1234856789 1013 t2 13:14 35 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 SHEETINO. OF|6. REQUISITION NUMBER lta. VOUCHER NUMBER AND DATE b. VOUCHER NUMBER AND DATE REQUISITION AND INVOICE / SHIPPING DOCUMENT REQ “2 (CONTINUATION SHEET) TEM NO. -a PMS" HD1012 7338 8000XXX FEDERAL STOCK NUMBER, DESCRIPTION, AND CODING OF MATERIEL AND/OR SERVICES b . 16 CUTTER, Cast, DNA Prop, No. 0331M 18 19 REGUL‘TOR, Air Tank, DNA Prop No. 0333M, O334M, 0506M — STERILIZER, Water Bath, DNA Prop No. O499M 17 20 21 HYFRECATOR, DNA Prop No, 0332M STAND, I.V., DNA Prop No. 500M TRON, Sealing, DNA Prop. No. 0046 22 TABLE, Emergency, DNA Prop No. 0502M 24 WHEEL CHAIR, DNA Prop No. 7038 27 BED, Hospital, Adjustable, DNA Prop No. NONE 23 WHEEL CHAIR, DNA Prop No, 0501M 25 26 28 CABINET, Medicine, 2 Door, SS, DNA Prop No. 0332 CABINET, Medicine, Narcotic, SS, DNA Prop No. 0332 STAND, Hospital Bed, DNA Prop No. NONE /x/x/xf/x/x/x/x/x/x/x/x/x/x/x/x/x/x/x/x/x/x/x/x/x/xLAST ITEM /x/x/ SUPPLY rS| QUANTITY ZOVIREQUESTED} Cc” ACTION d SPER ESSSER OPE p SHIPPING CONTAINER TALLY € |uZul amen 7 . |*02) nos [+i &@ re 1 a UNIT PRICE TOTAL COST A $,35.00 115.00 100.00 125.00 50.00 214.00 185,00 "85.00 104,00 300.00 400,00 150,00 40,00 i i$ 85.00 115.00 300,00 125,00 50.00. 214,00 185,00 785.00 104,00 300.00 400.00 150.00 40,00 | xfxf x/xfx/x/x/ x)xfx/x\x/x/x/ x]x/ x/x/xfx/xf "I CERTIFY THAT THE ABOVE LISTED ITEMS ARE IN THE CUSTODY OF THE YPSAF CLINIC, ENEWETAK," arbor Keb. CHARLES D. ROTH, TSGT, SSN 265-74-2217 NCOIC, USAF CLINIC ENEWETAK APPROVED: } DD JOHN R. SITTEN F OF LOGISTICS NA/JTG ENEWETAK ATOLL, M.I. SHEET TOTAL tn $2153, 00 abn . pyn imanss 1,149¢ PMARSO yh gs Mee wha . 5152 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74:75 76 7? 78 79 8O GI 2 83 84 65 66 87 88 89 9 91 92 93 94 95 96 97 98 9 REPLACES EDITION OF 1 MAY 58 WHICH MAY BE USED 4 me ee ee ee: OO