Environmental Education Equipment Checkout Form printable pdf download

Environmental Education Equipment Checkout Form

ENVIRONMENTAL EDUCATION EQUIPMENT CHECKOUT FORM

Date of checkout______________ Date of return ___________________

NAME _______________________________________________________

ADDRESS ____________________________________________________

CITY ___________________________ STATE _______ZIP_____________

PHONE #1 __________________________PHONE #2__________________

EMAIL_________________________________________________________

Enviroscape _________

River Lab (stream table) ________

Display Board _____

Ollie Otter ______

Projector Screen ________

Large Display (DOW) _______

Condition of equipment at checkout ____________________________

_____________________________________________________________

__________________________________

_____________________

DOW PERSONNEL CHECKING EQUIP. OUT

DATE

Condition of equipment at check in______ ________________________

_____________________________________________________________

____________________________________

_____________________

DOW PERSONNEL CHECKING EQUIP. IN

DATE

I agree to return the equipment that has been loaned to me by the Division

of Water. If I do not return the equipment or damage the equipment then I

agree to reimburse the Division of Water for the replacement cost or repair

cost.

_______________________________________________ ______________

Signature

Date

Equipment needs to be returned to Joann Palmer at 300 Sower Blvd., 3

Floor, Frankfort, KY, 40601. 502-782-7032, mobile 502-330-1748.

Joann.Palmer@ky.gov

Environmental Education Equipment Checkout Form