Attachment 04 - Certificate of Recycling.docx

RFP SP4530-12-R-0003

ATTACHMENT 4

CERTIFICATE OF

RECYCLING

Contract Number: ____________________ Company Name: ____________________ EPA I.D. Number: ____________________ Task Order Number: __________________ Date: ______________________________

This document is to certify that ________________________ has completed the recycling of your hazardous waste/cylinder(s).

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.

Generator: _____________________

CLIN: _____________________

Manifest Number: ______________ Weight/Serial: _________________ Number: ______________________

Approved by: ___________________