Location Breakdown By Lab Form · 2019. 9. 26. · CONSTRUCTION INDUSTRY DRUG FREE WORKPLACE PROGRAM 9848 E. BURNSIDE PORTLAND, OREGON 97216 (503) 261-0809 TOLL FREE 1 877 210-2654

CONSTRUCTION INDUSTRY DRUG FREE WORKPLACE PROGRAM 9848 E. BURNSIDE PORTLAND, OREGON 97216 (503) 261-0809 TOLL FREE 1 877 210-2654 FAX (503) 261-9973 E-MAIL: [email protected]

Location Breakdown By Lab Form Lab form #1 – Coastal Sites: Astoria, Warrenton, Tillamook, Newport, Coos Bay North Bend, Gold Beach, Lincoln City Lab form #2 – Longview and Vancouver Lab form #3 – East Portland, NW Portland, Gresham Lab form #4 – SW Portland, Beaverton, Hillsboro, Lake Oswego, Tualatin, St Helens Lab form #5 – McMinnville, Salem, Albany, Newberg, Corvallis, Lebanon, Eugene, Springfield, Junction City Lab form #6 – Roseburg, Grants Pass, Medford, Klamath Falls, Lakeview Lab form #7 – Hood River, The Dalles, Hermiston, Pendleton, Bend, Burns, Redmond, Baker City, Madras, Prineville, LaGrande Lab form #8 – Seattle, Puyallup, Lynwood, Friday Harbor, Mt Vernon Lab form #9 – Northern Idaho, Moscow, Montana, Kalispell Lab form #10 –Central Washington, Pasco, Walla Walla, Yakima, Ellensburg, Quincy Lab Form #11 – Eastern Washington, Spokane, Pullman Lab form #12 – Idaho, Boise, Idaho Falls, Lewiston


Lab Form #1

Please Attach This Form To All Paper Work Going To Lab

CLIENT # 4956

(Bricklayers, Carpenters, Cement Masons, Laborers)

NAME SS# Date Time

Home Mailing Address______________________________________________________________________________________ Employer_______________________________________________ Jobsite________________________Union Local_________

Reason for test: Random ____ Pre-employment ____ Post-accident ____ Other ____

COMPANY: CONSTRUCTION INDUSTRY TESTING: LEGACY LAB SERVICES/METROLAB (Client #4956)

Please bring this form with you at the time of your specimen collection. Please remember the lab will need to see picture identification. Please make sure the collection site gives you your copy of the chain of custody form as you will need to give a copy to the Union or your Employer. CURRY GENERAL HOSPITAL: 94220 Fourth St, Gold Beach, OR . Mon- Fri 8:00 am to 4:30 pm, (BY APPOINTMENT) 541-247-3145

COLUMBIA MEMORIAL HOSPTIAL INDUSTRIAL MEDICINE: 211 Exchange St, Astoria, OR 97103, (503)338-7558. M - G 8am - 1pm & 2pm - 4:30pm. Call for Appointment. HELENA’S DURG SCREENS –Pier 39 – 100 39th St #5, Astoria , 503-325-4888 Fax 503-325-4715, M-F 8-12/1-5pm DRUG SCREENS INC.: 737 E Harbor Dr, Suite B, Warrenton, OR (503)861-0693. M - F 9am - 4:30pm,

TILLAMOOK GENERAL HOSP. LAB: 1000 3rd Street, Tillamook, 503-815-2380, M - F 8 - 4pm, Fax 503-815-2446

LEGACY - BRIDGEVIEW: 1010 SW Coast Hwy, Ste 104, Newport M - F 8:30-4:30. Phone 541-265-8810, Fax 541-265-9555 SAMARITAN OCC MED: 775 SW 9th #F, Newport OR, M-F 8-5 (Closed 12-1) 541-574-4675 Fax 503-574-4965 BAY AREA HOSP LAB: 1175 Thomason Rd., Coos Bay 541 269-8071. M - F 8am – 4:30pm Appointment only MCCOWANS MED LAB: 178 West Commercial, Coos Bay, OR 97420, M-Th, 8:00-4:00pm Walk -in 541-267-7853

