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Home My WebLink AboutHR - 02/26/2014 Peninsula CERTIFICATE OF DESTRUCTION 1, ---,i _�� Acct #_ Oufr 'P s Customer Name Secure Document Shredding Pick -up Address A Program of Peninsula Services P O Box 5030, WA 98312 Billing Address Date of Pick-up ;-r 2l 2_61t1 By signing the bottom of this form we hereby certify the dficuments received and ALLSHRED ® Green Acres E= Pacific listed below will be completely destroyed by shredding within 48 hours r Quantity Container Typp Record Description (Optional) Unit Price Amount o. "o � l f 1 r. s This is also your invoice Please pay from ® This Invoice ® Statement Total Due ` - (.1 t 1 Print ' ' i ;" -r?ft l is Print 7- fr^ - Sign E f r ,� �,, f v'; %� / �, 1 ,i'Z% Sign Customers Authorized Agent ALL SHRED s Authorized Agent • Local Government Public Records Destruction Log The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum retention periods before being destroyed pursuant to RCW 40 14 070. WAC 434 - 610 -070. and WAC 434 - 640 -010. -020, and -030 Please fill out this form when destroying all public records whose minimum retention is other than "Retain until no longer needed for agency business then destroy" (such as records covered in the "Records with Minimal Retention Value" section of the Local Government Common Records Retention Schedule (CORE) Legal Disposition Authorit (taken from Records Retention Schedule) Agency Records Description Minimum Method(s) of Records Series Records Series Records Retention Minimum Destruction Title DAN Schedule Minimum Retention Period (Box/item numbers, Dates covered Retention volume, etc) (See examples, Met below*) Personnel GS50 -04B 6 Years Box 2002 -2005 1/2012 Outside -06 Shredding Co Recruitment/Hinng GS50-0413-01 3 YEARS BOX 6/201 0 - 9/2010 10/2013 Outside Shredding Co Benefits GS50 -04B 3 YEARS BOX 07/15/10 - 09130/10 10/2013 OUTSIDE -09 SHREDDING CO *Examples of methods of destruction electronic deletion, in -house OR outside contractor shredding, secure recycling, other (describe) Statement, The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably anticipated litigation or public records requests, are not needed for audit or other agency business, and shall be destroyed. The Individual responsible inventorying t e listed records must sign below prior to the Records Manager's approval: Employee Signature 6L Charlotte Belmore Human Resources rented Name Division The Records Manager must sign pprovai o is equest prior to the destruction of the listed records: f Records Manager Signature Printed Name Shannon Corin Date Approved X -19 ` Y The person /people responsible for the destruction of records must sign upon destruction of the listed records: Employee Signature Printed Name Date Records Destroyed Vendor Business Name (if used) Phone Vendor Signature Printed Name Date Records Destroyed The retention and disposition action for this Public Records Destruction Log is "Retain for the life of the agency" pursuant to CORE series GS50 -09 -06 This sample form was prepared by Washington State Archives as a courtesy to local government agencies in January, 2014 It may be modified to meet individual agency needs • Local Government Public Records Destruction Log The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum retention periods before being destroyed pursuant to RCW 4014 070, WAC 434 - 610 -070, and WAC 434 - 640 -010, -020, and -030 Please fill out this form when destroying all public records whose minimum retention is other than "Retain until no longer needed for agency business then destroy" (such as records covered in the "Records with Minimal Retention Value" section of the Local Government Common Records Retention Schedule (CORE) Legal Disposition Authority (taken from Records Retention Schedule) Agency Records Description Date Method(s) of Records Series Records series Records Retention Minimum Retention Period (Box/item numbers, Dates Covered Minimum Destruction Title DAN Schedule volume, etc) Retention (See examples, Met below*) Personnel GS50 -04B 3 YEARS BOX 2006-2008 2012 OUTSIDE -01 '' SHREDDING Personnel GS50 046 3 YEARS BOX I /2009 — V /2009 9 -2012 OUTSIDE SHREDDING Personnel GS50 -04B 3 YEARS BOX 2008 - 4/2009 4/5/2012 OUTSIDE -01 SHREDDING *Examples of methods of destruction electronic deletion, in -house OR outside contractor shredding, secure recycling, other (describe) Statement. The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably anticipated litigation or public records requests, are not needed for audit or other agency business, and shall be destroyed. The individual responsible fo nventorying the li ed records must sign below -p to the Reco Manager's approval Employee Signature rented Name ( �LW�® & PMX� Division The Records Manager must s' a approval o requejt prior to the destruction the listed rec ords: �J Records