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WESTERN PUMP <br /> Petroleum & Lubrication Equipment Specialists <br /> ACKNOWLEDGEMENT OF PRE-EMPLOYMENT DRUG SCREENING POLICY <br /> I understand that any offer of employment will be conditional upon me successfully passing a <br /> saliva drug screen for amphetamines, methamphetamines, cocaine, opiates , marijuana , and <br /> phencyclidine, before I begin employment at the Company, I further understand that a positive <br /> drug screen or refusal to take a drug test will mean that an offer of employment to me will be <br /> withdrawn . <br /> Signature Date <br /> Print Name <br /> Social Security No . <br /> Current Medications (optional) : <br /> i <br /> i <br /> i <br /> i <br /> 3235 " F" Street, San Diego, CA 92102-3315 619-239-9988 Fax 619-239-9925 <br /> www.westernpump . com <br /> California Contractor's License #673853 <br /> California Certified Small Business #33547 <br />