SURPLUS REQUEST FORM Request ID: Request Date: // Request Status: Submitted Department: COS - IT Pick Up Location: A Comments: In Hallway as you head towards Contact: Phone: Email: Surplus Action: Serial# FKMPUF Project Terry Byron /- tbyron@ncsuedu Pick-Up QTY Lot N Description Mac Pro (Trashcan) Asset Tag# Asset ID Condition Good N Large Monitors Poor N Small Gateway Monitor Poor N Dell AIO Computer CBXFW Poor N Dell PC HNCV Poor N HP Printer JFBF Poor N HP Printer JPJGJ Poor N HP Printer CNGP Poor QTY Lot N Description Dell PC Serial# BHMGS Project Asset Tag# Asset ID Condition Poor N Apple Laptop CRLNYGTHY Poor N HP Printer Poor N Mitsubishi TV Poor N Old Mac Mini YMPWG Poor N Mac Laptop CVHV 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