<p> 1. Department ID: Date: (mm/dd/yyyy) / / The University of Texas at San Antonio ● Surplus Department Surplus Property Turn-In Form Instructions: 1. Enter your department’s 6-digit Unit Code. Enter the date this form is prepared. 2. Enter departmental information, location where property is to be picked up from, and the contact information. 3. For Capitalized/Controlled property that has UTSA Tags and or Barcodes, etc., fill out a separate line item for each tag/barcode. For non-tagged/barcoded items, i.e. desks, enter “Desk” under Item Description and the Quantity. 4. Print Department Head name and obtain signature, send the ORIGINAL signed form to the “Surplus Department” through campus mail, faxed forms will not be accepted. Incomplete/incorrect forms will be returned to the department for correction. For assistance with preparing this form, call 458-6273. 2. Submitting Department: (PLEASE, NO ABBREVIATIONS) Department: Department Inventory Contact Person (ICP) Name: ICP Phone # or Extension:</p><p>Campus: Building: (Where Property is located) Room #: (Where Property is located) 1604 DT ITC Univ Hts 3. Property Information: Item Old UTSA New UTSA Serial # : Qty: Item Description: Brand: Model: Unit Cost Surplus Use Only Tag # : Barcode # : Works ? (Each): Y N Only UTSA 1 2 3 4 Tag Items </p><p>Check here if parts from the above Items that contain or have once contained hazardous materials (i.e. biological, radioactive, corrosives, Continuation Sheets Attached: items have been cannibalized. Attach all flammables, asbestos, chemicals, etc.) must be inspected & cleared by the Environmental Health, Safety & Yes No copies of cannibalization forms to this form. Risk Management office prior to Surplus turn-in. Call 458-6101 to request an inspection, attach a copy of Number of continuation sheets: the inspection clearance results to this form. 4. Request/Approval/Acceptance: Department Manager: By my signature, I certify that the Printed Name: Title: property listed above contains no documents or electronic Surplus Internal Use / Audit media that may contain personal, official or sensitive Signature: Date: information. Does not apply to computers as all computer </p><p> hard drives are destroyed by the Surplus Department. 5. Surplus Use Only: Customer Copy Accepted Decline Received by Surplus Rep: I certify that the property listed above contains no documents or electronic media. Date: Inventory Contact Person/Designee: Print Name: Sign: Property Transfer Verification: Date: Surplus Properties Supervisor Customer Initial’s: Surplus Rep Initial’s Date: </p><p>Surplus Property Turn-In Form This Form must be TYPED, handwritten forms will not be accepted Revised: 14 July 2016</p>