AUTOMOTIVE SAFETY ENFORCEMENT DIVISION …countytimes.somd.com/special/2011/yogi/Yogi-E5-E8.pdfSIB ....

16
AUTOMOTIVE SAFETY ENFORCEMENT DIVISION INSPECTION REPORT

Transcript of AUTOMOTIVE SAFETY ENFORCEMENT DIVISION …countytimes.somd.com/special/2011/yogi/Yogi-E5-E8.pdfSIB ....

Page 1: AUTOMOTIVE SAFETY ENFORCEMENT DIVISION …countytimes.somd.com/special/2011/yogi/Yogi-E5-E8.pdfSIB . Mervell Dean Road . N/O . Beck Road Trooper First Class Pilkerton . c. iAt-Ma~lI-,

AUTOMOTIVE SAFETY ENFORCEMENT DIVISION INSPECTION REPORT

Page 2: AUTOMOTIVE SAFETY ENFORCEMENT DIVISION …countytimes.somd.com/special/2011/yogi/Yogi-E5-E8.pdfSIB . Mervell Dean Road . N/O . Beck Road Trooper First Class Pilkerton . c. iAt-Ma~lI-,

APR-11-2011 09:23 FROM: TO: ··"1 07583078

MARYLAND STATE POLICE

SUBJECT:' Post Collision Investigation

A.S.E.D. February 14,2011 TO; Trooper First Class Bedell, MSP Crash Team, Leonardtown Barrack FORWARDED: The attached report details the post collisioJ) investigation of a 2010 Jeep Grand Cherokee, Serial # IJAPR4GK8AC161449, which was involved in a collision on January 19,2010. Please refer to your local case number 1) -82000629.

Livingsto Banks First Sergeant A.S.E.D.

LB/paj

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....... 6

APR-11-2011 09:23 FROM: TO: F1 07583078

AVTOMlJl'NE SAFETY ENFORCEMENT vlVISJON VEHICLE POST-CRASH EXAMINATION REPORT

CC#' 11-23-000049

"

MSP Leonardtown Ban-ack MILEAGE: ,'J4808

VEHICLE: , 2010 r IGrand C:;~~rokee I IJAPR4GK8ACI61449 54529M2 I-", ,.:~-~~ ....­

D./\ TE Of INCIDENT: Jnllualv 19,2011 IDATE OF EXAMINATION: JanualY 26, 20 J I ~~N Collision

TYPE OF EXAMINATION: Orher (Explain) Post Crash Examination.__.

REQUESTING AGENCY: rg)MS~_ DOrhel' AF,ency Name:MSP- Crash Team- TFC Bedell

LOCATION OF VEHICLE:

Year Maka MocM VlN Tag S'!.Cle~ Cumme/1fs: E. BODY Commenfs:r"""~.STEERING:

[8J POWER J. FENDERS PP - ."-­N/A 2. FLOOR PANrJ STANDARD P.

J. HOODI. WHEEL SIZE & LASH P D ...'." .. 4. BUMPERS2. RACK & PINION P D front damaged

N/A 5. DOORSJ. STEERING BOX P .. ­ ....­6, GLASS4. I-IOS£ & FLUID P

"

P- ., N/A 7. MIRRORS P5. DRAG L.INK

F. WINDSHIELD WlPERS6. PITMAN ARM -_. .... _.. N/A P .. PP G. LIGHTS7. BELT

N/A J. llEADLAMPS P8. IDLER ~~.~ -.. ,pP 2. STOPLAMPS9. FRONT AXLE p3. TAILLIGHTSD. BRAKES

4. TURN SIGNALSI. MASTER CYLINDER P P..._._. P

P N/A

r .... P

.. 5. PARKING LAMPS P2. VACUUM ,

p6. SIDE MARKER LAMPSJ. HYDRAULIC .. _. 7. WARNING LAMPS P4. EI.RCTRIC ...­8. REFLECTORS P5. !'ARK1!.':J.~J... .......__._....

