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LAST NAME: TEST # <br />F CITY OF PARIS <br />CONTROLLED SUBSTANCE AND ALCOHOL SCREENING RESULTS <br />1. All substances listed must be tested and marked as a .pass or fail. <br />2. Contact person listed on authorization sheet with verbal confirmation of results as soon <br />as possible. <br />3. Mail authorization letter and this completed form to the City of Paris Personnel <br />Department as soon as possible. <br />4. Positive results require immediate notification of the listed contact person and <br />automatic confirmation testing. <br />SUBSTANCE <br />PASS <br />FAIL <br />ALCOHOL <br />CANNABINOIDS (CARBOSY -THC) <br />N <br />PHENCYCLIDINE (PCP) <br />OPIATES <br />PROPDXYPHENE <br />AMPHETAMINES <br />BENZODIAZEPINES <br />BARBITURATES <br />COCAINE METABOLITES <br />INHALANTS <br />Failure of one or more of the controlled substance and alcohol abuse tests will <br />disqualify an incoming employee, and may be "Just Cause" for discharge of an employee of <br />the City of Paris. <br />PASS FAIL <br />Specimen forwarded to second testing facility for GC/MS confirmation: <br />YES. N/A <br />DATE TEST ADMINISTRATOR <br />TESTING FACILITY <br />86 Revised 01 -25 -05 <br />