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TION CODE 7. SPECIMEN NUMBER 8. COMPLETE SSN 5. DOCUMENT/ BATCH NUMBER 9. TEST BASIS 10. TEST INFO 6. DATE SPECIMEN COLLECTED YYYY MM 11. PRESCREEN E. DISC CODE DD (1) SIGNATURE DD Form 2624, FEB 1998 D. DRUGS TESTED F. ACCESSION NUMBER H. CERTIFICATION. I certify that I am a laboratory certifying official, that the laboratory results indicated on this form were correctly determined by proper laboratory procedures, and that they are correctly annotated. C. REPORT OF RESULT (DTG/Ser.

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