SURPLUS REQUEST FORM Request ID: Request Date: // Request Status: Submitted Department: COS - IT Pick Up Location: A Comments: In Hallway going towards Contact: Phone: Email: Surplus Action: Terry Byron /- tbyron@ncsuedu Pick-Up QTY Lot N Description Large Monitor Serial# Project Asset Tag# Asset ID Condition Good N DELL_LAPTOP SVXF Good N HP Printer CNBL Good N HP Priinter CNCTS Poor N DELL_OPTIPLEX_ CDG Poor N DELL_PRECISION_TOWER_ SQR Poor N DELL_PRECISION_TOWER_ SPR Poor N DELL_PRECISION_TOWER_ BTJ Poor QTY Lot N Description DELL_OPTIPLEX_ Serial# ZX Project Asset Tag# Asset ID Condition Poor N DELL_LAPTOP_ JYRL Poor N ASUS_LAPTOP KANCVR Poor N APPLE_IMAC_" DRJFAGGV Poor N APPLE_IMAC_" DRJFHGGV Poor N APPLE_IMAC_" CJXYDNMP Poor N APPLE_IMAC_" DMMWFJC Poor N APPLE_LAPTOP CCPHQPYV Poor N APPLE_LAPTOP FVFYQALJK Poor N APPLE_LAPTOP CYJKM Poor N APPLE_LAPTOP FVFWQDHVH Poor N APPLE_LAPTOP FVFYPHVH Poor QTY Lot N Description APPLE_LAPTOP Serial# CVGHTDG Project Asset Tag# Asset ID Condition Poor N LENOVO_LAPTOP R-V Poor N LENOVO_LAPTOP R-T 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