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SLATILE ROOFING AND SHEET METAL CO., INC. <br />1703 SOUTH IRONWOOD DRIVE <br />SOUTH BEND, INDIANA 46613 <br />BCRC APPLICANT/CARDHOLDER DRUC TEST <br />INFORMATION AND INSTRUCTION SHEET <br />BCRC is exercising extreme care to ensure that strict quality control measures are followed in <br />the collection, handling, and analysis of you specimen. You play an important role in this <br />process and should be certain that you have provided an unadulterated specimen to the <br />laboratory. Remember, you are certifying that the specimen which you provide is yours and is <br />unadulterated. Any adulteration or switching of specimen is a breach of BCRC's rules and, if <br />you are employed, may subject you to discipline up to and including termination by your <br />employer. <br />For your own protection and peace of mind, we ask that you: <br />• Provide a picture identification to the collection site/technician at time of arrival; <br />• Be escorted to a collection room and asked to provide an unadulterated specimen in <br />the collection bottle provided. The bottle should be filled to 45 ml; <br />• Return the specimen bottle to the medical technician and witness, initial and date the <br />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 the same as <br />that recorded on the log sheet and the Chain of Custody form. <br />I HAVE READ THE ABOVE AND HAVE HAD AN OPPORTUNITY TO ASK <br />QUESTIONS REGARDING THIS PROCEDURE. <br />BCRC Applicant/Cardholder Signature Date <br />