Surplus Disposal Request Form
Instructions/Purpose: This form should be completed by the department when a surplus pickup is requested.
If the surplus contains hazardous materials, the department must adhere to the REHS procedures listed here:
http://rehs.rutgers.edu/lslab_lcog.html
Department Name:
Name of Contact:
Department Address:
Campus Phone Number:
Department Reimbursement Account Code:
Quantity
Description of Surplus
Does it
Work?
Item Serial #
Rutgers Inventory Tag
Number
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
I hear by certify that items purchased with grant funds have been cleared with the Division of Grant and Contract
Accounting before being declared as surplus.
Departmental Authorization_____________________________________________________________________________
INTERNAL USE (REHS)
Clearance Date:
INTERNAL USE ONLY (MATERIAL SERVICES)
Received by:
Authorized By:
Date:
Date:
PO 62
Revised October 14, 2008