Manager Signature Printed Name 4 - 60� Date Approved The person /people responsible for the destruction of records must sign upon destruction of the listed records: Employee Signature Printed Name Date Records Destroyed Vendor Business Name (if used) Phone Vendor Signature Panted Name Date Records Destroyed The retention and disposition action for this Public Records Destruction Log is "Retain for the life of the agency" pursuant to CORE series GSSO -09 -06 This sample form was prepared by Washington State Archives as a courtesy to local government agencies in January, 2014 It may be modified to meet individual agency needs • Local Government Public Records Destruction Log The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum retention periods before being destroyed pursuant to RCW 40 14 070, WAC 434 - 610 -070. and WAC 434 - 640 -010, -020, and -030 Please fill out this form when destroying all public records whose minimum retention is other than "Retain until no longer needed for agency business then destroy" (such as records covered in the "Records with Minimal Retention Value" section of the Local Government Common Records Retention Schedule (CORE) Legal Disposition Authority (taken from R ecords Retention Schedule) Agency Records Description Date Method(s) of Records series Records series Records Retention Minimum Retention Period (Box/item numbers, Dates Covered Minimum Destruction Title DAN schedule volume, etc) Retention (See examples, Met below *) Personnel GS50 -04B 3 YEARS BOX 04/01/08- 07/31/08 8/2011 OUTSIDE -09 SHREDDING Personnel Gs50- 04B -09 3 YEARS BOX 12/01/07-03/31/08 4/2011 OUTSIDE SHREDDING Personnel GS50 -04B 3 YEARS BOX 12/16/08- 04/30/09 05/2012 OUTSIDE -09 SHREDDING *Examples of methods of destruction electronic deletion, in -house OR outside contractor shredding, secure recycling, other (describe) Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably anticipated litigation or public records requests, are not needed for audit or other agency business, and shall be destroyed. The individual responsibl nventorying the listed records must sign belo prior to the R Manager's approval: Employee Signature �� Printed Name l� lG�t/ l0 mill i Vro Division H�2y o_yl The Records Manager must sig approval his request prior to the destruction he lis records: Records Manager Signature a Printed Name K/ ►'J t � K �� Date Approved 11 The person /people responsible for the destruction of records must sign upon destruction of the listed records: Employee Signature Printed Name Date Records Destroyed Vendor Business Name (if used) Phone Vendor Signature Printed Name Date Records Destroyed The retention and disposition action for this Public Records Destruction Log is "Retain for the life of the agency" pursuant to CORE series GSSO -09 -06 This sample form was prepared by Washington State Archives as a courtesy to local government agencies in January, 2014 It may be modified to meet individual agency needs. • Local Government Public Records Destruction Log The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum retention periods before being destroyed pursuant to RCW 40 14 070, WAC 434 - 610 -070. and WAC 434 - 640 -010, -020, and -030 Please fill out this form when destroying all public records whose minimum retention is other than "Retain until no longer needed for agency business then destroy" (such as records covered in the "Records with Minimal Retention Value" section of the Local Government Common Records Retention Schedule (CORE) Legal Disposition Authority (taken from Records Retention Schedule) Agency Records Description Date Method(s) of Records series Records Series Records Retention Minimum Destruction Minimum Retention Period (Box/item numbers, Dates Covered Title DAN Schedule volume, etc) Retention (See examples, Personnel GS50 -04B 3 YEARS BOX 2005 2009 OUTSIDE -09 SHREDDING Personnel GS50- 04B 3 YEARS BOX 07/15/09- 09/30/09 10/2012 OUTSIDE SHREDDING Personnel GS50 -04B 3 YEARS BOX 08/01/08- 11/01/08 12/2011 OUTSIDE -09 SHREDDING *Examples of methods of destruction electronic deletion, in -house OR outside contractor shredding, secure recycling, other (describe) Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably anticipated litigation or public records requests, are not needed for audit or other agency business, and shall be destroyed. The individual responsible o Inventorying t isted records must sign below prior __ to // the Records Manager's approval: Employee Signature rinted Name vICUI�U`l+e. 6]9 - (l� ✓� Division - � The Records Manager must si a appro of this request prior to the destruction of the listed records: Records Manager Signatur Printed Name JV17mg ` drt` ' • Date Approved The person /people responsible for the destruction of records must sign upon destruction of the listed records: Employee Signature Printed Name Date Records Destroyed