OTHER6. EMERGENCY ~, ~.~ ~

FRONT WHEELS

I. LEFT FRONT WHE.EL I ~eadin~sl Commen{~' I. RlGIITFRONT WHEEL I Relldin~s/Commenfs I

1. TIRE (Brand/Mlldcll ..9~)lldyear Fortera ': TIRE (Brand/Model) Good\ ear Forrera

a. SIZE / TYPE P P245/65R17 a. SIZE / TYPE P P215/651{17 - ­b. AIR PRESSURE (psi)

c. TREAD DEPTH__.. ___ .0' ••••

f)

P 3::1 P!Jl-7/32

b. Am PRESSURE (psi)

c. TREAD DEPTH D P

opsi 5/32

', ­

'­1. DRUM / ROTOR (Si:£c) P" ....... 1. 185 2. DRUM / ROTOR (Size) r 1. )81

a. DISCARD 1.1.22 a. DISCARD 1.122 3. LlNINq§. / PADS P 14/32 3. LININGS / PADS P 14/32 4. BALL JOINT / KINGPIN_.. P 4. BA1~L JOINT / KINGPIN P 5. WHEEL BEARINGS P 5. WHEEL BEARINGS P

-~ 6. WHEE.~ 9Y.UNDER N/A 6. WHEEL CYLINDER N/A 7. WHEEL CALIPER P - 7. WHEEL CALIPER P .. ..­8. BRAKE HOSE P 8. BRAKE HOSE P !J. CONTROL ARMS P 9. CONTROL ARMS P - ­10. TIE ROD END P - lO. TlE ROD END P ..

"U.;..~T0RILlZBR P 11. STABILIZER P 12. MH.'H COMPONENTS P 12 MECH COMPONENTS P ._­

il). 5J 10CK.$ / SnWTS p 13. SHOCKS / STRUTS p .. 14. SPR.INGS P 14. SPRINGS .. P _. 15. WHEEL·LUGS·NUTS.......................__. P _...~

15. WHEEL·LUGS-NUTS P ..-PlIge 1 of~

I

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APR-11-2011 09:23 FROM: 1'O:J"107583078 P.4/6

REAR WHEELS

I t LEF'f REAR \¥HEEL I Read!!'!J!S! Comments L RJ.r.HT ~F,AR WHEF.L I Readillf!.v/Commenl.\· I J, TIRE (Brand/Model) Good>year F():L~ra 1. TIRE (BnmdlModel) Goodyear Fortera

a, SIZE / TYPE p J'24fi/65R17 a. SrZE / TYPE P:!45/6iiR17P .. -­29 pr.;b. AIR PRESSUR.E (psi) R b. AIR PRESSURE (psi) 29 psiR-_....~--

p7/32Pc. 'J'READ DEPTH c. TR.EAD DEPrH 7/:12 pO. 5582. DRUM (ROTOR (Si7.e) 2. DRUM / ROTOR (S;7.e)P O. 545

.w

0.492a. DISCARD a. DISCARD 0.492 7/32 3, LlN1NGS / PIIDS3. UNfNGS / PADS P 8/32P

4. BALL JOfNT / KINGPIN N/A 4. BALL J01NT / KINGPIN N/A... P5. WHEEL BEARINGS 5. WHEEL BEARINGS P

N/A6. WflEEL CYLINDf'J{ _......_. 6. WHEELCYLTNDER N/A 7. WHEEL CALIPER P 7. WHEEL CALIPER P

'.

...-.. 8, BRAKE HOSE8. BRAKE HOSE P P

~_._.-. "NO'

N/A 9. CONTROL ARMS9. CONTROL ARMS N/A 10, TIE IWD ENDN/A N/A10. TrE ROD END

'­I I. 5TABILlZER11. STABIL/7.F.R P P----'-'-'---_....._.__. ... .. -. 12. MECH COMPONENTS11. Ml:!CH COMPONENTS P_ ....- __.00_ P -J3. SHOCKS / STRUTS PIJ. SHOCKS / STRUTS P ... -... ... 14. SPRINGS14. SPRINGS P P..._..-.... _.....

P 15. WHEEL-LUGS-NUTSJ5. WHEEL·LUGS·NUTS P ~f'Jlt'''l'l:fl,r'l '''' fillm' ,JI'''" "'I 'lfJi'I :!trillfP' j - "',\l\l'f'P'\'W:'l'""rr '/ ,," '. 'h'l··'''! "1"'\"'['11 '" r 'I ,r', "I ''':If'',' I . 11" l"., q : . ~;fl ~·,;·.I l/;,' Pi '~Ilr~

J..lI:l~~lJII~'S\l!).ILI~~1~1'l"'/' 11~·)'li'd"r I:l~ :l~ JJ:..rSJ'~~~II,1 (:~'III!idlll J\ll.~fiJ,(,: ,q~#t"'fl l:i,!~V:':". /:·~IIII~JIL,jlll '~.t(:'!:~r I, '. I' 11'. I~ ...'.' .. :l",~......kJ:tL.<""I\ .:!. :..rJ " f11 r.l ,

COMMENTS:

. This vehicle had minor front end damage. Steering a'ld braldn!; components were chtn:I'cd lind all RICI minimum established :;:tl'ely standards. This is a new vehicle only 8 cOllple lIJonlhli IIld.

