OAKLAND COUNTY COMMUNITY CORRECTIONS DIVISION

							                                                                                        OFFICE OF THE SHERIFF
                                                                                                Michael J. Bouchard
                                                                                            Forensic Science Laboratory


                                                                     RESULTS
                                                      Drug & Alcohol Testing Program
                                                                        PBT Log

Print Client Name                                                                          Court         Probation Officer



Client Signature                                                     CStar ID #            Letter        Case Manager

                   LOCATION OF           BADGE # OF                                                      TESTERS PHONE
  DATE                                                          SIGNATURE OF TESTER                                                RESULTS           TIME
                      PBT                  TESTER                                                           NUMBER




RESULTS_F11_PBTLog.doc Rev. 05.22.2012

              OAKLAND POINTE OFFICE               All PBTs are to be administered at the RESULTS Program.                    SOUTH OAKLAND OFFICE
         250 ELIZABETH LAKE RD SUITE 1700                                                                                      1151 CROOKS ROAD
                                                  If a PBT is done elsewhere, You are responsible for faxing
                 PONTIAC MI 48341                                                                                                TROY MI 48084
                OFFICE: 248.451.2358              each PBT result on the day the PBT is required, to the                      OFFICE: 248.655.1259
             RESULTS FAX: 248.451.2329            RESULTS Program during our business hours.                                    FAX: 248.655.1278