sree one INTOXILYZER 5000 and Deug Testing SUBJECT TEST FORM RST, Tate von “SUBJECT NAME DIA | BN Carri A_siliek [DATFOFBIRTA SOA Li 137 | 6 | 23 _ : ADDRESS ~ fen ~ BOS WN rar rt widg SF Lisle (Bae 0 STATE “ib CONF 1 DRIVER LICENSE = OH | Ptah” \|_ SPB; hy 9p. ! ‘OF. ia ARRESTING OF DEP; TM ENT ~~ li Cowenaniars foe. bee VstatUTORNINANCE j Heit SLIM tan J YD ayed LE BP HED? [sonata cutee un, OC! /. TEST SITES OV Intoxilyter 5000 Operational Checklist LAW Observe subject for twenty minutes prior to testing to prevent oral intake of any oT material, (2) Press "START" button. (3) Enter dats as prompted by ument display. [£1 (4) Teke breath sampte when "PLEASE. BLOW" appears on display. TEST RESULT | rc COSC IF SUBJECT REFUSED TEST WZ g/210L : : __ is There” | n | EE 1! FE ssaas rT eb GEE |") | 80/303! \|FO82 YOO DLA PO, AMC MADD Ae. LeaQeERaTeR's ERNE TE! ede | Bee bh H orn 4 arenes 2616 SERIAL. % 6O-O53031 ROPER SBd0e} BUBJECT'S WANED SURCIE-CAETL MAN COLTS GORESSED Os GRAND ce nbbane ee S18 Hate oe Beewrh [OO a stan on i SUEIECT THAT ALE BLAME MANE,“ URREREY CHARLES or tea)