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Attachment E <br />BCRC APPLICANT/CARDHOLDER DRUG TEST <br />INFORMATION AND INSTRUCTION SHEET <br />BCRC is exercising extreme care to ensure that strict quality control measures are <br />followed in the collection, handling, and analysis of your specimen. You play an <br />important role in this process and should be certain that you have provided an <br />unadulterated specimen to the laboratory. Remember, you are certifying that the <br />specimen which you provide is yours and is unadulterated. Any adulteration or <br />switching of specimen is a breach of BCRC's rules and, if you are employed, may <br />subject you to 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 collection site/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 45 ml; <br />• Return the specimen bottle to the medical technician and witness, <br />initial 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 <br />is the same as that recorded on the log sheet and the Custody and <br />Control Form. <br />I HAVE READ THE ABOVE AND HAVE HAD AN OPPORTUNITY <br />TOASK QUESTIONS REGARDINGTHIS PROCEDURE. <br />BCRC Applicant/Cardholder Signature Date <br />61 <br />