Form DEA form 143 DEA form 143 National Clandestine Laboratory Seizure Report

OMB NO. 1117-0042
EXP. DATE:

NATIONAL CLANDESTINE
LABORATORY SEIZURE REPORT

TYPE OF REPORT*
Lab Seizure
Chem/Glassware/Equip Seizure (Only)
Dumpsite Seizure (Only)

Entered data must meet 28 CFR Part 23 guidelines.
I

Reporting Office (An asterisk symbol (*) indicates a mandatory field)

Seizure Date * (MMDDYYYY)
Agency State *

Agency *

ORI *

Case or File Number *

Agency City *

File Title

Reporting Officer/Agent Name * (First, Last)

COPS Number (DEA ‘S’ Number) *

Telephone Number *
(
)

Seizure Location* (Check one – put additional information in Remarks Section)

II

Apartment/Condo

Hotel/Motel

Family Dwelling

Storage Facility

Business

Outbuilding

Vehicle

Dumpster

Open – No Structure

Other – Describe:

III

Seizure Neighborhood (Check most appropriate)
Commercial/Industrial

Rural

Suburban

Public Land – Name:

IV

Urban

Other – Describe:

Estimated Lab Capacity (Based on seized chemicals, glassware, and equipment on site) (Mandatory if lab seizure is checked)
2 – 8 oz.

Under 2 oz.

V

9 oz. – 1 lb.

2 – 9 lbs.

10 – 19 lbs.

20 lbs. or Greater

Laboratory Status (Check all that apply) (Mandatory if lab seizure is checked)
Operational – Not in Production

Abandoned

Explosion/Fire

Operational – In Production

Boxed/Dismantled

Other – Describe:

VI

Lab Manufacturing Process (Check ONLY one)
Ephedrine/Phosphorus/Hydriodic Acid Reduction
and/or Iodine Reduction

Ephedrine/Lithium, Sodium or Potassium/
Anhydrous Ammonia (Nazi/Birch)

Ephedrine Tablet Extraction

Pseudoephedrine/Phosphorus/Hydriodic Acid
and/or Iodine Reduction

Pseudoephedrine/Lithium, Sodium or Potassium/
Anhydrous Ammonia (Nazi/Birch)

Pseudoephedrine Tablet Extraction

P2P/Methylamine

Hydriodic Acid Manufacturing

Ice Conversion

Hydrogenation

Anhydrous Ammonia Manufacturing

One-Pot Method
Other – Describe:

VII
Laboratory Equipment (Continue in Remarks)
Homemade/Improvised
Professional/Retail

Store Name:
City:

VIII

Laboratory Type (Check all that apply)

Amphetamine

Tablet Extraction

Anhydrous Ammonia

Methamphetamine

Ice Conversion

Hydriodic Acid

GHB

MDMA

Methcathinone

PCP

Other – Describe:

IX

Seizure/Laboratory Address

Street #

Dir. (E, S, etc.)

City

X

Street Name

County*

Suffix (St., Ave., etc.)
State*

Zip Code

Unit # (Apt) Box #

Latitude/Longitude

Chemist and Cleanup Personnel*
Hazmat Contractor
Used:
Yes
No

Chemist on Site:
None

State/Local

DEA

Name of Hazmat Contractor:

Evaluation of Hazmat Contractor:
Excellent

Satisfactory

Poor **

**(Provide details in Remarks Section)

XI

Persons Affected (Children are mandatory – indicate 0 when none were affected) (Check all that apply and indicate number)
Total Children Affected

(#

)

Child Injured

(#(#

) )

Child Killed

(#

)

Law Enforcement Killed

(#

)

Suspect Injured (#(#

) )

Suspect Killed

(#

)

Law Enforcement Injured

(#

)

Describe How People were Injured or Killed:

FORM EPIC 143 (05-2010)

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NATIONAL CLANDESTINE LABORATORY SEIZURE REPORT - CONTINUED

XII

Weapons/Explosives Seized (Check all that apply and continue in Remarks Section)

Type (Handgun, Rifle, etc.)

Number

Serial No.

