Oregon State Police Forensic Services Request

Oregon State Police Forensic Services Request Page of Agency Restrict This Case Lab Case # Sub # Rush Case - Reason & Date Due Agency Case # Additional Suspect Info Only Offense Previous EvidenceOffense Submitted Date County of Venue (Please select an offense) Last First Middle

Breath Test Given? Suspect Mentioned DOB RACE SID # Male FBI # Yes No Victim Deceased / / Female Result _____ Last First Middle

Breath Test Given? Suspect Mentioned DOB RACE SID # FBI # Male Yes No Victim Deceased / / Female Result _____ Last First Middle

Breath Test Given? Suspect Mentioned DOB RACE SID # FBI # Male Yes No Victim Deceased / / Female Result _____ Investigating Officer (Please Print) Phone # of Investigating Officer Email of Investigating Officer

Lab Exhibit Agency Description of Evidence Exam Requested Exhibit (Please associate evidence with appropriate individual) (Please include officer report on all physical evidence) URINE DRE Officer: DRE Agency:

Stimulants (specify): Inhalants (specify): Narcotics (specify): Disassociative Anesthetics Depressants (specify): Other (specify): MJ Confirm DRE evaluation for medications Hallucinogens (specify): Confirm DRE evaluation for controlled substances

Submitted to Lab By (Please Print) Submitted to Lab By (Signature) Date

Submitted via LAB USE ONLY Evidence Packaging Description – Storage Location UPS U.S. Mail Certified Mail

Other ______Date / Time

Lab Staff

Evidence Transfer or Referral Received From: Via: UPS Date/Time Lab Staff Items Submission

Blue and Yellow Copies - Lab White Copy – Agency Rev 05-06