Court filing
Information — United States v. David Butziger (Dkt. 14-1, D.R.I. No. 1:20-cr-00072)
Filed May 19, 2020 in Butziger; one of 33 filings from this case.
Record facts
| Court | U.S. District Court for the District of Rhode Island |
|---|---|
| Filed | 2020-05-19 |
U.S. District Court for the District of Rhode Island · No. 1:20-cr-00072-MSM-LDA · Doc. 14-1 · 2020-05-19 · Docket on CourtListener
Full text
SPECIMEN COLLECTION WORK ORDER
FROM:
ATTN:
DATE:
TO:
May-18-2020
COLLECTION INFORMATION:
Marie J. Turecamo
Vessel / Job Name:
07:36:28PM
EST
Rhode Island Party and Charter Boat
Anderson Kelly Associates
ATTN(Ph):
ATTN (Fax):
401-578-9381 cell
401-737-5812
Site / Berth:
EMPLOYER INFORMATION:
Employer Name:
Peter R. Keyes, 50 Locust Avenue, New Canaan, CT 06840-4737 USA
Address:
203-442-2129
Fax Number:
Peter Keyes
DER:
203-442-2839
Phone Number:
MORAN TOWING & TRANSPORTATION
Collection Location:
Collection Time:
Friday, May 29, 2020
Collection Date:
Albany, NY U.S.
USCG
DOT Agency:
MRO INFORMATION:
941-753-9975
Fax Number:
941-753-9199
Phone Number:
1451 Tallevast Road, Sarasota, FL 34243 USA
Address:
Hani J. Khella, M.D.
MRO Name:
MRO Company:
Industrial Medical Testing
Fax Number:
ebeller@andersonkelly.com (Work
Email:
973-945-9091 (Mobile
Phone)973-446-2560 (Work Phone)
973-271-2668 (Mobile Phone)
Erin Beller
Erin Beller
Phone Number:
Contact:
Agent Name:
LOCAL AGENT INFORMATION:
SERVICES TO BE PERFORMED:
Urine Specimen Collection, DOT, split sample
1 .
Quantity:
Account #:
339841008
Test Reason:
Random
MEDTOX
Lab:
Service Type: DOT
10
Male Donors:
Female Donors:
0
10
The following needs your attention:
ADDITIONAL NOTES
If you do not have the specified chain of custody form available, please contact Anderson Kelly Associates immediately for
instruction.
Please bring ten (10) extra kits and chain of custody forms to collection site in the event there are more donors than requested.
Please plan to conduct the collection on the assigned date and time and not upon vessel arrival to port. Please inform Anderson
Kelly Associates immediately if you are unable to board the vessel at the assigned date and time or of any other schedule
changes.
Please test the entire crew of the vessel. Please obtain an updated crew list from the Captain to ensure that all crew-members
are tested. Please refer to the additional instruction area printed on page two (2) of our work order regarding the distribution of
paperwork.
Page 1 of 2
500 International Drive, Suite 205, Mount Olive, New Jersey 07828 U.S.A.
Ph: 800-833-6676 Fax: 973-446-2615
Collection ID
40532928291
Case 1:20-cr-00072-MSM-LDA Document 14-1 Filed 05/19/20 Page 1 of 4 PageID #:
46
SPECIMEN COLLECTION WORK ORDER
*Collector charges for specimens that cannot be processed and/ or cancelled due to collector error will not be paid.*
ADDITIONAL INSTRUCTIONS
Please contact Anderson-Kelly Associates during the course of the collection process for instructions on any of the following
situations:
1. Shy bladder onset.
2. Wait time.
3. Inability to obtain vessel access, vessel schedules, ETA, berthing information.
4. The need to conduct a direct observation collection, specimen temperature out of range, suspected tampering.
5. Changes to the services requested (e.g. addition of BAT, changing of the testing from DOT to non DOT) from someone
other than Anderson-Kelly Associates.
6. Positive breath alcohol results on initial screening.
7. Lack of testing supplies.
8. Inability to test or locate all donors declared on the crew list.
Upon completion of the collection please call Anderson-Kelly at 973-446-2560 or 800-833-6676, regardless of the time.
Kindly submit, within 24 hours, or the next business day, the following documents to Anderson-Kelly Associates, via fax number
973-446-2615 or email sapp@andersonkelly.com:
1. 'Collector' copies of CCF forms. Each CCF must clearly list the vessel name and the collection site location under step 1,
section G of the CCF.
2. Copy of BAT form, if applicable.
3. Collection summary report.
4. Collection procedure checklist.
5. BAT or non DOT UDS consent forms, if applicable.
6. Collection donor listing.
7. Ship’s copy of crew list, if available.
For all U.S. based collectors: After the items listed have been successfully submitted to Anderson-Kelly Associates, please mail (U.S.
Postal Service) the employer copies of the CCFS/ATFS (original documents), to the SAPP Group c/o Anderson-Kelly Associates.
Anderson Kelly requests all samples obtained are shipped to laboratory within 24 hours or the next business day of collection completion.
If the collector is unable to ship the samples to the laboratory by the next business day, Anderson Kelly requests that the specimens are
kept refrigerated in a secure area until the shipment can be released to the courier or commercial delivery system.
FAILURE TO COMPLY with any of the above instructions or to produce all required documentation in a legible and timely manner MAY
RESULT IN NON-PAYMENT FOR SERVICES.
