Fillable Texas Department of Public Safety PRECURSOR CHEMICAL (Texas Real Estate Contracts)

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Texas Department of Public Safety PRECURSOR CHEMICAL (Texas Real Estate Contracts)

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Country of origin: US
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The Texas Real Estate Commission (TREC) is an agency that governs real estate practices in the state of Texas USA. I its headquarters are located in Ausin Texas at 1700 North Congress.

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RSD-905 (04/2020)
Texas Department of Public Safety PRECURSOR CHEMICAL
Regulatory Services Division LABORATORY APPARATUS
www.dps.texas.gov
REPORT OF THEFT, LOSS, OR SUSPICIOUS ORDER
PRECURSOR CHEMICAL, LABORATORY APPARATUS, EPHEDRINE, PSEUDOEPHEDRINE, OR NORPSEUDOEPHEDRINE
This form may be used to comply with Texas Health and Safety Code Chapters 481.077 (i), 481.080 (k), or 481.0771 (c).
A. General Information
Business Name
Physical Address
City County State ZIP
Mailing Address
City County State ZIP
Phone
DEA Number (If applicable)
Date
Check One: Theft Loss Discrepancy Suspicious Order
B. Theft, Loss or Discrepancy
Was the theft/loss/discrepancy reported to a police agency? Yes No
Name of Police Agency
Address of Police Agency
Type of theft/loss/discrepancy (night break-in, armed robbery, employee theft, customer pilferage, incorrect amount received, etc.).
Explain any difference between the amount received and the amount shipped.
List identifying marks, symbols, or prices codes on lost or stolen items.
Describe security measures in place to prevent future thefts.
C. Suspicious Order (Ephedrine, Pseudoephedrine, Norpseudoephedrine)
Name of Business placing order
Name of person (if known)
Address
DEA Number (If applicable)
New Account? Yes No
Date of Order
RSD-905 (04/2020)
List the items ordered below or attach invoice
D. List of all lost, stolen, missing, or suspicious orders of chemical precursors, laboratory apparatus, Ephedrine,
Pseudoephedrine,
or Norpseudoephedrine
Chemical
Quantity/Amount
Apparatus
Quantity
For suspicious orders please explain any unusual circumstances associated with this order.
I certify that the foregoing information is correct to the best of my knowledge and belief.
_________________________________________________
Signature
_________________________________________________
Printed Name
_________________________________________________
Date Signed
Mailing Address:
Texas Department of Public Safety
Precursor Chemical Laboratory Apparatus – MSC-0438 PO Box 4087
Austin, TX 78773-0438
To upload your form, please visit RSD secured website:
https://www.dps.texas.gov/rsd/contact/default.aspx
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Texas Department of Public Safety PRECURSOR CHEMICAL (Texas Real Estate Contracts)

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Completed 9 August 2021

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