Description (Make, Model, & Caliber)

Booby Trap – Describe:

XIII

Quantity of All Drugs Seized at Lab Site (Check all that apply/Specify amount & unit of measure)

Amphetamine

Amt

LSD

Amt

Methamphetamine

Amt

Cocaine

Amt

MDMA

Amt

Methcathinone

Amt

GHB/GBL

Amt

Marijuana

Amt

PCP

Amt

XIV

Precursor/Chemical Source (If more than one precursor, continue in Remarks Section)

Specify Precursor:

Source:

Store Name:

XV

Chemical Company

Convenience Store

City:

State:

Retail Outlet

Unknown

Other – Describe:

Country:

Precursor Agents/Catalysts/Solvents/Reagents Seized (Check all that apply/Specify unit of measure)

Precursor Agents (If Ephedrine or Pseudoephedrine is selected, Packaging category is mandatory)
Amt

Ephedrine

Amt

Pseudoephedrine

Packaging:*

Unknown

Powder

Tablets

Blister Packs

Source:

Domestic

Canada

Mexico

India

Packaging:*

China Source:

Unknown

Powder

Tablets

Domestic

Canada

Mexico

Brand Name(s):

Blister Packs
India

China

NOTE: Brand Names and Lot Numbers for chemicals
other than ephedrine and pseudoephedrine should be
entered in the Remarks Section.

Lot Number(s):
Benzaldehyde

Amt

GBL

Amt

Piperidine

Amt

Benzylchloride

Amt

Methylamine

Amt

P2P

Amt

Benzylcyanide

Amt

Phenylpropanolamine

Amt

Other

Amt

Catalysts/Solvents/Reagents
Acetone

Amt

Grignard

Amt

PCC

Amt

Alcohol

Amt

Hexamine

Amt

Phenylacetic Acid

Amt

Aluminum

Amt

Hydriodic Acid (HI)

Amt

Phosphorus

Amt
Amt

Ammonium Nitrate

Amt

Hydrochloric Acid (Muriatic)

Amt

Potassium Chlorate
(Perchlorate)

Ammonium Sulfate

Amt

Hydrogen Chloride Gas

Amt

Potassium Cyanide

Amt

Anhydrous Ammonia

Amt

Hydrogen Gas

Amt

Potassium Metal

Amt

Benzene

Amt

Hydrogen Peroxide

Amt

Potassium Nitrate

Amt

Bromobenzene

Amt

Hypophosphorous Acid

Amt

Potassium Permanganate

Amt

Castor Seeds

Amt

Iodine (Crystals)

Amt

Sodium Chloride (Salt)

Amt

Caustic Soda

Amt

Iodine (Tincture)

Amt

Sodium Cyanide

Amt

Charcoal Lighter Fluid

Amt

Lithium Metal

Amt

Sodium Dichromate

Amt

Chloroform

Amt

Magnesium

Amt

Sodium Hydroxide (Lye)

Amt

Chromium Trioxide

Amt

Mercuric Chloride

Amt

Sodium Metal

Amt

Citric Acid

Amt

Methanol

Amt

Sulfuric Acid

Amt

Coleman/Camping Fuel

Amt

Methyl Ethyl Ketone (MEK)

Amt

Thionyl Chloride

Amt

Cyclohexanone

Amt

Methylsulfonylmethane
(MSM)

Amt

Toluene

Amt

Ether

Amt

Naphtha

Amt

Urea

Amt

Ethylene Glycol

Amt

Nitric Acid

Amt

Other

Amt

Freon

Amt

Nitromethane

Amt

Other

Amt

FORM EPIC 143 (05-2010)

USE ADDITIONAL PAGES AS NECESSARY – LOCAL REPRODUCTION AUTHORIZED
Previous Editions Obsolete

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NATIONAL CLANDESTINE LABORATORY SEIZURE REPORT - CONTINUED

XVI

Criminal Affiliation (If applicable)

Asian Org

Mexican Org

Militia Group

Motorcycle Gang

Other – Describe:

XVII

Organized Crime

Middle Eastern Group

Organization/Gang/Group Name:

Suspect/Criminal Business/Criminal Vehicle Information

Suspect #1 Information
Last Name (Paternal)

Last Name (Maternal)

Alias/Moniker

DOB (MMDDYYYY)
Phone Type:

Home

Cell/Mobile

Middle Name

Generation
(Jr., Sr., etc.)

Male

Height

Weight (lbs)

Alt DOB (MMDDYYYY)

Suspect Residence Information
Street Number
Dir. (E., S., etc.)
City

First Name

Pager

Race

Phone Number

Nationality (US, MX, etc.)