~9EN.Q: P Component Passed Minim~m Safety Stnndal'ds'" R Component Rejected; Below Minimum S~llely Standards Prior to incident

~'-

D Damaged in Incj~~t (Unable to Determine if Passed Minimum Safety Standards) N/A Nor Applicable UTE .. _..;,_.Unable to Examine Because of Damage- to Orher Components

2107 1DII

Jallumy26.2(J]N1 ----­

Dal~:

lOll

. ~~---- Page! oft,------ ­

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APR-11-2011 09:23 FROM: TO: ' "17583078

AVTOMOI1VE SAFETY ENFORCEMENT DIVISION VEHICLE POSTCRASH EXAMINATION SUMMARY

cc#: 11-23-000049

CONCLUSION:

o The vehicle examined met all minimum safety standards as per the Code ofMaryland Regulations (COMAR), Title 14, Subtitle 1.1, Chapter 01-06.

0~\Jhe vehicle examined Jailed to meet all minimum equipment safety standards as per Code of

Maryland Regulations (COMAR), Title 14, Subtitle 11, Chapter 01-06 (See remarks for specific defects).

o Unable to determine whether the vehicle met minimum safety standards (See remarks for explanation)

REMARKS: (Explain Defects, Conclusion, and Miscellaneous Comments)

On Wednesday, January 26,2011 Myself and VSI R. Lasky responded to the Leonardtown Barrack, Leonardtown, MD to perform a Post Crash Examination on a 2010 Jeep, Grand Cherokee~ VIN IJAPR4GK8AC161449. The vehicle was invoJved in a fatal collision on January 19,20'11. The 'post crash exam was requested by, TFC 1. Bedell oflhe MSP Crash Team. The area of concern was the brakes of the vehicle.

---~S""'t,eering-e-omponents:-Al1 steering components were examined. 11le vehicle was driven into the wash bay at the barrack and no steering issues were noted at tha1lime. No pre-existing damage to the stee.ring components were noted during the examination.

Braking Components: All braking components were checked and measured. The measurements for the rotors were within the manufactures recommended specifications. The brake pad readings were aU within minimum established safety standards. No pre-existing defects or damage was noted during the examination of these components.

Suspension: All suspension components were examined, there did not appear to be any pre-existing damage. All springs, shocks and stabilizer bars were connected and undamaged. No pre-ex.isting defects or

.damage was noted during the examinaiton of these components.

Tires: All tires were checked for damage or defects. The tread depth on all tires meet minimum established safety standards. The DOT date numbers were as follows: LF- 0810, RF- 0810, LR-081O, RR- 0810, with speed ratings of 105S. The three tires that were inflated were not inflated to the manufactures recommedations. The Tire label on the vehicle has the manufactures recommendation of 33 psi on the front and rear tires. The air pressure in the two rear tircs were below the recommeded; LR 29 psi, RR 29 psi. I did not observe any pre·existing damage or defects other than the tire inflation being below the recommended pressure, and this caused the tires to fail to meet minimum established safety standards.

MSP ASED 23·56A (11 ~07)

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APR-11-2011 09:24 FROM: TO:' 17583078

AUTOMOTrV-:E SAFETY ENFORCEMENT DIVISION VEIDCLE POSTCRASHEXAMINATION SUMMARY

AcceJeration Components: The acceleration components were checked and there were no noted issues with the components. The vehicle was driven through the parking lot ofthe barrack and the accelerator worked properly.

Conclusion: The vehicle failed to meet minimum established standards as noted above for the tire inflation of the rear tires of the vehicle.

2107 Date: January 26. 2011 --';';';;;~--'-"--'-------11)#

DOJ4 Date: IT>ll

MSP ASED 23-56A ( IJ-07)

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PHOTOG APHIC REC RDS .

