Evidential Breath Alcohol Testing (EBAT) Program


This order form is for records pertaining to any EBAT conducted using the Intoxilyzer 5000EN and performed prior to May 1, 2013,
Litigation packets for any EBAT conducted using the Intoxilyzer 9000 and performed after May 1, 2013 are now included as part of every subject test report provided by the law enforcement agency.

Requester Information

Record Information


                                     Enter lot number above as:  # - ## - ##

Records Requested


*If a signed copy of the solution label is needed, contact the law
  enforcement agency where the Intoxilyzer instrument is located directly.


**COBRA records - 30 days before and 30 days after date of offense
    will be provided, unless indicated in additional instructions box.

All records are deemed certified by the
Colorado Department of Public Health and Environment.

A certifying statement signed by the Laboratory Services
Division Director will accompany each request.


All records printed will be sent via United States Postal Service.

Litigation packets = $5.00
COBRA records & any other items =  $0.25 per image

Invoices will be mailed monthly.

For assistance please contact the EBAT Program at
303-692-3295 (voice)
303-344-9965 (fax)

* Indicates Response Required