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Wilfredo Arroyo Atiquipa L10050543 -26454 <br />SUBJECT (PLEASE PRINT CLEARLY) <br />HALL <br />COUNTY OF INCIDENT <br />Mark Young <br />NAME OF COUNTY ATTORNEY TO BE NOTIFIED <br />Officer Jason Allyn 443 <br />ARRESTING OFFICER AND NUMBER <br />Grand Island Police Department <br />ARRESTING AGENCY <br />THIS LAB REPORT IS TO BE MAILED TO: <br />(Please Print Complete Address) <br />Officer Jason AIItn <br />Grand Island Police Department <br />P.O. Box 532 <br />Grand Island, NE 68802 <br />HH5 REGULATION AND LICENSURE LABORATORY SERVICES <br />3701 SOUTH 14TH, BOX 2755, LINCOLN, NE 88502 <br />BLOOD ALCOHOL TEST <br />❑ FATALITY <br />State Lab No. <br />2.0\n- n$cc2 <br />SAMPLE COLLECTION 22:50 ON 5/4/2010 <br />TIME DATE <br />DWI REQUIRED HIPAA PRIVACY DISCLOSURE <br />This sample is being submitted as part of a law <br />enforcement investigation and de- identified information <br />ZERO cannot be reasonable used, <br />TOLERANCE <br />e <br />This sample is being submitted as part of the Fatal <br />e <br />Accident Reporting System Ne.Rev.Stat. 60 -6102 et.seq. <br />MAIL ❑ LOCKED BOX ❑PERSONAL DELIVERY <br />DATE RECEIVED: n l 7 1 l 0 <br />AUTOMATED HEAD SPACE GAS CH ROMATOGRAPHY <br />BLOOD ALCOHOL CONTENT . l (0(12 g/100m1. <br />DATE TESTED <br />ANALYST <br />