Attachment 8 - Example of a Certificate of Destruction.pdf

PDF 132 KB Posted

Attached to
RILEY KS & MINOT ND Regional HW Removal and Disposal
Solicitation number
SP4500-22-R-0013
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Attachment 8 - SP4500-22-R-0013 Riley Minot Ellsworth Regional HW

Disposal Facility Name Address

Contact Information

CERTIFICATE OF DESTRUCTION

Certificate No.: Pickup D

Task Order #: Date Received:

Manifest Number:

CLIN#

Treatment

Disposal Date

Method

I certify, to the best of my knowledge, the above listed items were treated/disposed of as indicated in accordance with applicable laws and regulations at this permitted treatment, storage and disposal facility and have been rendered unusable and unrecoverable.

Print Name Signature Date

Print Title

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