2025-11 GB Instruments Serviced.pdf
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- Solicitation number
- 36C25226Q0075
About this file
This is a packing slip from STERIS Instrument Management Services, INC. documenting the shipment of on-location instrument maintenance services to Milo C Huempfner VA Medical Center in Green Bay, Wisconsin. Order Number 4286876 was placed on November 14, 2025, with Service Request Number V7W743159. The customer contact is Rodney Champeau at 920-431-2613, and the services are being delivered to the Operating Room department. The sales representative is Jared Michael Justice.
The packing slip lists 18 line items representing various instrument service kits and repair work performed on-location at the VA Medical Center facility. Services include maintenance on dental hygiene kits, dental restorative kits, dental clinic basic kits, dental perio extraction sets, specialty clinic surgical sets, cataract surgery kits, and a repair bin. Each line item specifies the serial number of the instrument kit and itemizes the specific instruments serviced with their corresponding service level (ranging from Level 1 basic inspection and cleaning to Level 3 comprehensive maintenance including adjustments, sharpening, and alignment). All line items are priced at $0.00, with a subtotal of $0.00 USD. The document notes that payment should not be made from this packing slip, as an invoice will follow, and applicable taxes and shipping/handling charges will be added separately.
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| VAAR 852.219-75-Certification Page.docx | DOCX document | |
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| C03 Attachment 1 - Instrument List 1.xlsx | XLSX spreadsheet | |
| 2025-12 GB Instruments Serviced.pdf | ||
| 2025-10 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: 4286876 Service Request Number: V7W743159
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 11/14/2025 Page 1 of 6
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
14-NOV-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:C10000899 ON-LOCATION INSTRUMENT SERVICE (GB Dental Hygiene Kit 43) 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 3 $0.00 $0.00
Item Total USD $0.00
2 SN:C10011507 ON-LOCATION INSTRUMENT SERVICE (GB Dental Hygiene Kit 57) 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 3 $0.00 $0.00
Item Total USD $0.00
3 SN:10266 ON-LOCATION INSTRUMENT SERVICE (Cataract 11) 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
3 $0.00 $0.00
ONL2372 - Manipulator-Ophthalmic: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align
1 $0.00 $0.00
Item Total USD $0.00
4 SN:C10003428 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL PERIO
EXTRACTION SET 4)
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
ONL2342 - Elevators: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen 4 $0.00 $0.00
ONL2352 - Elevators-D/E: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen
7 $0.00 $0.00
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00
Service Request Number: V7W743159
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 11/14/2025 Page 2 of 6
ONL2521 - Knife-Handles: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00 ONL2552 - Knives: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Sharpen 5 $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 2 $0.00 $0.00
ONL2732 - Retractors-Handheld: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Straighten, Deburr
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 9 $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 2 $0.00 $0.00
Item Total USD $0.00
5 SN:C10001492 ON-LOCATION INSTRUMENT SERVICE (GB Dental Hygiene Kit 46) 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 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 1 $0.00 $0.00
Item Total USD $0.00
6 SN:C10000067 ON-LOCATION INSTRUMENT SERVICE (GB Specialty Clinic Surgical Set 001)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 2 $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
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
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
ONL2851 - Skin Hooks: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00 ONL2871 - Skin Rakes: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00
Item Total USD $0.00
7 SN:C10000663 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL
RESTORATIVE KIT 21)
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
Service Request Number: V7W743159
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 11/14/2025 Page 3 of 6
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
8 SN:10267 ON-LOCATION INSTRUMENT SERVICE (Cataract 2) 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
6 $0.00 $0.00
ONL4303 - Micro Forceps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Adjust, Straighten, Align Tips
1 $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
2 $0.00 $0.00
ONL2372 - Manipulator-Ophthalmic: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Align
2 $0.00 $0.00
Item Total USD $0.00
9 SN:C10000070 ON-LOCATION INSTRUMENT SERVICE (GB Specialty Clinic Surgical Set 4)
1 $0.00 $0.00
ONL2121 - Clamps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate 2 $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
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
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
ONL2851 - Skin Hooks: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00 ONL2871 - Skin Rakes: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00
Item Total USD $0.00
10 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 2 $0.00 $0.00
ONL2383 - Forceps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Straighten, Align Tips
1 $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 3 $0.00 $0.00
Item Total USD $0.00
11 SN:C10000844 ON-LOCATION INSTRUMENT SERVICE (GB OR DENTAL OS
EXTRACTION 10)
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
5 $0.00 $0.00
Service Request Number: V7W743159
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 11/14/2025 Page 4 of 6
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
ONL3103 - Needleholder: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Align Jaws, Align Ratchet, Align Shank
1 $0.00 $0.00
ONL2701 - Rasps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 3 $0.00 $0.00
ONL2732 - Retractors-Handheld: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Straighten, Deburr
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 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 1 $0.00 $0.00
Item Total USD $0.00
12 SN:C10000419 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL
RESTORATIVE KIT 7)
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
13 SN:C10002545 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL CLINIC BASIC
KIT 35)
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 2 $0.00 $0.00
ONL2383 - Forceps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Straighten, Align Tips
1 $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
14 SN:C10001041 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL CLINIC BASIC
KIT 33)
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, 1 $0.00 $0.00
Service Request Number: V7W743159
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 11/14/2025 Page 5 of 6
Lubricate, Sharpen
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
15 SN:10251 ON-LOCATION INSTRUMENT SERVICE (GB Dental Clinic Basic Kit 8) 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
ONL2381 - Forceps: Level 1: Inspection, Ultrasonic Clean, Rinsing, Dry 2 $0.00 $0.00
ONL2383 - Forceps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust, Straighten, Align Tips
1 $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 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
16 SN:9999 (Repair Bin) 1 $0.00 $0.00
ONL2123 - Clamps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Align, Adjust, Set Ratchet, Adjust Shank
2 $0.00 $0.00
ONL2412 - Forceps-Bone Cutting S/A: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Sharpen Edge
2 $0.00 $0.00
ONL4303 - Micro Forceps: Level 3: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Adjust, Straighten, Align Tips
2 $0.00 $0.00
ONL2782 - Retractors-Self Retaining: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Align, Reset
2 $0.00 $0.00
ONL2792 - Rongeurs-S/A: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Lubricate, Reset, Sharpen Edges
1 $0.00 $0.00
ONL3252 - Needle Holder-Ophthalmic: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust Jaws
1 $0.00 $0.00
ONL8803 - Misc Repair: Level 3 Remove labels from baskets 15 $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:C10000502 ON-LOCATION INSTRUMENT SERVICE (GB DENTAL
RESTORATIVE KIT 14)
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 6 $0.00 $0.00 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 4 $0.00 $0.00
Service Request Number: V7W743159
STERIS Instrument Management Services, INC.
3316 2nd Ave North Birmingham, AL 35222 800-783-9251 www.steris-ims.com
Date Printed: 11/14/2025 Page 6 of 6
Item Total USD $0.00
18 SN:C10000818 ON-LOCATION INSTRUMENT SERVICE (GB Dental Hygiene Kit 40) 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 ONL2962 - Probe: Level 2: Inspection, Ultrasonic Clean, Rinsing, Dry, Adjust 1 $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 .