SURPLUS REQUEST FORM Request ID: Request Date: Request Status: Department: Pick Up Location: Comments: In Hallway // Submitted College of Sciences - Dean _ Contact: Phone: Email: Surplus Action: Terry Byron /- tbyron@ncsuedu Pick-Up QTY Lot N Description PC - Dell Serial# ZTPJH Project Asset Tag# Asset ID Condition Good N PC - Dell ZSTJH Good N PC - Dell Prec YF Good N PC - Dell Prec HPTCH Good N PC - Dell PFSD Good N Apple - Mac Mini CHRCDJD Good N Apple - Mac Mini CJXVDYH Good N Laptop - Latitude JHGZ Poor QTY Lot N Description UPS - APC Rack Mount N UPS - Dell W N Printer - HP-Pdn N Serial# Project Asset Tag# Asset ID Condition Poor Poor CNB Poor PC - Dell T ZTPM Poor N PC - Dell T SFDZV Poor N PC - Dell YPFCP Poor N Laptop - Apple CMHDHPGDV Poor N Laptop - Apple CMQWLHDV Poor N Laptop - Dell JHGZ Poor N Laptop - Apple WMX Poor N Laptop - Apple FVFWTKHVF Poor N Laptop - Apple WZEYJZ Poor Certifications Hazardous Materials Notice Y Certified By TBYRON // : AM Person/Department disposing of equipment that (i) may have been used to process hazardous materials, or (ii) may contain hazardous material which cannot be removed, or (iii) which contains radioactive materials, must receive clearance as appropriate from the Environmental Health & Safety Dept, or the Radiation Protection Office before this equipment may be surplused Data Security Note Y Certified By TBYRON // : AM When including devices that may have internal storage (eg, copiers, printers, scanners, projectors, etc) on this form, please check with the manufacturer for verification if storage exists If equipped with internal storage, it is the responsibility of the department to erase all data on the internal storage or remove it before turning the device over to Surplus Devices with internal storage retain images made during the life of the equipment Risk Management Y Certified By TBYRON // : AM Person/Department disposing of (i) tractors, mowers, skid steers or (ii) cars, trucks, vans and trailers, must provide signed copy of the surplus request with signatures from your department and Surplus Property to remove the item (s) from Risk Management Insurance Created By: TBYRON // : AM Last Updated: TBYRON // : AM