E.G

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MARYLAND STATE POLICE DETAILED PHOTOGRAPHIC RECORD NAME OF CASE/MOTOR VEHICLE DRIVERS IF MORE THEN THREE DRIVERS, USE ADDITIONAL FORMS

" 1. Wesley Kenneth Goldston Fatal 10·50

TYPE OF CASE

01/19/2011 DATE OF INCIDENT

1901 TIME OF INCIDENT

9082 Leonardtown BARRACK

2. N/A 11/82/000629 CASE NUMBER

3. N/A Clear WEATHER

SIB Mervell Dean Road N/O Beck Road Trooper First Class Pilkerton c. iAt-Ma~lI -,

LOCATION

I N/ADigital TABOR FRAME NO. NO. OF FILM SENT PRINTS REQUIRED

Trooper First Class Bedell N/A N/APERSON TAKING PHOTOS DATE FORWARDED MAILED BY I

Atlach one copy of Inis lorm 10 inslallalion case file. Mail original end two copies 10 Ihe Pholo Lab for processing. Mail in ,nler-departmental envelope

MSP 62 (9- 81) Please return photographs to TFC Bedell TSS/Crash Team Centreville BK

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.. MARYLAND STATE POLICE DETAILED PHOTOGRAPHIC RECORD

NAME OF CASE/MOTOR VEHICLE DRIVERS IF MORE THEN THREE DRIVERS, USE ADDITIONAL FORMS

1. Buhmlan Kenneth Baird AR T TYPE OF CASE BARRACKI

2. Wesley Price Goldston 1/19/2011 11-82-000629 DATE OF INCIDENT CASE NUMBER

3. NIA 1915 Clear TIME OF INCIDENT WEATHER

TFC. Bedell Mervell Dean Rd at Beck Rd, Hollywood, MD INVESTIGATING TROOPER LOCATION

Yes No XDIGITAL 16 PRINTS REQUIRED ­NO. OF FILM SENT TAB OR FRAME NO. \

Tpr. Wiesemann 5573 RETAINED \ N/A DATE FORWARDED MAILED BYPERSON TAKING PHOTOS

Attach one coPy of this, form to i~stsl1ation cas::: file. MSP 62 (9 - 61)

L

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VEHICLE STORAGE

E.7

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Not Applicable

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CHAIN OF CUSTODY RECORDS . AND/OR

PROPERTY HELD RECORDS

E.8

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1

_....... .

REQUEST FOR LABORATORY EXAM/NAT/ON­CHA/N OF CUSTODY LOG

/INS1ALLA110N/AGENCY

g?-Lte'l"..ruv-dt:n.u V\ sU

N1A Dr.r.<~iSE

U.lJ~Foi(J,~1 !V1'" IV r Vr)I\; c Ie -ACcdjblr.f TYPE r~ArA110N.REOUESTED I (

TRACE EV1PEI~CE Or~LY ( SEX, RACE, 0.0.8. OF VICTIM AND/OR SUSPECT - BRIEFLY DESCRIBE LOCATION OF CRIME SCENE AS TO OWNERSHIP) AND IMMEDIATE SURROUNDINGS - EXAMPLE - BEDROOM, CAR, WOODS. ETC.

NIA .J

LIST OF ARTICLES

_ r,TJ,.CVf'{l..-' A: ~() '~" fl 1\) ttov~ b; Its us Cuo Vrlr..,V.,

(f C+cJ:i : '~ ~oo~ (fu, ,t

-- g..-- 1j; \l'll 'IV)r " ;") 0 'j\) ,

-'\ ~VV1 ..... oj'\,i2 ) I VJ·lVtull)erlbr ~: c.ux~l· -ro1v1'. t~ 1.-- l \)

f.t

~' ""Dille;.,( 'iJ .. H us nI-kw c~ o1t'J!./ ) v!!. /:J bl , -fiOllinrun ci. 1M • \~ .j 0 , ·tJ

\, I,l..,roT~ v~: Wnl ­... Y;-'.J ..

~

THE UNDERSIGNED HEREBY CERTIFIES THAT THE ABOVE LISTED EVIDENCE SUBMITTED IN THIS CASE, WHILE IN CUSTODY, REMAINED AND WAS DELIVERED TO THE PERSON/LOCATION INDICATED ON THE DATE AND TIME STATED IN ESSENTIALLY THE SAME CONDITION AS WHEI'! RECEIVED, EXCEPT THAT MATERIAL OR PORTION CONSUMED IN THE ANALYSIS AT THE CRIME LABORATORY.

