Fillable Southwest Virginia Community College, PO Box SVCC, Richlands, (Southwest Virginia Community College)

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Southwest Virginia Community College, PO Box SVCC, Richlands, (Southwest Virginia Community College)

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Revised January 2013
Southwest Virginia Community College, PO Box SVCC, Richlands, VA 24641
Phone: 276/964-2555 - Fax: 276/964-9307
APPROVAL
Supervisor Date
DISTRIBUTION
Storekeeper/Physical Plant (Original)
Supervisor
VP of Financial & Administrative Services Office
Temporary Custodian
RETURN RECORD
DATE:
SWCC Inventory Tag Number:
DEPARTMENT
Serial Number:
Item Description:
I accept custody of the above equipment belonging to SWCC for official off-campus use. By signing this form,
I acknowledge that I am assuming responsibility for such equipment. I agree to return the equipment to the
college for maintenance procedures as requested/required. I also understand that the equipment is on
temporary loan and must be returned to the college upon request of Supervisor and/or Dean, VP, President.
Approximate Date of Return
Signature of Temporary Custodian
Home & Cell Phone
Date Returned
Returned To
Received By
AUTHORIZATION AND CUSTODY RECORD
EQUIPMENT TEMPORARILY REMOVED FROM CAMPUS
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Southwest Virginia Community College, PO Box SVCC, Richlands, (Southwest Virginia Community College)

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Completed 27 July 2020

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