Vendor Business Name (if used) Phone Vendor Signature Printed Name Date Records Destroyed The retention and disposition action for this Public Records Destruction Log is "Retain for the life of the agency" pursuant to CORE series GS50 -09 -06 This sample form was prepared by Washington State Archives as a courtesy to local government agencies in January, 2014 it may be modified to meet individual agency needs Local Government Public Records Destruction Log The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum retention periods before being destroyed pursuant to RCW 40 14 070, WAC 434 - 610 -070, and WAC 434 - 640 -010, -020, and -030 Please fill out this form when destroying all public records whose minimum retention is other than "Retain until no longer needed for agency business then destroy" (such as records covered in the "Records with Minimal Retention Value" section of the Local Government Common Records Retention Schedule (CORE) Legal Disposition Authority (taken from Records Retention Schedule) Agency Records Description Date Method(s) of Records series Records Series Records Retention Minimum Retention Period (Box/item numbers, Dates covered Minimum Destruction Title DAN Schedule volume, etc) Retention (See examples, Met below *) Personnel GS50 -04B 3 YEARS BOX 2008 2012 OUTSIDE -01 SHREDDING Personnel Gs50 -03E -02 3 YEARS BOX 2008 201 OUTSIDE SHREDDING Personnel GS50 -04B 3 YEARS BOX 2002 2006 OUTSIDE -09 SHREDDING *Examples of methods of destruction electronic deletion, in -house OR outside contractor shredding, secure recycling, other (describe) Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably anticipated litigation or public records requests, are not needed for audit or other agency business, and shall be destroyed. The individual responsible frQr inventorying the listed records must sign below prior to the Rec Manager's approv Employee Signature anted Name //1 C,�(Ul�fe �bc�/(//��j Division f�t 2lWee / 450UPM The Records Manager must sign approval is request prior to the destruction of the listed records: 6 17 Records Manager Signature Printed Name C - ion / - JA- Date Approved `� The person /people responsible for the destruction of records must sign upon destruction of the listed records - Employee Signature Printed Name Date Records Destroyed Vendor Business Name (if used) Phone Vendor Signature Printed Name Date Records Destroyed The retention and disposition action for this Public Records Destruction Log is "Retain for the life of the agency" pursuant to CORE series GS50 -09 -06 This sample form was prepared by Washington State Archives as a courtesy to local government agencies in January, 2014 It may be modified to meet individual agency needs • Local Government Public Records Destruction Log The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum retention periods before being destroyed pursuant to RCW 40 14 070. WAC 434 - 610 -070, and WAC 434 -640 -010, -020, and -030 Please fill out this form when destroying all public records whose minimum retention is other than "Retain until no longer needed for agency business then destroy" (such as records covered in the "Records with Minimal Retention Value" section of the Local Government Common Records Retention Schedule (CORE) Legal Disposition Authority (taken from Records Retention Schedule) Agency Records Description Date Method(s) of Records Series Records Series Records Retention Minimum Retention Period (Box/item numbers, Dates covered Minimum Destruction Title DAN Schedule volume, etc) Retention (See examples, Met below *) Personnel GS50 -04B 3 YEARS BOX 2000 -2004 2008 OUTSIDE -09 SHREDDING *Examples of methods of destruction electronic deletion, in -house OR outside contractor shredding, secure recycling, other (describe) Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably anticipated litigation or public records requests, are not needed for audit or other agency business, and shall be destroyed. The individual responsibl f inventorying the listed records must sign below rior to the Reco Manager's approval: Employee Signatur _/I/ �� Printed Name D & S" - f a — Division The Records Manager must sign approval of is request prior to the destruction of listed records: Records Manager Signature c Printed Name �` N ` � Date Approved � 6 IZ71 The person /people responsible for the destruction of records must sign upon destruction of the listed records- Employee Signature Printed Name Date Records Destroyed Vendor Business Name (if used) Phone Vendor Signature Printed Name Date Records Destroyed The retention and disposition action for this Public Records Destruction Log is "Retain for the life of the agency" pursuant to CORE serves GSSO -09 -06 This sample form was prepared by Washington State Archives as a courtesy to local government agencies in January, 2014 It may be modified to meet individual agency needs