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ATTACHMENT II <br />BCRC APPLICANT/CARDHOLDER DRUG TEST <br />INFORMATION AND INSTRUCTION SHEET <br />BCRC is exercising extreme care to ensure that strict quality control <br />measures are followed in the collection, handling, and analysis of you <br />specimen. You play an important role in this process and should be certain <br />that you have provided an unadulterated specimen to the laboratory. <br />Remember, you are certifying that the specimen which you provide is <br />yours and is unadulterated. Any adulteration or switching of specimen is a <br />breach of BCRC's rules and, if you are employed, may subject you to <br />discipline up to and including termination by your employer. <br />For your own protection and peace of mind, we ask that you: <br />• Provide a picture identification to the collectionsite/technician at time <br />of arrival; <br />• Be escorted to a collection room and asked to provide an unadulterated <br />specimen in the collection bottle provided. The bottle should be filled <br />to 60 ml; <br />• Return the specimen bottle to the medical technician and witness, initial <br />and date the integrity seals placed on your specimen; <br />• Verify the proper spelling of your name as recorded on the log sheet; <br />• Verify that your social security number has been properly recorded; <br />• Verify that the social security number placed on your specimen bottle is <br />the same as that recorded on the log sheet and the Chain of Custody <br />form. <br />I HAVE READ THE ABOVE AND HAVE HAD AN OPPORTUNITY <br />TO ASK QUESTIONS REGARDING THIS PROCEDURE. <br />BCRC Applicant/Cardholder Signature Date <br />7Q <br />