY: I hereby certify that the records to be disposed of are 7. NOTICE OF INTENTION correctly r resented below, that any audit requirements for the records have bee ully justified, and that further retention is not required for any The scheduled records listed in Item 8 are to be disposed of in the litigatio imminent. manner checked below (specify only one): �r✓ Sign ture Date X Destruction F b. Microfilming and Destruction a.1 Shred F7 a.2 Recycle Samuel Heady, Deputy Director, Utilities F7 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 2006 .140 �( 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. y (Witness to the Records Disposition) Signature: /li.r Date: Si gnature: /� Date: W" Va Print Name: Lori McWilliams Print Name: Print Title: Village Clerk Print Title: NOTE: Upon disposition retain this form for your records •'� '• • �• NO. Revised : 1/22/14 PAGE 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 pendin r imminent. manner checked below (specify only one): Only the Depart nt Head has the authority to sign off on Item 6. Recycle Signature Date 6 Name Title Samuel Heady, Deputy Director Utilities S. 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 58 Operating Reports - Monthly - MOR's 10 Years 2006 1 ll 9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have been authorized. An nq deletions or modifications are indicated disposed of in the manner and on the date shown in column g. (Witness to the Records Disposition) Signature ICY I Date �t 1� Signature �d, , ) Date ��1r Print Name: Lori McWilliams, MMC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this form for your records Print For •'� '• • �• NO. 0 —t Revised : 1/22/14 PAGE I 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 o mminent. manner checked below (specify only one): Only the Departm n Head has 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 GS14 55 Monitor Well Data Reports: Monthly 10 Years 2003 -2006 1 i 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 �/� Date I/a w ? Signature Date a Print Name: Lori McWilliams, MMC Print Name Print Title: Village Clerk Print Title NOTE: Upon disposition retain this form for Your records Print Form