Female
Hair Color Eye Color

(

Arrested

No

)

Street Name

Unit # (Apt)

County

Yes

State

Box #

Country

Zip Code

Involvement (Role) and Identification Numbers
Cook/Chemist

Enforcer

Smuggler

Distributor

Financier

Broker

Chemical Courier
Other – Describe:

Social Security Number

Driver License Number/State

FBI Number

Alien Registration Number

NADDIS Number

Other Numbers

Suspect #2 Information
Last Name (Paternal)

Last Name (Maternal)

Alias/Moniker

Phone Type

First Name
Generation
(Jr., Sr., etc.)

DOB (MMDDYYYY)
Home

Alt DOB (MMDDYYYY)
Cell/Mobile

Suspect Residence Information
Street Number
Dir. (E., S., etc.)
City

Criminal Associate

Height

Pager

Middle Name
Race
Male

Weight (lbs)

Phone Number

Nationality (US, MX, etc.)

Female
Hair Color Eye Color

(

Arrested

No

)

Street Name

Unit # (Apt)

County

Yes

State

Box #

Country

Zip Code

Involvement (Role) and Identification Numbers
Cook/Chemist

Enforcer

Smuggler

Distributor

Financier

Broker

Chemical Courier
Other – Describe:

Social Security Number

Driver License Number/State

FBI Number

Alien Registration Number

NADDIS Number

Other Numbers

Suspect #3 Information
Last Name (Paternal)

Last Name (Maternal)

Alias/Moniker

Phone Type

First Name
Generation
(Jr., Sr., etc.)

DOB (MMDDYYYY)
Home

Alt DOB (MMDDYYYY)
Cell/Mobile

Suspect Residence Information
Street Number
Dir. (E., S., etc.)
City

County

Pager

Criminal Associate

Height

Middle Name
Race
Male

Weight (lbs)

Phone Number

(

Nationality (US, MX, etc.)

Female
Hair Color Eye Color

Arrested

Yes

No

)

Street Name

Unit # (Apt)
State

Country

Box #
Zip Code

USE ADDITIONAL PAGES AS NECESSARY – LOCAL REPRODUCTION AUTHORIZED
FORM EPIC 143 (05-2010)

Previous Editions Obsolete

Page 3 of 4

NATIONAL CLANDESTINE LABORATORY SEIZURE REPORT - CONTINUED
Involvement (Role) and Identification Numbers
Cook/Chemist

Enforcer

Smuggler

Chemical Courier

Distributor

Financier

Broker

Other – Describe:

Social Security Number

Driver License Number/State

FBI Number

Alien Registration Number

NADDIS Number

Other Numbers

Criminal Associate

Criminal Business Information (Include all a.k.a.’s)
Business Name:
Street Number

Dir. (E., S., etc.)

City

Street Name

Unit # (Apt)

County

Phone Type

Regular

Cell

State
Fax

NADDIS Number

Phone Number

(

Country

Box #

Zip Code

)

Other Numbers (TECS, Case, etc.)

Criminal Vehicle Information (If applicable)
License Plate Number

Temporary License Plate #

VIN Number

State

Type (Car, SUV, Pickup, etc.)

Model

Year

Owner Type

Country

Seized

Yes

No

Make
Privately Owned

Rental

Other

XVIII DEA Reporting Only
GDEP Identifier

Special Agent’s Name * (First, Last)
Yes

XIX

DEA Office Identifier and Case Number
if other than Reporting Office

Special Operations Division Supported Case

No

Phone # *
(
)
Acknowledgement that the Clan Lab Seizure has been reported to CCF via a standard seizure form and submitted to the
Division Asset Removal Group for processing and input into the Consolidated Asset Tracking System.

Remarks Section

Internet: https://www.esp.gov
915-760-2135: Technical Assistance

UNCLASSIFIED FAX:
(915) 760-2359

UNCLASSIFIED FAX:
(915) 760-2312

E-mail Address

MAILING ADDRESS

[email protected]

El Paso Intelligence Center
ATTN: DMU/CLS
11339 SSG Sims Street
El Paso, Texas 79908-8098

USE ADDITIONAL PAGES AS NECESSARY – LOCAL REPRODUCTION AUTHORIZED
FORM EPIC 143 (05-2010)

Previous Editions Obsolete

Page 4 of 4