Date:__________
I acknowledge receipt of and responsibility in accordance with SBTCE Equipment Manual, Section 1-B6 for the items described below.
TO:
FROM:
Name(Print):_________________________________________ Org.(Dept.):___________________________
Signature:____________________________________________ Ext.:___________ Org#:__ __ __ __ __
Name(Print):_________________________________________ Org.(Dept.):___________________________
Signature:____________________________________________ Ext.:___________ Org#:__ __ __ __ __
State ID Number Description From To Reason Return Date
CCTC Inventory Form 5, July 2017
EquipmentTransfer/Turn-in Receipt
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