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AUTHORIZATION FOR POST.ACCIDENT/INJ URY <br />CONTROLLED SUBSTANCES/ALCOHOL TESTING <br />TO Medical Testing Facility <br />FROM: Visu-Sewer, lnc. <br />SUBJECT: Authorization for Post-Accident Controlled Substances/AlcoholTesting <br />Visu-Sewer, lnc. requires that all employees involved in vehicle accidents or injured in work related accidents be <br />tested for controlled substances and/or alcohol. lf verbal authorization for the testing is required, please contact a <br />member of Visu-Sewer's management at 800-876-8478. <br />Billing for the tests to be performed and related services should be sent to: <br />Visu-Sewer, lnc. <br />W230 N4855 Betker Road <br />Pewaukee, Wl 53072 <br />Telephone Number: 800-876-8478 <br />Alcohol Testing Results and Specimen Collected should be forwarded with Custody Forms to: <br />Advanced Toxicology Network (ATN) <br />3560 Air Center Cove, Suite 101 <br />Memphis, TN 38118 <br />Telephone N um ber: 888-222-4894 <br />Profile #1361 61 (FMCSA) <br />ACL Laboratories <br />8901 W. Lincoln Avenue <br />West Allis, Wl 53227-0901 <br />Telephone: 800-877-7016 <br />Account#: A5228999 <br />Non-DOT Testing: <br />Tests to be performed: X_51001 - 5 Panel (AR-76939) <br />Chain of Custom Forms for non-dot collections should reference Visu-Sewer's name and address and <br />Employers lD Number: 90489N. <br />Federal Drug Testing: <br />Tests to be performed: THC, Cocaine, PCP, Opiates and Amphetamines <br />Federal Drug Testing Custody and Control Forms should reference Visu-Sewer's name and address and <br />Employers lD Number: 90489. <br />The MRO Name and address is: <br />Kevin B. Edwards, M. D. <br />Noble Diagnostics <br />19525 Janacek Court Suite 103 <br />Brookfield, Wl 53045 <br />Telephone: 262-957 -1 967 F ax: 262-7 84-0 1 88 <br />Thank you for your assistance in performing the tests required by Visu-Sewer's Controlled Substances/Alcohol <br />Policy. <br />APPENDIX I