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T#1 INTOX DMT MAINTENANCE REPORT Complete this report at the time of the regular monthly preventive maintenance check (not to exceed 35 days). Complete this report whenever the instrument is serviced or repaired and whenever it is placed into service. Retain the original and send a copy within 15 days to the Breath Alcohol Program, DHSS. DATE OF INSPECTION NAME OF AGENCY INTOX DMTSN 500058 04/01 /2016 Missouri State Highway Patrol TIME OF INSPECTION LOCATION OF INSTRUMENT (STREET AND CIT.

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