HomeMy WebLinkAboutDisposition Forms_12-17_03/21/2017_Utilities /a —�
RECORDS DISPOSITION DOCUMENT N o.
PAGE 1 OF l PAGES
1. AGENCY NAME 2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA Number)
Lori McWilliams, MMC
DEPARTMENT: Water Treatment Plant - Utilities (561) 768 -0443
3. NOTICE OF INTENTION: The scheduled records listed in Item 5 are to be disposed of in the manner checked
below (specify only one).
0 a. Shred O b. Imaging and Destruction O c. Recycle
O d. Removed from Server 0e. Other
4. SUBMITTED BY:
I here y certify that the records to be disposed of are correctly represented below, that any audit requirements for the
recorfI have been fully justified, and that further retention is not required for any litigation pending or imminent.
<�� 0 fVul ,01267-J F �7 - ) �
� rJ S - 2, �2 /I �,
Si ature Na a and Title (Senior Staff only) ate
5. LIST OF RECORD SERIES
6.
a. b. C. d. e. f. g,
Schedule Item Title Retention Inclusive Volume Disposition
No. No. Dates in Action and
Cubic Date
Feet Completed
Afte r
Authorization
GS14 83 Public Water Records 10 Yrs. 2000-2006 1
Chemical Analysis:
THM & HAA5
TOTAL CUBIC FEET THIS PAGE: 1
7. DISPOSAL AUTHORIZATION: Disposal for 8. DISPOSAL CERTIFICATE: The above and below listed records have
the above listed records is authorized. Any been disposed of in the manner and on the date shown in column g.
deletions or modifications are indicated. Hess to the records disposition)
lC� a�/ /�
Signature Date
Custodian /Records Liaison Officer Date n l��
(j /Vl
Name and Title
Form Updated: 1/3/17