2025-10 GB Instruments Serviced.pdf
PDF 121 KB Posted
- Solicitation number
- 36C25226Q0075
About this file
This is a packing slip from STERIS Instrument Management Services, INC. documenting the return of repaired surgical and dental instruments to the Milo C Huempfner VA Medical Center in Green Bay, Wisconsin. The shipment, dated October 17, 2025, contains 21 line items representing on-location instrument service kits for various dental and surgical specialties, including dental clinic basic kits, restorative kits, hygiene kits, oral surgery extraction sets, gynecology kits, cataract surgery kits, and a repair bin. All items are priced at $0.00 with a subtotal of $0.00.
Each kit contains multiple instruments requiring various levels of service, ranging from Level 1 (basic inspection, ultrasonic cleaning, rinsing, and drying) to Level 3 (comprehensive processing including adjustments, sharpening, alignment, and deburring). Representative instruments include forceps, scissors, elevators, clamps, needle holders, retractors, probes, scalers, and suction tubes/tips. The order number is 4252359 with service request number V7W735650, and the document notes that an invoice will follow separately and customers should not pay based on this packing slip.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2025-11 GB Instruments Serviced.pdf | ||
| VAAR 852.219-75-Certification Page.docx | DOCX document | |
| 2026-02-02 MIL Instruments Serviced.pdf | ||
| C03 Attachment 1 - Instrument List 1.xlsx | XLSX spreadsheet | |
| 2025-12 GB Instruments Serviced.pdf | ||
| S06-36C25226Q0075 0001.docx | DOCX document | |
| S05-VENDOR QUESTIONS-ANSWERS.docx | DOCX document | |
| 2026-02-09 MIL Instruments Serviced.pdf | ||
| 2026-02-17 MIL Instruments Serviced.pdf |
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Text version
Packing Slip Order Number: 4252359 Service Request Number: V7W735650
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 10/17/2025 Page 1 of 7
Customer
MILO C HUEMPFNER VA MEDICAL CENTER- GEEEN BAY
2851 UNIVERSITY AVENUE
Green Bay, WI 54311
Deliver To
Purchase Order Department Operating Room
Last Ship Date
17-OCT-2025
Reference
Sales Person Justice, Jared Michael
Customer Contact Rodney Champeau
Contact Phone Number 920-431-2613
Customer Number 65906
Special Instructions
Notes :
Line Description Qty Unit Price Ext Price
1 SN:C10000688 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL CLINIC BASIC
KIT 32)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00 ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00
ONL1102 - General Scissors: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 1 $0.00 $0.00
Item Total USD $0.00
2 SN:10264 ON-LOCATION INSTRUMENT SERVICE (GYN Clinic IUD Kit 1) 1 $0.00 $0.00 ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 3 $0.00 $0.00
ONL1102 - General Scissors: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen
1 $0.00 $0.00
Item Total USD $0.00
3 SN:C10000816 ON-LOCATION INSTRUMENT SERVICE (GB Dental Hygiene Kit 38) 1 $0.00 $0.00 ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
12 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 2 $0.00 $0.00
Item Total USD $0.00
4 SN:C10000383 ON-LOCATION INSTRUMENT SERVICE (GB OR DENTAL OS
EXTRACTION 6)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00 ONL2342 - Elevators: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen 8 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
6 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00
ONL1102 - General Scissors: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen
1 $0.00 $0.00
ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2701 - Rasps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00 ONL2732 - Retractors-Handheld: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, 1 $0.00 $0.00
Service Request Number: V7W735650
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 10/17/2025 Page 2 of 7
Straighten, Deburr ONL2771 - Retractors-D/E: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL2792 - Rongeurs-S/A: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Reset, Sharpen Edges
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
2 $0.00 $0.00
ONL2181 - Extractor-Dental: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 4 $0.00 $0.00 ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
Item Total USD $0.00
5 SN:C10000899 ON-LOCATION INSTRUMENT SERVICE (GB Dental Hygiene Kit 43) 1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
12 $0.00 $0.00
ONL2211 - Forcep-ENT: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00 ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00
Item Total USD $0.00
6 SN:C10002072 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL
RESTORATIVE KIT 34)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
11 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 4 $0.00 $0.00 ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2781 - Retractors-Self Retaining: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
4 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 7 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 4 $0.00 $0.00
Item Total USD $0.00
7 SN:C10003109 ON-LOCATION INSTRUMENT SERVICE (GB OR DENTAL OS
EXTRACTION 2)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00 ONL2342 - Elevators: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen 8 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
6 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00 ONL2382 - Forceps: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 1 $0.00 $0.00
ONL1102 - General Scissors: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen
1 $0.00 $0.00
ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2701 - Rasps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL2732 - Retractors-Handheld: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Straighten, Deburr
1 $0.00 $0.00
ONL2771 - Retractors-D/E: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
Service Request Number: V7W735650
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 10/17/2025 Page 3 of 7
ONL2792 - Rongeurs-S/A: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Reset, Sharpen Edges
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
2 $0.00 $0.00
ONL2181 - Extractor-Dental: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 4 $0.00 $0.00 ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
Item Total USD $0.00
8 SN:9999 (Repair Bin) 1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
2 $0.00 $0.00
ONL2413 - Forceps-Bone Cutting S/A: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen Edge, Align, Tighten Screws, Reset, Adjust Springs
5 $0.00 $0.00
ONL4303 - Micro Forceps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Adjust, Straighten, Align Tips
1 $0.00 $0.00
ONL1302 - TC Scissors: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen
1 $0.00 $0.00
ONL7817 - Container-Lid: Level 7: Inspection, Clean, Refurbish, Align Rim, Remove Minor Burrs, Remove Major Dents, Remove/Replace Pins, Adjust Latch, Replace Gasket, Lubricate
1 $0.00 $0.00
ONL3252 - Needle Holder-Ophthalmic: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust Jaws
1 $0.00 $0.00
Item Total USD $0.00
9 SN:C10000677 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL
RESTORATIVE KIT 23)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
9 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 4 $0.00 $0.00 ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2781 - Retractors-Self Retaining: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
3 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 6 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 5 $0.00 $0.00
Item Total USD $0.00
10 SN:C10000128 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL CLINIC BASIC
