Fillable EXHIBIT G-1 OPERATIONAL CHECKLIST ARIZONA DEPARTMENT OF PUBLIC (Arizona Department of Public Safety)

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EXHIBIT G-1 OPERATIONAL CHECKLIST ARIZONA DEPARTMENT OF PUBLIC (Arizona Department of Public Safety)

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EXHIBIT G-1
OPERATIONAL CHECKLIST
ARIZONA DEPARTMENT OF PUBLIC SAFETY
STANDARD OPERATIONAL PROCEDURE
INTOXILYZER MODEL 8000
DUPLICATE BREATH TEST
SUBJECT NAME ____________________________________________________ DATE ___________________________
AGENCY ______________________________________ OPERATOR __________________________________________
INSTRUMENT SERIAL # ________________________ LOCATION ___________________________________________
TEST RESULTS 0.__________ AC TIME _________
0.__________ AC TIME _________
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: Duplicate breath tests shall be administered at intervals of not less than 5 minutes nor more than 10 minutes apart and
the two consecutive tests shall agree within 0.020 alcohol concentration.
DPS Form Exh G-1 (Rev 05-1)
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EXHIBIT G-1 OPERATIONAL CHECKLIST ARIZONA DEPARTMENT OF PUBLIC (Arizona Department of Public Safety)

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Completed 20 July 2020

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