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I acknowledge, by signing this form, that my full compliance with, the Anti -Drug and Alcohol <br />Misuse Prevention Plan (the "Plan") and DOT drug and alcohol regulation requirements is a <br />condition of my initial and continued employment with the Company, I understand and agree <br />that I may be discharged or otherwise disciplined for any drug and/air alcohol violation, <br />committed by me, as cited in the Plan and/or in the DOT drug and alcohol regulatory <br />requirements. <br />I also acknowledge, by signing this form, that a copy of the Plan has been made available to me <br />and that I have read and understand the requirements of the Company and DOT drug and <br />alcohol program. I have also been provided with informational material on the dangers and <br />problems of drug abuse and alcohol misuse. <br />Signed, this the day of , 20 <br />Employee Name (Please Print) <br />Employee Signature <br />Company Representative Name (Please Print) <br />Company Representative Signature <br />J. RANCK ELECTRIC, INC. <br />PHMSA DRUG/ALCOHOL PLAN <br />NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. (NCPAS) ^ 2010 35 <br />