A B C D E F G H
1 DEQ Records Management          
2 Destruction Authorization   To be completed before records are destroyed  
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4 Prog Box # if relevant Schedule/Series # from current retention schedule Contents including time frame Series Title from current retention schedule Volume of records Retention from current schedule Record Officer Approval Shredding Required
5 14 - 18 2008 - 2009 (147) Medford VIR (1/2/15 - 12/31/15) Vehicle Inspection Reports 5 boxes 3 yrs  
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15 Name of staff requesting destruction   Program/Division   Date    
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17 Program Manager authorization signature       Date    
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19 Records Officer authorization signature       Date    
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21 Records Coordinator signature       Destruction Date  
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23 I certify that the above-referenced records were destroyed in accordance with        
24 ORS 192.105.            
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26 Duplicate copies should be destroyed before the official copy but must be destroyed when the official copy is destroyed.  
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28 This signed document is the official record and will be retained permanently by the Records Officer        
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30 filename: CRUMBLE_DestructionAuthorization.xls (updated: April 14, 2011)          

Destruction Authorization

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Retention Schedule Info

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Retention Schedule Example

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1 Records Destruction Authorization
3 To request destruction of “official copies” of records, the Records Destruction Authorization form must be completed. Please follow these steps:
5 1. Complete the Records Destruction Authorization form
7 2. Print the form
9 3. Sign the form
11 4. Obtain management signature
13 5. Send the form with the original signatures to the agency Records Officer (via mail)
15 6. The Records Officer will review, assign approvals, and mail the form back to the requestor
17 7. The program Records Coordinator works with the Records Officer to arrange appropriate destruction of the records.
20 If you have any questions regarding completing the form, please contact Ella Crumble, Agency Records Officer, at 503-229-5559.
26 Last Updated:
28 Q-Net is DEQ's official Intranet site.
29 If you have questions or comments contact DEQ's Web Communications Coordinator.

Procedure