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