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WES71ERN PUMP <br /> Petroleum & Lubrication Equipment Specialists <br /> ACKNOWLEDGEMENT OF UPDATED DRUG SCREENING POLICY <br /> i <br /> I acknowledge I have received the updated Company Drug & Alcohol policy as of <br /> (date) I further understand that a positive drug screen or refusal to takea <br /> drug test will result in immediate disciplinary action and possible termination ofemployment. <br /> Signature Date <br /> Print Name <br /> Social Security No . <br /> Current Medications (optional) : <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 />