NAME AND ADDRESS OF REPORTING AGENCY LOCATION OF PROPERTY
Dept
FARMINGDALE STATE Building
PROPERTY CONTROL Room No REPORT OF DISPOSAL (UNUSABLE) PROPERTY
FARMINGDALE, NY 11735 Contact Person Department disposing of equipment should fill out all sections
Phone No pertaining to equipment
The personal property listed below is no longer required by this agency. For further
information about this property, contact:
Name: Phone No:
Dept. Head Signature: Date:
ITEM DESCRIPTION HAZARD NO. OF ASSET NO. SERIAL NO. CONDITION
CODE*
NOTE: SHOULD THE DISPOSAL OF THIS EQUIPMENT REQUIRE ANY * HAZARD CODE: B=Biological R=Radiation
SPECIAL HANDLING OR EXPEDITING, PLEASE EXPLAIN AND C=Chemical N/A=Not Applicable
JUSTIFY. If Hazard Codes B, R, or C are used, contact Environmental Health &
Safety (2-641-0) prior to forwarding form to Property Control.
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