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11085 - March 13, 2024 -

Date

March 13, 2024

Repair Order

11085

Facility

Facility Name

Superior Surgical

Contact Name

John Skupien

Billing Name

Skupien

Email Address

john@superiorsurg.com

Phone Number

Shipping Address

2182 Hillsboro Valley Road,

brentwood, State 37024

United States

Billing Address

Equipment

PO #

26912

Manufacturer

Alaris

Model #

8100

Serial #

14197640

Asset Tag #

036329

Reported Failure

FAULT: Air in Line

Anything Else

Please quote prior to repair for approval