See Instructions on Back of Page 5

~""" m"~,, , 70\- Yl5-8tSS

I CASE II Ip~r~R~ ~EL~IIII-~}- COD b1q I - ~ :>111--,1

I~'M \!Q 11\11\1 ~J".,hr 'rf1c.i.-V'l.. If II( -y" 'BU'-I v-r:J COUNTY )IDATE ( F OFFrSE

01 \9 1/ SLJV1Q \'" \/".;IrrrxTION REOUES1ED BY

Print and Sign Name or Location Date Time Print and Sign Name or Location Date Time

Original Source: location or person from whilO:h:.<::"",: :,' ,; , 13. '\ (. , evidence was obtained 1",:;,;\';:': "_, ' ~ I cJ..lf'1\ . ";,.",:,,... '!:':....,;, " ,'. 14. -,.... ....,... \!I"" ,; L.!'\") I. I 'q 15.* I \- C ,\. I.-i;: K~ r~I', 1\ I P\1)) 19 iI .' I ?o

16.

17.

18.

19.

20.

21.

22.

23.

24.

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Cl-tIME LABORATORY FILE IIIVIARVLAND DSPAATMENT OF STATE POLICE \

REQUEST FOR LABORATORY EXAMII'JATION- ~ AGEI~CY TELEPHOI~E II

CHAIN OF CUSTODY LOG 301-475-8955 )

CASE II(jNSTi,LU17/0NlAGc';CY IPR~~~~HELlJl;11-82-00062982-Leonardtowll SUSPECT IVICTIM

None Burhman Kennetb Baird Ol'fENSE GOUI'lTYIOAIE Of07/19/2011 I

Recovered Property St. ~1ary 's 1YPE EXAIvIINI\IIOI~ REOUESTED IEXAMINAllON HEOUESTEIJ BY

None None WACE EVIDENCE ONLY ( SEX. RACE. 0.0.8 Of VICTIIv1I1NLJIOf! :;USPECT . BHIE'FLY DESCRIBF LOCAl ION OF GHIME SCENE liS TO OWNERSHIP)

ANOIIvIMEDIIITE SllAflOLJNDINGS . EXAMPLE· BEOROOM. CN1. WOOuS. E1C.

None

..LIST OF AR /ICLES

1. One (1) black leather wallet 2. One (1) PNC check in the victims name Check# 1256

THE UNDERSIGNED HEREBY CERTIFIES THAT THE ABOVE LISTED EVIDENCE SUBMITIED II~ THIS CASE, WHILE IN CUSTODY, REMAINED AND WAS DELIVERED TO THE PERSON/LOCATION INDICATED ON THE DATE AND TJME STATED IN ESSEI~TIALLYTHE SAME CONDITJOI-J AS WHEN RECEIVED, EXCEPT THAT MATERIAL OR PORTION CONSUMED IN THE ANALYSIS AT THE CRIME LABORATORY.

See Instructions on Back of Page 5

Prin1 and Sign Name or Location Date Time Print and Sign Name or Location Date Time .J .

Original Source: location or person from which 13. evidence was obtained .­ '<'..

Victim 14. ,

TFC Pinerwn//c /' ~ 1/19/ 1 190 15. - I

Barrack T EViden~e /20/1 0130 16.

17. I

18.

19.

~D.

21.

22. -~

23. ---;

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DO NOT DAMAGE OR DESTROY THIS RECORD - ALL PROPERTY RECORDS MUST BE ACCOUNTED FORI1t Maryland State Police ~ PROPERTY RECORD

INSTALLATION CODE IDATE ITYPE OF FIELD REPORT ANU CASE u

9J82 01 /19 / 2011 AR 11-82-000629 OWNER OF PROPERTY (OFI SUSPECT IF CDS)

Buhrman, Kenneth Baird TELEPHONE /I /tDDRESS OF OWNER

None 24350 Old Hollywood Rd, Hollywood, MD OH-IER CLAIMANT or PROPERT\'· NAME

TELEPHONE /I rOOflESS OF OT)-JEfi CLAIMANT

IfITEM DESCRIPTION

IRECORD'~O. p- ??81S0,-...J 1..,,:.1

RELATEU PROPERlY NUMBER(S)

none lJATE AND TIME OWNER NOTIFIED TO CLAIM PROPERlY

I~/A 0 / / HRS HUW NOTIFIUJ [TeICpllOm:. JlI I'"",ur,. MILE~, I" olner PD. CIC.)

DATE AND TIME CLAllvlANi 1V00IFIEU TU CLAIM PROPERTY

NlA 0 / / HRS

HOW NOTIFIED (l ,,'epllone, JI) person, MILES 10 all"" PD. CIC.)

