1. REQUEST FOR SANITIZATION OF DATA STORAGE DEVICE

 


REQUEST FOR SANITIZATION OF DATA STORAGE DEVICE

 

                 

Requestor:                  Date:

 

Title

Department

 

Justification for Data Sanitization

 

 

 

 

               

No more than 10 items per record (submit additional record if needed).

#

Item Description

State Tag No./ *Serial No.

For OIT Use:

 Results

 

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*When item does not have a State Tag No., provide Serial No. of item.

 

 

________________________________________  _______________________________________

Requestor’s Signature      Date    Department Head’s Signature    Date

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

 

Certification: My signature certifies that the above computer/data storage device(s) have been properly sanitized.

 

_______________________________________ ___________________________________________

Authorized Sanitizing Technician  Date   Authorized IT Supervisor/Computer Lab Supervisor  Date

Form 1822/009 (6/05)

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