HomeMy WebLinkAboutPolice - 02/06/2012 4 FOR USE BY THE CITY OF BREMERTON
Public Records Destruction Log
Request for In -House Destruction
To comply with RCW 40 14 060, WAC 434 -610 -070, and WAC 434 -640 -010, 020, and 030, it is vital
that public records be destroyed according to their approved retention periods Therefore, the
purpose of this form is to verify compliance and reasonable accou provin s pecific public
records h ave clearl met a reten pen ods for disp osal Please fill out this fo rm for p bu lic
re cords disposal in - house with an a retention period g reater than 1 year , THE RETENTION
PERIOD FOR THIS FORM IS PERMANENT AS STATED IN THE LOCAL GOVERNMENT
GENERAL RECORDS RETENTION SCHEDULE (GSS- 09 -06).
DATE I DIVISION/SECTION RECORDS OFFICER
February 06, 2012 1 Police Lt. Luis D. Olan
BOX NUMBERS RECORDS SERIES DAN INCLUSIVE DATES RETENTION PERIOD DATE DESTROYED
Secondary L07 -01 -03 08 -09 -11 02 -06 -12
copies no Appendix A 02 -06 -12
retention value
All public records listed have been identified to be at the end of their designated retention period,
have no need to be retained for audits, lawsuits, public records request or program requirements and
shall be destroyed
The Individual who is responsible for destroying the listed records must sign below prior to the Records Officer signature
approval
Employee Signature �/ Date & l Z--
Employee Name (Please print clearly) Lt Luis D Olan
The Records Officer must sign the approval of this request prior tojpe destruction of the listed records
2 Records Officer Signature �� - ate — / �—
Peninsula CERTIFICATE OF DESTRUCTION `i
SHRED Acct# �`��((_l { 4 tTttL
Secure Document Shredding Customer Name
Pick -up Address
A Program of Peninsula Services
P 0 Box 5030, Bremerton, WA 98312
Billing Address
Date of Pick -up I f r 1 , , !
By signing the bottom of this form we hereby certify the documents received and ALLSHRED D Green Acres [ _ k PBCIt - IC
listed below will be completely destroyed by shredding within 48 hours
Quantity Container Type Record Description (Optional) Unit Price / Amount
This is also your invoice Please pay from ® This Invoice Q Statement Total Due f
i
Prmt- t Print f /
Sign , / Sign
Customer's Authorized Agent l ALL SHRJ� Authorized Agent
All Shred
Peninsula Services INVOICE
P O Box 5030 Invoice Date Feb 29, 2012
Bremerton, WA 98312 -0464
Voice ( 360 ) 373 -1446 Invoice Number 58196
Fax (360) 415 -0332
Bremerton City Police
1025 Burwell St
Bremerton, WA 98337
— Bremerton CityPolice Net 30 Days
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CD # 58196 (2/6/12) 7200
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THANK YOU FOR YOUR BUSINESS