<p> 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</p><p>Breath Test Given? Suspect Mentioned DOB RACE SID # Male FBI # Yes No Victim Deceased / / Female Result _____ Last First Middle</p><p>Breath Test Given? Suspect Mentioned DOB RACE SID # FBI # Male Yes No Victim Deceased / / Female Result _____ Last First Middle</p><p>Breath Test Given? Suspect Mentioned DOB RACE SID # FBI # Male Yes No Victim Deceased / / Female Result _____ Last First Middle</p><p>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</p><p>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: </p><p>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</p><p>Submitted to Lab By (Please Print) Submitted to Lab By (Signature) Date</p><p>Submitted via LAB USE ONLY Evidence Packaging Description – Storage Location UPS U.S. Mail Certified Mail</p><p>Other ______Date / Time</p><p>Lab Staff</p><p>Evidence Transfer or Referral Received From: Via: UPS Date/Time Lab Staff Items Submission</p><p>Blue and Yellow Copies - Lab White Copy – Agency Rev 05-06</p>