Textile Industry Destruction Certification Form
Please complete all sections to certify the destruction of textile materials. All information is required for official documentation.
Company Name
*
Requester Name
*
First Name
Last Name
Requester Email Address
*
example@example.com
Destruction Request Reference Number
*
Description of Textile Items
*
Quantity of Textile Items (specify units)
*
Destruction Method
*
Please Select
Shredding
Incineration
Chemical Treatment
Other
Date and Time of Destruction
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Destruction Location
*
Witness or Approver Name
*
First Name
Last Name
Certification Statement: I hereby certify that the above-listed textile materials have been destroyed in accordance with the stated method and requirements.
*
I certify the destruction as stated above.
Submit Certification
Should be Empty: