Child Development Department
Date: ________________
CUSTODIAL (Clean Source) ORDER FORM 13-14
School Site:
Teacher:
CLEAN
SOURCE
Qty.
Unit
Classroom #:
Deliver to:
Cost Per
Unit
Description
Item Number
SCA290088
cs
Paper towels, brown, roll (6 rolls)
$43.95
SCASK1850A
cs
Single fold paper towels(16 pks/250 per pack)
$24.14
060805
ea
Deod Dry D’Vour lemon - 1 use container
$7.69
070140
ea
Cleanser Crème Comet
$4.43
090124
ea
#7 Disinf Deod Deterg
$11.95
120244
cs
Toilet paper (12 rolls per cs)
$39.95
140142
ea
# 20 Daily floor cleaner
$18.35
REN05235
bx
Glove nitrile GP PF MED (100per box)
$5.89
REN05236
bx
Glove nitrile GP PF LGE (100per box)
$5.89
190120
ea
#4 Disinf PH7Q ultra 32547 * for tables etc.
190124
ea
#4 Pre-screen bottle with trigger
260099
cs
Liner LLD 24X32 .8ML (500 per cs)
$25.80
261354
cs
Liner LD 33X39 1.5ML (100 per cs)
$14.20
266136
cs
Liner LD 36X60 28MIC DK GRN (100 per cs)
$23.84
315000
ea
#7 Disinf Deod Deterg AF315 – bottle w/trigger
343600
cs
½ Fold seat covers (250 pieces per pack/20 packs)
$28.50
343660
cs
Facial tissue 2 Ply (30 boxes per case)
$21.67
420133
cs
Non-foaming lotion hand soap pump bottle (12/cs)
$26.28
420166
gal
Non-foaming lotion hand soap gallon
420936
gal
Foaming lotion hand soap gallon
$12.49
420969
cs
Foaming lotion hand soap pump bottle (6/cs)
$43.86
425328
cs
Hand soap, bag-in-a-box (6 box)
$38.20
427785
cs
Alcohol free, waterless foam hand sanitizer
6/550ML/case
59.41
440060
ea
Water spray bottle – 32oz
$0.36
440070
ea
Pumps for gallon bottles
$3.30
440081
ea
Trigger spray for water bottle
$0.68
Total
cost
$18.00
$1.29
$1.29
$7.85
*When using disinfectant on table tops, table tops must be rinsed with clean water.
Ordered by: ______________________________________________________
Document1
Date: __________________
Coordinator Approval: ____________________________________________
Date: __________________
Child Development Department
Date: _________________
CUSTODIAL (Clean Source) ORDER FORM 13-14
School Site: __________________Teacher: _________________ Classroom #: ____ Deliver to:_____________
CLEAN
SOURCE
Qty.
Unit
Description
Item Number
Ordered by: ______________________________________________________
Document1
Cost Per
Unit
Total
cost
Date: __________________
Coordinator Approval: ____________________________________________
Document1
Date: __________________