MOBILE BACKPACK WITH SUPPLIES – Fieldtex Products Inc.

FIELDTEX ORDER#- LINE: *

CUSTOMER NAME: (IF APPLICABLE) *

MOBILE BACKPACK SERIAL NUMBERS: *

All Serial Numbers that include these lot numbers listed individually or by 00001-00010 Format

PIECES: *

922-99908-TOURNIQUETS-LOT NUMBER: *

Quantity 4 per kit

933-00286B-WATER-JEL BURN DRESSING-LOT NUMBER: *

Quantity 2 per kit

WATER-JEL BURN DRESSING-EXPIRATION DATE: *

922-99902-QUICK CLOT-LOT NUMBER: *

Quantity 2 per kit

QUICK CLOT-EXPIRATION DATE: *

933-00286D-CHEST SEAL-LOT NUMBER: *

Quantity 2 per kit

CHEST SEAL-EXPIRATION DATE: *

933-00286F- ISRAELI 6" BANDAGE-LOT NUMBER: *

Quantity 2 per kit

922-00087F-SAM SPLINT 36" FLAT-LOT NUMBER: *

Quantity 1 per kit

922-99124-UNITIZED TRIANGULAR BANDAGE-LOT NUMBER: *

Quantity 2 per kit

922-00013-ELASTIC BANDAGE 4" X 5 YDS.-LOT NUMBER: *

Quantity 2 per kit

922-00031-ROLLED GAUZE 4"-LOT NUMBER: *

Quantity 2 per kit

922-00038-COMBINE PAD 5" X 9"-LOT NUMBER *

Quantity 4 per kit

922-99910-UREA ICE PACK 4" X 5"-LOT NUMBER: *

Quantity 1 per kit

922-00081-EMERGENCY SPACE BLANKET-LOT NUMBER: *

Quantity 2 per kit

922-00084-FIRST AID GUIDE-LOT NUMBER: *

Quantity 1 per kit

922-00099-GLUCOSE-LOT NUMBER: *

Quantity 1 per kit

GLUCOSE-EXPIRATION DATE: *

922-00146-CPR FACE SHIELD-LOT NUMBER: *

Quantity 1 per kit

922-04061 UTILITY SCISSORS 5.5”-LOT NUMBER: *

Quantity 1 per kit

922-08212-CLOTH SURGICAL TAPE 2" X 10 YDS.-LOT NUMBER: *

Quantity 1 per kit

922-10240-EXAM GLOVES -LOT NUMBER: *

Quantity 5 per kit

922-99187-BIOHAZARD CERTI BAGS-LOT NUMBER: *

Quantity 1 per kit

922-90598-GS ASPIRIN-LOT NUMBER: *

Quantity 1 per kit

GS ASPIRIN-EXPIRATION DATE: *

922-91115-BZK HAND WIPES-LOT NUMBER: *

Quantity 1 per kit

BZK HAND WIPES-EXPIRATION DATE: *

922-99178-ALLERGY MEDS-LOT NUMBER: *

Quantity 1 per kit

ALLERGY MEDS-EXPIRATION DATE: *

922-99179-TRAUMA DRESSING/GAUZE-LOT NUMBER: *

Quantity 2 per kit

888-120631-GERSTNER-MOBILE RESCUE POUCH (WHT/RD)-BATCH NUMBER:

Include Batch and number

922-00001-3/4 x 3 BULK-LOT NUMBER *

Quantity 6 per kit

922-00002-2 x 4 BULK-LOT NUMBER: *

Quantity 3 per kit

922-00009-1 x 3 BULK-LOT NUMBER: *

Quantity 7 per kit

922-00033-EYE PADS BULK-LOT NUMBER: *

Quantity 2 per kit

922-00048-WATER JEL FIRST AID CREAM-LOT NUMBER: *

Quantity 10 per kit

WATER JEL FIRST AID CREAM-EXPIRATION DATE: *

922-00051-TRIPLE-LOT NUMBER: *

Quantity 10 per kit

TRIPLE-EXPIRATION DATE: *

922-00057 -EYEWASH 1 OZ.-LOT NUMBER: *

Quantity 1 per kit

EYEWASH 1 OZ.-EXPIRATION DATE: *

922-11984- SANI-HANDS ALC-LOT NUMBER: *

Quantity 10 per kit

SANI-HANDS ALC-EXPIRATION DATE: *

922-00073-TWEEZERS-LOT NUMBER: *

Quantity 1 per kit

KIT ASSEMBLED BY: *

KIT CHECKED BY: *

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