Attachment_16_-_Certificate_of_Destruction_Sample.pdf

Solicitation SP4520‐14‐R‐0003, Attachment 16

Certificate of Destruction

Date:

From: Received by:

Date:

This is to certify that the waste identified on Shipping Document: ______________ ,Manifest # ____________

Line# ____________ was received by _________________________ on this Date:

The waste(s) were subsequently disposed of by the process bearing this Disposal or Recovery code __________ on this

Date: ______________ in accordance with all permits and laws regulating this process.

Reference number: Delivery Order XXXX, Line Item(s): XX –XX.

Material:

Number of containers:

Type of container:

Address of the Facility Disposing of the Waste:

Certifying Official Printed Name: ________________________________________________

Signature: ______________________________________________________________

Verifying Official Printed Name: _________________________________________________

Signature: _______________________________________________________________