HomeMy WebLinkAboutENGINEERING - 03/18/2104 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 volume, Minimum Destruction
Title DAN Schedule Minimum Retention Period (Bo m numbers, Dates Covered Retention (See examples,
volume, etc) Met below*)
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*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 for inventorying the listed records must sign below prior to the Records Manager's approval:
Employee Signature l l(�CX�Uc_ '�OiC.� Printed Name � D LZ OCS Division V IV
The Records Manager must sign the approval of this request prior to the destruction of the listed records:
Records Manager Signatur Printed Name AoT upoks Date Approved
The person /people responsible for the destruction of records must sign upon destruction of the listed records. a
Employee Signature �C6 Printed Name AnrAaL. ( 7tJods Date Records Destroyed s 1 - \
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 mdividual agency needs