Attachment 7 - Example of a Certificate of Recycling.pdf

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RILEY KS & MINOT ND Regional HW Removal and Disposal
Solicitation number
SP4500-22-R-0013
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SP4500-22-R-0013

Riley Minot Ellsworth Regional HW

ATTACHMENT 07

Example of a Certificate of Recycling

CERTIFICATE OF RECYCLING

Contract Number:

Company Name:

EPA I.D. Number:

Delivery Order Number:

Date:

This document is to certify that (Company Name) has completed the recycling of your hazardous waste.

Under civil and criminal penalties of law for the making or submission of false or fraudulent statement or representations (18 U.S.C. 1001 and 15 U.S. C. 2615), I certify that the information contained in or accompanying this document is true, accurate, and complete.

I certify as the company official having supervisory responsibility for the persons who acting under my direct instruction made the verification that this information is true, accurate, and complete.

Company Officer’s Signature Date

Title

Generator:

CLIN:

Manifest Number(s):

Weight:

Approved by:

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