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* Be escorted to a cohecti()i[I a,(�orn and mked to pirovkie ai[t unaduherated u.n ns, <br />rope cin-leas in uhc, wHevion botfl,, pro�Jdedl Fhe bo0e' shouht N., 1"Ned to 60mk <br />* Return flne spec4n.cn botdk.: to the nic.,dical techniciall wild Wtn(.,Ns, initnfl and <br />date; die ultegrity Seals pkced 0111 your qxuinlejl, <br />the:; pwGpXy SPCHng ofyour nanic an record.ed onthe log <br />t, <br />VC -TIN ffiat 1�'4)Citfl security o,unnbeir has V--�neon prq.,)(:,i-Jy recorded <br />Vuriiy that the socials sc�ctniiy number IpLmed ou vo�,iir spe.cirnen bmde is the <br />Sayre th"111 uccordcd on thou per, sheet and dn, chall of"i)(18ses"Jon (Jonn, <br />I HAVT RLAD -11 HE ABOW', ANL) HAVE HAID AN OPPORTUNITY TO ASK Q[JE' TIONS <br />THIS <br />D "al C: <br />A,rTACHMEN'r u <br />BURA)ING AND CONS1 RUC 110N 141,;SQURCE CENTER IN(' <br />:�I;"9"@IQRJZATJQN FOR CONSENTTO DRUG AN[) ALCM-101, _Nlt, 1, S Is <br />4Nl) 1. A 11,10 It -o R F 1'. EA sli, () r, I z 1,,s I " 1 :vs, <br />L the undersigned, do hereby authorize the testing of my body fluids for <br />employnaent reasons and understand and a�grce that the results of any such ttsting wiH be lumed <br />over to the Buildin,- and Consnuction Resource Center, hic. and, further that the testing procedures <br />will be hiniled to tests for prohibited and illegal dritgs and controlled substances. <br />I undenstand that the results of these tests may be used for eniployment and disciplinary rc"Lsonsand <br />hereby awhorize-the retelse ofstoch inn ormation fironi die Moratory and MRO, <br />t further certify that the urine specimen collected front me is mine and not adulterated or altered in <br />any manner. I have been advised that matters affecting rne relative to the interpretation or <br />application of the Drug Policy are subjCCt eXClUSiVC1y co the grievance and arbitration procechire <br />under my collective bargaining agreement (if applicabie). <br />0 <br />