KIT 2)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00 ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00
ONL1102 - General Scissors: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 1 $0.00 $0.00
Item Total USD $0.00
11 SN:C10004297 ON-LOCATION INSTRUMENT SERVICE (GB Dental Perio Basic Kit 1 $0.00 $0.00
Service Request Number: V7W735650
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 10/17/2025 Page 4 of 7
15)
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL2383 - Forceps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Straighten, Align Tips
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
2 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00
Item Total USD $0.00
12 SN:10265 ON-LOCATION INSTRUMENT SERVICE (OR Cataract 10) 1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL4301 - Micro Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
5 $0.00 $0.00
ONL4303 - Micro Forceps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Adjust, Straighten, Align Tips
2 $0.00 $0.00
ONL4103 - Micro Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Align, Proximate Tips
2 $0.00 $0.00
ONL2371 - Manipulator-Ophthalmic: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry
1 $0.00 $0.00
ONL2372 - Manipulator-Ophthalmic: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align
3 $0.00 $0.00
ONL2451 - Speculum-Ophthalmic: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
Item Total USD $0.00
13 SN:C10000646 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL PERIO
EXTRACTION SET 2)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL2342 - Elevators: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen 7 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
9 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00 ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2701 - Rasps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL2732 - Retractors-Handheld: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Straighten, Deburr
1 $0.00 $0.00
ONL2771 - Retractors-D/E: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL2792 - Rongeurs-S/A: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Reset, Sharpen Edges
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
2 $0.00 $0.00
ONL2181 - Extractor-Dental: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 8 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 1 $0.00 $0.00
Item Total USD $0.00
14 SN:C10000399 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL 1 $0.00 $0.00
Service Request Number: V7W735650
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 10/17/2025 Page 5 of 7
RESTORATIVE KIT 5)
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
11 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 4 $0.00 $0.00 ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2781 - Retractors-Self Retaining: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
3 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 7 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 4 $0.00 $0.00
Item Total USD $0.00
15 SN:C10000674 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL
RESTORATIVE KIT 22)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
11 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 4 $0.00 $0.00 ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2781 - Retractors-Self Retaining: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
5 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 8 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 3 $0.00 $0.00
Item Total USD $0.00
16 SN:C10000683 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL
RESTORATIVE KIT 27)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
11 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 4 $0.00 $0.00 ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2781 - Retractors-Self Retaining: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
4 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, 2 $0.00 $0.00
Service Request Number: V7W735650
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 10/17/2025 Page 6 of 7
Align, Remove Burrs ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 8 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 3 $0.00 $0.00
Item Total USD $0.00
17 SN:C10000128 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL CLINIC BASIC
KIT 2)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00 ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00
ONL1102 - General Scissors: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 1 $0.00 $0.00
Item Total USD $0.00
18 SN:C10001241 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL CLINIC BASIC
KIT 34)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00 ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00
ONL1102 - General Scissors: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
3 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00
Item Total USD $0.00
19 SN:C10000517 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL
RESTORATIVE KIT 15)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
11 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00 ONL2382 - Forceps: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 2 $0.00 $0.00 ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2781 - Retractors-Self Retaining: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
4 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 7 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 4 $0.00 $0.00
Item Total USD $0.00
20 SN:C10000063 ON-LOCATION INSTRUMENT SERVICE (GB Dental Hygiene Kit 28) 1 $0.00 $0.00 ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
12 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00
Service Request Number: V7W735650
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 10/17/2025 Page 7 of 7
ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 1 $0.00 $0.00
Item Total USD $0.00
21 SN:C10000400 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL
RESTORATIVE KIT 6)
1 $0.00 $0.00
ONL2123 - Clamps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Align, Adjust, Set Ratchet, Adjust Shank
1 $0.00 $0.00
ONL1203 - Delicate (Tenotomy/Iris) Scissors: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen, Deburr, Align, Proximate Tips, Adjust Shank
1 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
11 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 4 $0.00 $0.00 ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 1 $0.00 $0.00
ONL3101 - Needleholder: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
1 $0.00 $0.00
ONL2781 - Retractors-Self Retaining: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry
1 $0.00 $0.00
ONL2911 - Suction Tubes/Tips: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate
4 $0.00 $0.00
ONL2203 - Scaler-Dental: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align, Remove Burrs
2 $0.00 $0.00
ONL2961 - Probe: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 7 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 4 $0.00 $0.00
Item Total USD $0.00
Customers: Do not pay from this document, invoice will follow.
Where applicable, tax and shipping/handling will be added.
******************************************************************** Subtotal USD $0.00
Customer Signature
We appreciate your business!
In the event any item(s) identified on this Packing Slip is currently subject to a recall, please be aware that in the process of completing the repairs indicated, IMS did not take actions related to any such recall. We encourage you to strictly follow any guidance provided by the Recalling Firm with respect to any recall in effect.
File details come from the government source that posted it. Updated .