CERTIFICATE OF DESTRUCTION
Store Name: Account Number:
Date of Destruction:
Address:
City: State: Zip:
Phone: Fax:
This is to certify that the above listed customer did destroy product
Product was destroyed by:_______________________________________
Item UPC Item Description Qty Date Code Destruction
Disposed Date
Based on the RECALL event reported, this is your authorization to destroy the above
product(s). ONLY products affected by the Huntington Beef RECALL will be credited for
destruction. No other products are to be destroyed without proper authorization.
Form completed by: __________________________________________________
Printed Name
____________________________________________________________________
Signature
Title: ____________________________________Date:_______________________
Time: __________
This certificate must be completed with each damage report when product is
destroyed. Missing or incomplete information may result in no credit being issued.
66c68654-5641-4f24-962e-cc447f229754.doc