THIS AREA FOR PARTIAL RELEASE ONL Y EVll)t.I~~EITEM Use separale PlOperl\' Records lor (1) CDS 12) Found/Recovered Properly or Ev,dencc:

MAI~y. RELEASED TO : PRINTED NAME f, RELEASED BY: SIGNATURE /IDIINUMUEH Ilavlng resale value (3) Conlwband (4) Mane)' sOiled lor lurlellur" In CDS Of gambling Wl1h IXI SIGI~ATURE & DATt' RELEASED

HElD'!.'caser. an,} (5) lor each known owner if mlllllPle Ilemf. a:e reCl1Vefe,}

Four (4) Fifty Dollar Bills US Currency XXA

Total: $200.00

One (1) TWenty Dollar Bill US Currency XXB

Total: $20.00

~ . One (1) Five Dollar Bill US Currency-' XX

Total: $5.00 ..

'T'nt~ 1 \7~ 1111:>' .'1:')') r; nn ''- .,

Verified by Cpl M.~~1{a ~1865 ..,lnl:;I:-;':';I:-;'-:;bl\'"k'il:-"kil-:;hlril:i'rUST ITI~rk;I:"k"k;':"k'i,\;hl:;I:'iI:-;I:'iI:-iI:"k"k

i

S SPliCE FOR DPU USE ONL y. LEAVE BLAI~I< TRACKING NUMBER:

v1ARKS: The above US Curreny was recovered during a check of a decedents personal belongs

ter a fatal motor vehicle collision

RECOVEREu BY (TriOOPER). SIGNATURE I:. ID~. .~'ERn' RELEASED TO ( PRII~T NAME· FULLi FINAL RELEASE OI~L Y)

TFC J Pilkerton #431~~~,~ ET ADDRESSOF RECIPIENT (FULL RELEASE) RELEASED TO (SIGNATURE·FUlUFINAL RELEASE o/JL Y)

_ .._".- ....... , .......... , ... ; r-r, lRFI EASEu BY· SIGI~ATURE t ID/: IFULU FII~AL RELEASE Ol~L Yl

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._- .. ,.,. -- .-- ,..." -- ... ,." ..... , ...... ..., "'"'''' ...... ,

MARYLAND DEPARTMENT OF STATE POLICE

REQUEST FOR LABORATORY EXAMINATION-CHAiN OF CUSTODY LOG

"

INSTALLATION/AGENCY

82-I.ron:n:d1:cMrJ SUSPECT IVICTIM

Io/A I'VA OFFENSE

r DATE OF au19/11

CRIMe L.ASORATORY FILE /I

AGENCY TELEPHONE /I

(3J1)475-8955 ;CASE /I IPRON/AY HELD /IfiR # ll-82-ffiJ629

,I COUI,TY

/Vbtor Vehicle kcident ' 18-St. M3ry's TYPE EXAMINATION REOUESTED IEXAMINATION REQUESTED BY

I'VA I'VA . TRACE EVIDENCE ONLY ( SEX, RACE, 0.0.8. OF VICTIM AND/OR SUSPECT· BRIEFLY DESCRIBE LOCATION OF CRIME SCENE AS TO OWNERSHlf')

AND IMMEDIATE SURROUNDINGS - EXAMPLE - BEDROOM, CAR, WOODS, ETC.

LIST OF ARTICLES

Itan # 1 (he (1) Carp3::t Dis: Coot:a:in:irg .9..Irveillirrx FCXJtage Fmn the I-bllywxx:l, MJ. R\C funk

fron 01/19/11

*;bl:k,ldd\i'dddd\kk,'vldd\k·kk;l:k,hbldddchlddd,,'c~iPSf YIEJIp'~'vI:k;'~I\k,ldd:;':I'dddd\;h'ddddd\i'd:;IObl\i'd~I:ilddd:;'\;ldd d:il\';'\;'v'd:;r~ldc'dc':;bl:;l\ilddd:;\"

THE UNDERSIGNED HEREBY CERTIFIES THAT THE ABOVE LISTED EVIDENCE SUBMITTED IN THIS CASE, WHILE IN CUSTODY, REMAINED AND WAS DELIVERED TO THE PERSON/LOCATION INDICATED ON THE DATE AND TIME STATED IN ESSENTIALLY THE SAME CONDITION AS WHEN RECEIVED, EXCEPT THAT MATERIAL OR PORTION CONSUMED IN THE ANALYSIS AT THE CRIME LABORATORY.

See Instructions on Back of Page 5

Print and Sign Name or Location Print and Sign Name or Location TimeDate Date Time Ii":;,, ---':,' -'-~-:"-'.' 13.Original Source: location or person from which

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