uchc_logo.gif (10775 bytes)REFERENCE #   M Hit Counter         
                                                                                     MATERIALS MANAGEMENT
                                                                                         "MOVE REQUEST FORM"

MAIL ENTIRE PACKAGE TO:        Mike Stephens,  Materials Management and Surplus Property
                                                        Building 0J,   MC 6170,  Phone:   679-1956   Fax # 679-1964
NAME:    
BUILDING: FLOOR: ROOM  #:      TEL. #:      
DEPARTMENT:
MAIL CODE:  MC         E-MAIL: 
1.  
This is a request to move assets.
.
 2.  
This is a request to move and store assets.
.

MOVE FROM:  Internal Moves, Complete Line 1.    Off-Campus Moves, Complete Lines 1 & 2
1.  DEPARTMENT:    
     BUILDING: FLOOR: ROOM  #:     
     CONTACT:      TEL. #: 
2. INSTITUTION:     
     STREET:    ZIP CODE: 
    CITY:      STATE:     

HC NUMBER

DESCRIPTION

HC NUMBER

DESCRIPTION

SPECIAL INSTRUCTIONS: 

CODING:

FISCAL YR

LEDGER

ACCOUNT

SUBCODE

AMOUNT

AUTHORIZED SIGNATURE
 

________________________

IMPORTANT NOTICES TO DEPARTMENT HEAD:

  1. YOUR SIGNATURE ALSO CONFIRMS THAT ALL EQUIPMENT & ACCESSORIES USED WITH/OR HAVING CONTAINED RADIOACTIVE OR OTHER HAZARDOUS MATERIALS HAVE BEEN INSPECTED & APPROVED FOR SURPLUS, SHIPPING AND/OR STORAGE BY ENVIRONMENTAL & RADIATION SAFETY. FREON MUST BE REMOVED FROM ALL REFRIGERANT EQUIPMENT BEFORE DISPOSAL.
     

  2. YOUR SIGNATURE ALSO CONFIRMS THAT ALL ELECTRONIC STORAGE EQUIPMENT & DEVICES HAVE BEEN PROPERLY CLEANED OF INFORMATION ACCORDING TO UCHC HIPAA POLICIES.

AUTHORIZED SIGNATURES    (Signatures 3-6 are needed only if ownership changes)
RELEASED BY:         RECEIVED BY:  
___________________________
1.  DEPARTMENTAL PROPERTY COORDINATOR		 _______
DATE		 1.  DEPARTMENTAL PROPERTY COORDINATOR
 _______
DATE
___________________________
2. DEPARTMENT HEAD		 _______
DATE		 2.  DEPARTMENT HEAD _______
DATE

OMM OFFICE USE ONLY

OPMM USE ONLY

INITIALS: _________

TIME: _________       

DATE: ________

 REQUEST IS

 - APPROVED
- NOT APPROVED
 SCHEDULED MOVE DATE

INITIALS: _________

TIME: _________       

DATE: ________		 APPROVED STORAGE DATE

FROM: _____________
TO:  _______________

dotblink.gif (1956 bytes) MM-1 ACTION REPORT

MOVE COMPLETED

INITIALS: _________

TIME: _________       

DATE: ________

                                            MAKE A COPY FOR YOUR FILE


IF YOU NEED ASSISTANCE COMPLETING THIS FORM, CALL 679-1953