SURPLUS REQUEST FORM Request ID: Request Date: // Request Status: Submitted Department: COS - IT Pick Up Location: A Comments: In Hallway as you head towards on wire shelf Contact: Phone: Email: Surplus Action: Terry Byron /- tbyron@ncsuedu Pick-Up QTY Lot N Description Apple Mini Serial# CYDJYVX Project Asset Tag# Asset ID Condition Good N Apple Mini CCLPJJ Good N Apple MIni CXXQMJYVX Good N iPad Lg DLXQTNXGMLL Good N iPad DMPMMLAFYF Good N iPad DLXNQJDGYQ Good N iPad DMPTH Good N iPad DMPNTRHGYN Good QTY Lot N Description iPad Serial# DLXNLXGYL Project Asset Tag# Asset ID Condition Good N iPad DMPRCDHMJ Good N iPad DMPMMANF Good N iPad Mini DLXJWMFF Good N " iMac DTGUGQ Good N " iMac DSPGGD Good N " Apple Laptop CSSGWL Good N " Apple Laptop CCJMDV Good N Apple Laptop CCPHRPYV Good N Apple Laptop CCPHPYV Good N Apple Laptop FVFZDTRL Good N Apple Laptop FVFHVQLX Good QTY Lot N Description Apple Laptop Serial# CYTGMLVDP Project Asset Tag# Asset ID Condition Good N Apple Laptop CPMBGCN Good N Apple Laptop CPMBGCN Good N Apple Laptop CGYPDJY Good N Apple Laptop " CYDFLJGH Good N Apple iMac DQXGQ Good N Apple Mac Pro FKTFVN Good N Apple iMac DRJFTGGV Good N Apple iMac CD Good N Apple Mini CYPJYVX Good N Apple iPad DMPMMJXFYF Good N Apple Laptop " CDFFSMDM Good QTY Lot N Description Apple iPad Serial# DMQLTQLGFK Project Asset Tag# Asset ID Condition Good N Apple Monitor " Good N Apple Monitor " Good N HP LaserJet Printer CNGJC Poor N Dell Laptop WPQV Poor N Apple iMac DWQUEJGN 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 // : PM Last Updated: TBYRON // : AM