COMPANY REMOVAL FROM RANDOM PROGRAM Today's Date * MM DD YYYY Requester's Name * First Name Last Name * DOT (DEPARTMENT OF TRANSPORTATION) NON- DOT This form is intended to be used as an official letter to remove the company below: Company Name * DOT # (if applicable) from Precision Mobile Lab Testing's Random Enrollment Program. I am aware that there are no refunds and that all sales are final. I acknowledge that If I am subject to the Department of Transportation and I am not currently under a consortium, I can potentially fail my safety audit and risk having my operating authority suspended. Effective Date * MM DD YYYY Reason for removal * Closing down company Seeking other options Other I Agree to the above statement * I AGREE Name of person filling out the form: * First Name Last Name Additional details Thank you!