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ATTACHMENT 5
HEPACO, INC.
CHAIN-OF-CUSTODY ACKNOWLEDGEMENT
I acknowledge that in my presence the urine specimen was sealed, and a label bearing my initials
and Social Security Number was applied.
Date Signature of Applicant/Employee
Social Security Number
Date Signature of Witness
Document No. 804: Drug and Alcohol Abuse Policy
Revised December 2000 Attachment 5
