HomeMy WebLinkAboutPARKS & RECREATION 05/11/2018City 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
Records Series rtttle
Records Series
DAN
Records Retention
Schedule
Minimum Retention Period
Description
(Box/Item numbers,
Dates covered
Date
Minimum
Retention
Method of
Destruction (See
_ —t To a*tet �
examples 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 Record's Manager approval:
Employee Signature:( U Printed Name: ��-'n¢ �l'�'� Division: 1� I"'-Cr--0—CL+1 6 r,-.,
The Records Manager must sign the approval of this request prior to the destruction of the listed records:
Records Manager Signature: Printed Name4(y/ia/�� ��� Date Approved:
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: e L/V M" Name: M RJ V/ /V tom. W -lX Date Records Destroyed: 1:�).J22- l
Vendor Business Name (if used): m�J 1 ' `00,1 '" <�'Vo-ec " i "1 Phone: -3CpQ 4-13 5305
Vendor
Printed
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.
Form Revised 05/06/2014
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j/%O%iii .��i ii
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Name: CO OP BREMERTON PARKS
Address: 680 LEBO BLVD
City: BREMERTON 98310
Phone: 360-473-5305
Request: MR-MS-CORRINE
CERTIFICATE OF DESTRUCTION
2910 Hogum Bay Rd
Olympia Wa 98516
E -Mail: Ims@wcnx.org
Phone: 1-877-898-0112
Fax: 1-360-486-2467
Account: 2185-952778-926
Invoice Date: 5/2x/2018
Route Id: SN92
Invoice #: 1332989
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
Notes: 5/22 PURGE 26 BOXES. $34.70 PER 95 GALLON CONTAINER. HOURS 8:30-4:30. OK TO BILL.
Service Description Qty Rate Amount
SHPURGE 1.00 SHRED ONE TIME PURGE Z' 34.70
SHEXB 1.00 SHRED EXTRA BOX 3.47
t
Driver Signature:
Date: Truck
Customer Signature: wukk-1- Date: 5��� 0 Time