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Attachment E <br />BCRC APPLICANT/CARDHOLDER DRUGTEST <br />INFORMATIONAND INSTRUCTION SHEET <br />BCRC is exercising extreme care to ensure that strict quality control measures are <br />Mowed in the collection, hatndling, and analysis of your specimen. You play an <br />important role in this process and should be certain that you have provided an <br />unadultemtcd specimen to the laboratory. Remcmbe , yvu are certifying that the <br />specimen which yvu provide is yours and is unadultmted. Any adulteration or <br />switching ofspedmcn is a breach of BCRCs rules and, ifyou are employed, may <br />subject yvu to discipline up to and including termination by your Employe <br />For your own protection and peace of mind, we ask that you: <br />Provide a picture idenfification to the collection site/technician at time <br />ofarrival <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 45 ml; <br />• Return the spcdmcn botdc to the medical technician and witness, <br />initial and date the integrity seals placed on your specimen; <br />Verify the proper spelling ofyour name as recorded on the log shod <br />• Verify that your social security number has been properly recorded; <br />Verify that the social security number placed on your specimen bottle <br />is the same as that recorded on the log sheet and the Custody and <br />Control Form <br />IIIAVE READTIIEABOVEAND HAVEIIAD AN OPPORTUNITY <br />TO ASK QUESTIONS REGARDINGTIIIS PROCEDURE. <br />BCRC AppB=tICadwlderSignatwe Doe <br />M <br />