Ariz. Admin. Code § tit. 13, ch. 10, art. 1, exh. G-4
THIS REPORT PREPARED PURSUANT TO DUTY IMPOSED BY A.A.C. R13-10-104(A)
ARIZONA DEPARTMENT OF PUBLIC SAFETY
STANDARD QUALITY ASSURANCE PROCEDURES
INTOXILYZER MODEL 8000
STANDARD QUALITY ASSURANCE PROCEDURE
QA SPECIALIST ______________________________AGENCY ____________________________
DATE ________________________________TIME _____________________________________
INTOXILYZER SERIAL # __________________________LOCATION _________________________
() 1. Display Reads "PUSH BUTTON TO START"
DIAGNOSTIC TESTS
() 1. Clock time check.
() 2. Date check.
OPERATIONAL TESTS
() 1. Alcohol-free subject test result 0._____________AC.
() 2. Error recognition logic system functioning.
Not a Successfully Completed Test Sequence printed
() 3. Proper sample recognition system.
Not a Successfully Completed Test Sequence printed
Deficient sample printed.
() 4. Standard Calibration Check standard 0._____________AC. Result 0._____________AC.
Instrument is operating properly and accurately. YES ______ NO ______
COMMENTS _____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
SIGNATURE ____________________________________________________________________
DPS Form Exh G-4 (Rev 05-01)
Ariz. Admin. Code tit. 13, ch. 10, art. 1, exh. G-4