Page 2 of 2
500 International Drive, Suite 205, Mount Olive, New Jersey 07828 U.S.A.
Ph: 800-833-6676 Fax: 973-446-2615
Collection ID
40532928291
Case 1:20-cr-00072-MSM-LDA Document 14-1 Filed 05/19/20 Page 2 of 4 PageID #:
47
SPECIMEN COLLECTION WORK ORDER
FROM:
ATTN:
DATE:
TO:
May-18-2020
COLLECTION INFORMATION:
James Turecamo 203-247-8144
Vessel / Job Name:
07:32:16PM
EST
Rhode Island Party and Charter Boat
Anderson Kelly Associates
ATTN(Ph):
ATTN (Fax):
401-578-9381 cell
401-737-5812
Site / Berth:
EMPLOYER INFORMATION:
Employer Name:
Peter R. Keyes, 50 Locust Avenue, New Canaan, CT 06840-4737 USA
Address:
203-442-2129
Fax Number:
Peter Keyes
DER:
203-442-2839
Phone Number:
MORAN TOWING & TRANSPORTATION
Collection Location:
Collection Time:
Friday, May 29, 2020
Collection Date:
Albany, NY U.S.
USCG
DOT Agency:
MRO INFORMATION:
941-753-9975
Fax Number:
941-753-9199
Phone Number:
1451 Tallevast Road, Sarasota, FL 34243 USA
Address:
Hani J. Khella, M.D.
MRO Name:
MRO Company:
Industrial Medical Testing
Fax Number:
ebeller@andersonkelly.com (Work
Email:
973-945-9091 (Mobile
Phone)973-446-2560 (Work Phone)
973-271-2668 (Mobile Phone)
Erin Beller
Erin Beller
Phone Number:
Contact:
Agent Name:
LOCAL AGENT INFORMATION:
SERVICES TO BE PERFORMED:
Urine Specimen Collection, DOT, split sample
1 .
Quantity:
Account #:
339841008
Test Reason:
Random
MEDTOX
Lab:
Service Type: DOT
10
Male Donors:
Female Donors:
0
10
The following needs your attention:
ADDITIONAL NOTES
If you do not have the specified chain of custody form available, please contact Anderson Kelly Associates immediately for
instruction.
Please bring ten (10) extra kits and chain of custody forms to collection site in the event there are more donors than requested.
Please plan to conduct the collection on the assigned date and time and not upon vessel arrival to port. Please inform Anderson
Kelly Associates immediately if you are unable to board the vessel at the assigned date and time or of any other schedule
changes.
Please test the entire crew of the vessel. Please obtain an updated crew list from the Captain to ensure that all crew-members
are tested. Please refer to the additional instruction area printed on page two (2) of our work order regarding the distribution of
paperwork.
Page 1 of 2
500 International Drive, Suite 205, Mount Olive, New Jersey 07828 U.S.A.
Ph: 800-833-6676 Fax: 973-446-2615
Collection ID
87412928127
Case 1:20-cr-00072-MSM-LDA Document 14-1 Filed 05/19/20 Page 3 of 4 PageID #:
48
SPECIMEN COLLECTION WORK ORDER
*Collector charges for specimens that cannot be processed and/ or cancelled due to collector error will not be paid.*
ADDITIONAL INSTRUCTIONS
Please contact Anderson-Kelly Associates during the course of the collection process for instructions on any of the following
situations:
1. Shy bladder onset.
2. Wait time.
3. Inability to obtain vessel access, vessel schedules, ETA, berthing information.
4. The need to conduct a direct observation collection, specimen temperature out of range, suspected tampering.
5. Changes to the services requested (e.g. addition of BAT, changing of the testing from DOT to non DOT) from someone
other than Anderson-Kelly Associates.
6. Positive breath alcohol results on initial screening.
7. Lack of testing supplies.
8. Inability to test or locate all donors declared on the crew list.
Upon completion of the collection please call Anderson-Kelly at 973-446-2560 or 800-833-6676, regardless of the time.
Kindly submit, within 24 hours, or the next business day, the following documents to Anderson-Kelly Associates, via fax number
973-446-2615 or email sapp@andersonkelly.com:
1. 'Collector' copies of CCF forms. Each CCF must clearly list the vessel name and the collection site location under step 1,
section G of the CCF.
2. Copy of BAT form, if applicable.
3. Collection summary report.
4. Collection procedure checklist.
5. BAT or non DOT UDS consent forms, if applicable.
6. Collection donor listing.
7. Ship’s copy of crew list, if available.
For all U.S. based collectors: After the items listed have been successfully submitted to Anderson-Kelly Associates, please mail (U.S.
Postal Service) the employer copies of the CCFS/ATFS (original documents), to the SAPP Group c/o Anderson-Kelly Associates.
Anderson Kelly requests all samples obtained are shipped to laboratory within 24 hours or the next business day of collection completion.
If the collector is unable to ship the samples to the laboratory by the next business day, Anderson Kelly requests that the specimens are
kept refrigerated in a secure area until the shipment can be released to the courier or commercial delivery system.
FAILURE TO COMPLY with any of the above instructions or to produce all required documentation in a legible and timely manner MAY
RESULT IN NON-PAYMENT FOR SERVICES.
Page 2 of 2
500 International Drive, Suite 205, Mount Olive, New Jersey 07828 U.S.A.
Ph: 800-833-6676 Fax: 973-446-2615
Collection ID
87412928127
Case 1:20-cr-00072-MSM-LDA Document 14-1 Filed 05/19/20 Page 4 of 4 PageID #:
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