SURPLUS REQUEST FORM Request ID: Request Date: // Request Status: Submitted Department: College of Sciences - Dean Pick Up Location: A Comments: In Hallway on shelf as you head toward Contact: Phone: Email: Surplus Action: Terry Byron /- tbyron@ncsuedu Pick-Up QTY Lot N Description Dell AIO - Serial# YHDH Project Asset Tag# Asset ID Condition Good N Dell AIO - XNDH Good N Dell AIO - XFDH Good N Dell AIO - XLDH Good N Dell AIO - WHDH Good N Dell AIO - WJDH Good N Dell AIO - WPDH Poor Y Old Monitors Poor QTY Lot N Description HP Printer Serial# VNBF Project Asset Tag# Asset ID Condition Poor N HP Printer PHBGR Poor N HP Printer CNB 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