Transmittal Sheet Page     of    

** Note: Regarding the use of social security numbers and birth dates. Use of this information constitutes personal data that may be protected by privacy laws. Iron Mountain is
happy to include this data, and the furnishing of such data by the Customer constitutes the Customer's consent to its inclusion on Iron Mountain's inventory management systems.
CUSTOMER ID CUSTOMER NAME Division ID* (up to 12 characters) Department ID* (up to 12 characters)

                       

Customer Box Number Record Code* Date Range / FROM Date Range / TO Alpha/Numeric Range - FROM Alpha/Numeric Range - TO Create Date Event Date Destruction Eligibility Hold Code

1            
MM DD YYYY

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MM DD YYYY

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MM DD YYYY

   /    /     
MM DD YYYY

   /    /     
MM DD YYYY

   /    /      or Permanent or Undefined    

Major Description Reference #1

           
Minor Description

     
Customer Box Number Record Code* Date Range / FROM Date Range / TO Alpha/Numeric Range - FROM Alpha/Numeric Range - TO Create Date Event Date Destruction Eligibility Hold Code

2            
MM DD YYYY

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MM DD

   /    /     
YYYY

           
MM DD YYYY

   /    /     
MM DD YYYY

   /    /     
MM DD YYYY

   /    /      or Permanent or Undefined    

Major Description Reference #1

           
Minor Description

     
Customer Box Number Record Code* Date Range / FROM Date Range / TO Alpha/Numeric Range - FROM Alpha/Numeric Range - TO Create Date Event Date Destruction Eligibility Hold Code

3            
MM DD YYYY

   /    /     
MM DD

   /    /     
YYYY

           
MM DD YYYY

   /    /     
MM DD YYYY

   /    /     
MM DD YYYY

   /    /      or Permanent or Undefined    

Major Description Reference #1

           
Minor Description

     
Customer Box Number Record Code* Date Range / FROM Date Range / TO Alpha/Numeric Range - FROM Alpha/Numeric Range - TO Create Date Event Date Destruction Eligibility Hold Code

4            
MM DD YYYY

   /    /     
MM DD

   /    /     
YYYY

           
MM DD YYYY

   /    /     
MM DD YYYY

   /    /     
MM DD YYYY

   /    /      or Permanent or Undefined    

Major Description Reference #1

           
Minor Description

     
Customer Box Number Record Code* Date Range / FROM Date Range / TO Alpha/Numeric Range - FROM Alpha/Numeric Range - TO Create Date Event Date Destruction Eligibility Hold Code

5            
MM DD YYYY

   /    /     
MM DD

   /    /     
YYYY

           
MM DD YYYY

   /    /     
MM DD YYYY

   /    /     
MM DD YYYY

   /    /      or Permanent or Undefined    

Major Description Reference #1

           
Minor Description

     
*Note: Only customers specifically set up to use a Division ID, an 11- or 12-character Department ID, or a 7- to 10-character Record Code should place information in the gray boxes.

                                                     

PREPARER’S FULL NAME DATE DIVISION ID DEPARTMENT ID TELEPHONE NO. AND EXTENSION FLOOR
IMRM e-FORM TransPad (003) REV 12/04 PROVIDE ORIGINAL FORM TO IRON MOUNTAIN RECORDS MANAGEMENT. PHOTOCOPY THIS ORIGINAL AND RETAIN FOR YOUR RECORDS.