ISSRO PMO SERVER DECOMMISSION REQUEST FORM v1.

3 (revised 3/21/2011) Note: Presently, ISSRO PMO is responsible for submitting all server and non-server equipment (i.e., routers, SAN, switches, etc.) decom requests via Remedy. Instructions 1) As a minimum, please provide information requested on the bolded items. 2) Please coordinate a date and time with the CSvD rep for actual server shutdown. Both you and the CSvD rep should be present during shutdown. 3) Once the server is shut down, please inform "ISSRO Census Blade Migration Office List" via e-mail. 4) ISSRO PMO will send you the Remedy ticket no. of the decom request, upon submission. Internal Tracking (Remedy) Number: to be assigned by ISSRO PMO IT Division Manager (CSVD, LTSO, etc) Program Area (Owner) Date of Submission Required Completion Date (if none Mark N/A) Contact Name Contact Extension Asset Title Operating System Make & Model Equipment Barcode # Equipment Location (e.g., BCC MOD #)/VM Farm Name Data Center Domain Name System (DNS) Name Node name IP Address Aliases Power Specifications Manufacturer's British Thermal Unit (BTU) rating (if known) Manufacturer's electrical load requirements (if known)

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Form v.5 - 7/7/2008