SURPLUS REQUEST FORM Request ID: Request Date: // Request Status: Submitted Department: COS - Dean Pick Up Location: A Comments: In hallway as you go towards SAS On wired shelf Contact: Phone: Email: Surplus Action: Terry Byron /- tbyron@ncsuedu Pick-Up QTY Lot N Description Apple Mac Mini Serial# CGXCDJD Project Asset Tag# Asset ID Condition Good N Microsoft Surface Good N Apple Laptop CVBHVR Good N Apple Laptop CWQNHVR Good N Apple Laptop FVFYPDSHVH Good N Apple Laptop FVFWQHVH Good N Apple Laptop FVFWQCMHVH Good N Apple Laptop FVFWQHHVH Good QTY Lot N Description Apple Laptop Serial# CTXAYHHV Project Asset Tag# Asset ID Condition Good N Apple Laptop FVFYMGHVF Good N Apple Laptop FVFYPAUHVH Good N Apple Laptop FVFWQCLHVH Good N Apple Laptop FVFWQQHVH Good N Apple Laptop CVBXHV Good N Apple Laptop CFTQN Good N Apple Laptop CWJGWN Good N Apple Laptop CNXSGQP Good N Apple Laptop CPRDGWM Good N Apple Laptop CVJDHHC Good N Apple Laptop CPMFGCN Good QTY Lot N Description Apple Laptop Serial# FVFWQNHVH Project Asset Tag# Asset ID Condition Good N Apple Laptop CYWDJK Good N Apple Laptop FVFYPCHVH Good N Apple Laptop CWROUBHVW Good N Apple Laptop CRMRFVH Good N Apple Laptop CVHV Good N Apple Laptop CCPHAML Good N Apple iMac DRJFGGV Good N Apple iMac DKPDDNMP Good N Apple iMac DRJFGGV Good N Apple Laptop CMHDHPDV Good N Apple Laptop CMHDHNDV Good QTY Lot N Description HP MFP Printer Serial# CMGZ Project Asset Tag# Asset ID Condition Good N Dell Laptop BMZRV Good N Dell Laptop BYY Good N Dell Laptop DYYTP Good N Apple Laptop CFTQN Good N HP Printer CNB Poor N Apple Mac Mini CCRGPJJ Poor N Apple Laptop CFTQN Poor N Apple Laptop CFTQN Poor N Apple Laptop CFTQN Poor N Apple Laptop CFTDQN Poor N Apple Laptop CMKHCFH Poor QTY Lot N Description Apple Laptop Serial# CFJTQQ Project Asset Tag# Asset ID Condition Poor N Dell Laptop GLHR Poor N HP Printer MYE Poor N Apple Monitor Poor N Canon Printer HRKA Poor N Apple Laptop FVFWTKXHVF 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