SURPLUS REQUEST FORM Request ID: Request Date: // Request Status: Submitted Department: College of Sciences - Dean Pick Up Location: _ Comments: At the end of Hallway on Red Shelves Contact: Phone: Email: Surplus Action: Terry Byron /- tbyron@ncsuedu Pick-Up QTY Lot N Description Apple Monitor (Req Tag ) Serial# Project Asset Tag# Asset ID Condition Good N HP Printer CNDFB Poor N Apple iMac CTTHVF Poor N Apple iMac CZPETJWF Poor N Apple iMac CZJJWF Poor N Apple iMac (White) WAUP Poor N Apple iMac (White) WUP Poor N Apple iMac DGXMJDHJW Poor QTY Lot N Description Dell Serial# RZK Project Asset Tag# Asset ID Condition Poor N HP Printer JPBCKCRCH Poor N Lenovo ThinkCentre MJJCDB Poor N Dell DW 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