HQ F 1400.

18 TP/TI
U.S. Department of Energy
( 10/2011 )

PROPERTY Date
TRANSFER or TURN-IN ✔
PICKUP DELIVERY

Name: Odell Robinson Name: Property and Supply

Org. Code/Rm. #: EE-62W/5E-079 Org. Code/Rm. #: MA/Loading Dock
Phone Number: #6-7585 Phone Number: #6-0202
Property Location: Property Location:
Property Stock No. Description Serial No. Qty. Unit Age and
Tag No. of Articles Price Condition

Justification/Remarks: Replacement Item Requested: yes no

 Safes: I certify that the safe has been cleared, unlocked and the combination set to 50-25-50.
 Media: I certify that all electronic media and/or hard drives have been removed.

PICKUP ACCOUNTABLE PROPERTY REP DELIVERY ACCOUNTABLE PROPERTY REP

Pickup Date: Received Date:

Signature: Signature:

Print Name: Print Name:

APPROVED:
PROPERTY ACCOUNTABLE OFFICER DATE

ORIGINAL; COPY 1 - TRANSFEREE; COPY 2 - PROPERTY ACCOUNTABLE OFFICER; COPY 3 - TRANSFEROR

Printed with soy ink on recycled paper