Ariz. Admin. Code § tit. 13, ch. 10, art. 1, exh. G-6
THIS REPORT PREPARED PURSUANT TO DUTY IMPOSED BY A.A.C. R13-10-104(A)
ARIZONA DEPARTMENT OF PUBLIC SAFETY
STANDARD OPERATIONAL AND QUALITY ASSURANCE PROCEDURES
INTOXILYZER MODEL 8000
DUPLICATE BREATH TEST WITH CONCURRENT QUALITY ASSURANCE PROCEDURES
SUBJECT NAME ___________________________________DATE ____________________
AGENCY _______________________________________OPERATOR __________________
INSTRUMENT SERIAL # ________________________LOCATION ______________________
SUBJECT TESTS | DIAGNOSTIC CHECKS | CALIBRATION CHECKS | ||
0. _________ AC | TIME ___________ | _________PASS | _________FAIL | 0. _________AC |
0. _________AC | TIME ___________ | _________PASS | _________FAIL | 0. _________ AC |
0. ________AC | TIME ___________ | |||
Immediately preceding administration of the tests, subject underwent at least a 15-minute deprivation period:
From | _______ | to | _______ | by | _______ |
(Time) | (Time) | (Name) |
() 1. Display reads "PUSH BUTTON TO START".
() 2. Push Start Test button.
() 3. Follow automated instructions on instrument display.
() 4. If test record reads "Successfully Completed Test Sequence" go to step 5
OR
If test record reads "Not a Successfully Completed Test Sequence", and subject will be tested again, remove test record and go to step 1
OR
If test record reads "Not a Successfully Completed Test Sequence", and subject will not be tested again, go to step 5
() 5. Remove test record.
Note: A successfully completed test sequence includes the following:
- At least a 15-minute deprivation period.
- Successful concurrent diagnostic checks
- Successful Concurrent Calibration Check Procedures bracketing the duplicate breath test
- Duplicate breath test administered at intervals of not less than 5 minutes nor more than 10 minutes apart and the two consecutive tests agreeing within 0.020 alcohol concentration.
DPS Form Exh G-6 (Rev 05-01)
Ariz. Admin. Code tit. 13, ch. 10, art. 1, exh. G-6