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G.O.#: EFFEC. DATE: PREV. DATE: Page 12 of 12 Pages <br />ACKNOWLEDGEMENT <br />I acknowledge that I have received and read a copy of LPFD's Substance Testing Policy. I <br />understand the Policy, and agree to abide by it. I understand the Policy may be updated in the <br />future. <br />Employee Signature <br />Employee Name (printed) <br />This form shall be retained by Human Resources. <br />Date <br />Please complete and return this form immediately. <br />71 <br />