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