LION alcolmeter 500 - Page 24

lion alcolmeter
®
500 Mk IV User Handbook
24
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LION ALCOLMETER 500
Instrument Serial Number: 12345
Last Calibration Check:
16:54 on 01/12/2011
SUBJECT BREATH TEST
Time: 12:37:06
Date: 01/03/2012
Test Number: 0004
Blank Check: 0.00mg/L
Breath Result: 0.65mg/L
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Subject Name
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Subject Signature
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Operator Name
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Operator Signature
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Witness Name
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Witness Signature
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Location
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LION ALCOLMETER 500
Instrument Serial Number: 12345
Last Calibration Check:
16:54 on 01/12/2011
SUBJECT BREATH TEST
Time: 14:01:10
Date: 01/03/2012
Test Number: 0004
Blank Check: 0.00mg/L
Breath Result: NO SAMPLE [3]
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Subject Name
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Subject Signature
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Operator Name
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Operator Signature
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Witness Name
………………………………………..
Witness Signature
………………………………………..
Location
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