Laserfiche WebLink
List I or List II Chemical Transaction <br />Strong Order ID: <br />Manifest Doc ID: <br />Date of Transaction: <br />Date of Destruction: <br />Supplier <br />Registration Number: <br />Name: <br />Address: <br />City: State: Zip: <br />Business Phone: <br />Purchaser <br />Registration Number: RS0239219 <br />Name: Strong Pharmaceutical Services, a Stericycle company <br />Address: 6264 Crooked Creek Road <br />City: Norcross State: GA Zip: 30092 <br />Business Phone: 770-409-1500 <br />Ship To Address (If Different than Purchaser Address) <br />Street: <br />City: State: Zip: <br />Date of Shipment: <br />Name(s) of Listed Chemical(s): <br />DEA Chemical Code Number (List One per Line - Add more lines on reverse): <br />Quantity and Form of Packaging (number of discrete units, total gross weight, and description) <br />Transportation and Destruction <br />Name of Transporter: <br />Method of Transport: <br />Witness (if applicable) <br />1. <br />2. <br />4 <br />