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["Date:_____________________",null,"Department:________________________ "]
["Location of Equipment:  Building:__________     Room:____________     ",null,null,null,"Contact Name:______________________"]
["Goods Identified:              Surplus:________     Obsolete:__________",null,null,null,"Contact Local:______________________"]
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["Dean/Director Signature:________________________________________________________________________"]
[]
["Purchasing Use Only"]
["Revenue associated with disposal:___________________"]
["Costs associated with disposal:______________________"]
["Sold/Scrapped/Donated:____________________________",null,null,"Date:__________________"]

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