HomeMy WebLinkAboutPROSECUTOR - 08/22/2014 Ir
City of Bremerton 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 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 Records Retention Schedule(CORE)).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Description Date Method of
Records Series Title Records Series Records Retention Minimum Retention Period (Box/item numbers, Dates Covered Minimum Destruction(See
DAN Schedule volume,etc) Retention examples below*)
c�a•:nod C1�cs� Z ao�3- Le►-►-,a y
39 boXes SaruaYry 12-0 10 o ►2131 IZd13 Shredd I'n9
DccernlJig
euYS�dt:
'ivac Fcv
*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 Record's Manager approval: p 1,
Employee Signature: , 1{�� Printed Name: 1�1i1V l L • yy-\ I/�-D 1 Division: ` 0-s e w 1 0 n I,�-�
J 1y 1 a&wN
The Records Manager must sign the approval of this re est prior �
to the destruction of the listed records:
nI/
Records Manager Signature: Printed Namee X o Q S,V\1 f)V✓1 Date Approved: � �c•��
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: �/� c Printed Name:,., Date Records Destroyed:
Vendor Business Name(if used): Le ' `��� vyc[T(JIJI..I'L!/i Phone:
Vendor Signature: see Q,*6� 4VOPrinted Name: Date Records Destroyed: — 1 LV
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.
Form Revised 05/06/2014
Le MoMobile CERTIFICATE OF DESTRUCTION
FOR INf° m
P2910 Hogum Bay Rd
�� � % �� Olympia Wa 98516 °z
1�i,� r'01 E-Mail: Ims@wcnx.org o
Phone: 1-877-898-0112
Name: CO OP ATTORNEYS OFFICE-BREMERTON Fax: 1-360-486-2467
Address: 345 6TH ST#600 �I ;.,
City: BREMERTON 98337 '
Phone: 360-473-2345 Account : 2185-952778-697 Route Id: SN92
Request: CARRIE-SARAH Invoice Date: 8/19/2014 Invoice#: 1116019
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
Notes: 8/19 EMPTY BIN AND TAKE 39 BOXES $3 EACH CODED AS PURGE
Service Description Qty Rate Amount
65SC 2.00 65 GAL SHRED CART 2.65
SHPURGE 1.00 SHRED ONE TIME PURGE '3Ct 3.00
Driver Signature: Date: Truck
Time
Customer Signat Date: ��