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� . 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) Agenty Retords
Date Method of
Records Series Records Retention Description Minimum
Records Series Title Minimum Retention Period (Box/Item numbers, Dates Covered Destruction(See
DAN Schedule Retention exam les below•)
volume,etc.) Met p
8/26/15 08-008200 7/23/2008 TO 9/15/2008 Outside
To 9/16/15 LE2010-064 7 Years TO 08-010399 Contractor
Shredding
*Examples of inethods of destruction:electronic deletion,in-house OR outside contractor shredding,secure recycling,ather(describeJ
Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably anticipated litigation or
puhlic 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:
Employee Signature: ����R'�� Printed Name: � ����-�C..��i V�. Division: �I[C�2 �C(.�G S
The Records Manager must sign the approval of this request prior to the destruction of the listed records:
Records Manager Signature: � Printed Name: I-�• ` I�� VJ `v Date Approved: / I` ����—_
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
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Employee Signature•. Printed Name: l.�i3 �J �,�/ 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 Destrudion Log is'Retain for the life of the agency"pursuant to COREseries G550-09-06.
Form Revised 05/06/2014
, ���i M�� MO�II(�i CERTIFICATE OF DESTRUCTION
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' � ���%'�����. �,�����,, ��� 2910 Hogum Bay Rd p�� o
������ � � ���"' �� � Olympia Wa 98516 � Z
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E-Mail: lms@wcnx.org • �
Name: CO OP POLICE-BREMERTON Phone: 1-877-898-0112 �~
Address: 1025 BURWELL ST Fax: 1-360-486-2467 ��1 .�c
City: BREMERTON , 98337 ��'_�'. N�
Phone: 360-473-5237 Account#: 2185-g52778-700 Route Id: TSP4
Request: MS-LT OLAN , Invoice Date: � Invoice#: 1185815
On the date shown, Desi nated Confidential Data was Shredded and Destro ed as er Customers Instructions.
Notes: �1'I - T�41idERS�—�
Service Description Qty Rate Amount
65SC 5.00 65 GAL SHRED CART � 2•89
SHPP 1.00 SHRED PER POUND 1.08
Driver Signature: � Date: Truck
Customer Signature: Date: Time