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MRO Name, Address, Phone No. and Fax No. OMB No . 0930-0158. C. Donor SSN, Employee I.D., or CDL State and No. D. Specify Testing Authority: ☐ HHS. ☐ NRC.
The MRO must request testing of the split specimen (Bottle B) in writing (i.e., a memorandum or letter format). The written request may be mailed, faxed, or.
Should you be extended an offer of employment you will need to complete and take this form to a collection site for drug testing. MRO: Dr C Kirby Griffin (
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