I acknowledge that I have been provided with a copy of the Burnt Mountain Services (the Company) Drug and Alcohol Policy requirements.  I understand that disciplinary action, up to and including termination, will result if I violate this policy.

I also hereby consent to disclosure by the Burnt Mountain Services and its agents, including, but not limited to, any collecting and testing agencies, of the test results identified above and any related information to clients of the Company and its authorized agents, assigns, or representatives.