DISPOSAL FORM
SEND OR FAX COMPLETED FORM TO:
WORK ORDER #
1. University Facilities Customer Service UB Facilities will email the Work Order # to the Requestor. This
number must appear on the form attached to the item.
or fax 645-5965
AND DISPOSAL #
Asset Management: Departments may assign their own disposal number.
2.
Retain a copy in your departmental file for audit IT IS ILLEGAL TO REMOVE EQUIPMENT/FURNITURE
purposes and attach a copy to each item. WITHOUT PROPER FORMS ON FILE.
THIS FORM IS FOR ITEMS IN “POOR” OR “SCRAP” CONDITION.
Date _
Requestor Email _ Phone _
Print/type name
Department Inventory Account # _
Location for pick up _
(Different locations require separate forms)
Qty Asset # Serial # Mfr. Model Description
The signatures below ascertain that the condition of the above listed items are in “poor” or “scrap” condition
and authorizes their disposal. Also, the signatures below certify that the equipment listed is free from any and
all radioactive or hazardous materials.
Signature of Dept. Inventory Coordinator
Print/type Inventory Coordinator name ________________
Email address
Signature of Department Head
Print/type Department Head name
This form must contain two separate authorized signatures as
indicated.
Disposal is handled through University Facilities. For questions regarding pickup, call University Facilities at 645-2025. To learn
more about equipment disposal or UB SWAP, call Asset Management at 645-2619 or visit http://www.buffalo.edu/administrative-
services/managing-procurement/ub-asset-management.html.
Asset Management Revised 03/2020
