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SCREENSAFE, <br />to ScreenSafe,Inc. <br />2364 Essington Rd. Suite 128, Joliet, IL 60435 <br />P: 877-727-3369 F: 815-676-2210 <br />www.ScreenSafeinc.com <br />Dear: <br />Authorization for a UrineUrine Dn billed <br />Form Fox Users Quest Bar Code 80303765 <br />Date & Time of Delivery to Participant <br />Northern Indiana NECA & IBEW Local Union 153 have adopted a Substance Abuse Policy. According to that policy, <br />all participants shall report to the nearest test facility listed below as soon as possible after notification by your <br />employer through the presentation of this letter. Please arrive with a full bladder and try not to drink excessive <br />amounts of fluids just prior to your arrival. You may also be required to take a breath alcohol tests. According to <br />the Substance Abuse Policy you will receive a $35.00 participation stipend for submitting to the testing. <br />Northern Indiana NECA/Local Union 153 information: <br />It is your responsibility to notify Northern Indiana NECA/Local Union 153 of any address and/or phone <br />number changes. <br />• Northern Indiana NECA/Local Union 153 offers a fully independent, professional Employee Assistance <br />Program (EAP) for you and your family. <br />The EAP's toll -free, 24 hour 7 day a week hotline is 800-731-6501. <br />You will need to present this letter and a valid picture ID at the collection facility. <br />Collector: If using Form Fox please use Quest Bar Code Account number 80303765 to generate <br />CCF. PLEASE PROVIDE RECEIPT for proof of testing. <br />Quest Diagnostics — South Bend (Preferred) <br />16598 State Road 23, South Bend, IN 46635 <br />Monday, Thursday, Friday - 7:30 am to 12:30 pm and 1:00 pm to 3:00 pm <br />Tuesday and Wednesday - 7:30 am —1:00 pm <br />574-273-3323 <br />Professional Diagnostics & Safety — Nappanee (Preferred) <br />717 S. Oakland Avenue, Nappanee, IN 46550 <br />Monday - Friday 7:00 am to 4:00 pm <br />574-773-1000 <br />Michiana Drug Testing Center — Cassopolis (Preferred) <br />114 Spencer Road, Cassopolis, MI 49031 <br />Monday, Thursday, Friday 10:00 am — 2:00 pm <br />Tuesday and Wednesday 10:00 am — 6:00 pm <br />Lifeplex Urgent Care — Plymouth <br />2855 Miller Drive, Plymouth, IN 46563 <br />Monday — Friday 9:00 am — 7:00 pm <br />574-941-1000 <br />Any Lab Test Now — Mishawaka (Preferred) <br />313 W. University Drive, Mishawaka, IN 46545 <br />Monday - Friday 8:00 am-6:00 pm <br />574-287-5041 <br />Windsor Work Care— Elkhart (Preferred) <br />3100 Windsor Court, Elkhart, IN 46514 <br />Monday— Friday 7:00 am — 5:00 pm <br />574-266-6555 <br />Physicians Urgent Care — Warsaw <br />2680 Escalade Way, Warsaw, IN 46582 <br />Monday — Friday 8:00 am — 8:00 pm <br />574-306-4128 <br />Lakeland Center for Outpatient Services — St. Joseph <br />3900 Hollywood Road, St. Joseph, Michigan <br />Monday— Friday 6:00 am — 7:00 pm <br />269-556-2837 <br />I consent and authorize for the <br />following: <br />To provide a urine drug screen test <br />and/or breath alcohol as per The <br />NECA/Local Union 153 Substance <br />Abuse Policy. <br />When at the collection facility if you have any issues please contact ScreenSafe <br />