SAMARITAN NORTH LINCOLN HOSP. 3043 NE 28TH St, Lincoln City, 541-557-6427, M-F 8-5pm ADAPT COASTAL: 400 Virginia Ave, Ste 208, North Bend, 541-756-9707, Fax 435-0036 M-F 8-5pm SOUTHERN COOS HOSP: 900 11th Street SE, Bandon Oregon. 541-347-2426. Hours 6am-5pm

*DO NOT CONSUME ALCOHOL PRIOR TO TESTING*


Lab Form #2


CLIENT # 4956


NAME SS# Date Time

Home Mailing Address______________________________________________________________________________________

Employer_______________________________________________ Jobsite________________________Union Local_________



Please bring this form with you at the time of your specimen collection. Please remember the lab will need to see picture identification. Please make sure the collection site gives you your copy of the chain of custody form as you will need to give a copy to the Union or your Employer.

A WORK SAFE SERVICE: 3305 Main Street, Suite 111, Vancouver WA. M-F 8:00-5:00 closed 12-12:30 for lunch. 360-256-5640 , Fax 360-750-9770

ARC POINT LABS: 9330 NE Vancouver Mall Drive, Suite 201, Vancouver. Walk-In Hours: M-F 7:30-5pm. 360-597-4543, fax 360-597-4907.

ADVANCED DIAGNOSTIC SERVICES: 9106 NE Hwy 99 Suite F, Vancouver, 98665, 360-546-1986, Fax 360-573-8095, Hours: Mon –Fri 7:30am-4pm API GLOBAL: 5501 NE 109th Drive, Ste E (Behind KFC in Orchards), Vancouver, 360-256-0322 Walk-in Hours: Mon –Fri 8:00am-5:00pm, Fax 360-256-0611.

PEACE HEALTH MED. GROUP OCCUPATIONAL HEALTH: 1405 Delaware, Longview, WA. M - F 8am - 5:00pm, Walk-in (360) 414-2332, Fax 360-414-2330

ALLIANCE TESTING & CONSULTING: 9336 NE 76th Street Vancouver. Tuesday-F 8am-3:00, (closed 12-1pm). Phone 360-597-4956, Fax 360-597-4854. East of 205, just south of Padden Parkway. Monday by appointment only. ANY LAB TEST NOW: 5201 E Fourth Plain Blvd, Ste 105, Vancouver. M-F 8am-6pm. 360-828-5600



Lab Form #3


CLIENT # 4956 Bricklayers, Carpenters, Cement Masons and Laborers

NAME SS# Date Time

Home Mailing Address_____________________________________________________________________________________ Employer_______________________________________________ Jobsite________________________Union Local_________




LEGACY CENTRAL LAB: 1225 NE 2ND Ave. 1st floor, (East of Rose Garden Arena close to Max Stop)Portland. Open Monday @ 7am and open 24 hours thru Sat. 4:30pm. Walk in . (503) 413-5000. Fax (503) 413-5485 GRESHAM O’BRIEN DRUG TESTING: 1217 NE Burnside, Bldg A, Suite 202 (next to Busters) M-F 9-5 closed for lunch 12-1. 503-907-1301, Fax 503-907-1302

ADVENTIST HEALTH OCC MED : 1350 NE 122nd Ave (1 blk South of Halsey) Portland, 503-408-7040 Mon-Thurs 8am-12pm/1pm-5pm, Friday 8am-12pm/1pm-4pm. Fax 503-408-7045 PROVIDENCE OCC HEALTH : 9290 SE Sunnybrook #220, Clackamas 503-215-2874, Fax 503-215-2875. M-F 8am-5pm.

AFC URGENT CARE : 7033 NE Sandy Blvd, 503-305-6262, fax 971-888-4671 – 8am – 8pm

CONCENTRA SWAN ISLAND: 3449 N Anchor St, Ste 300A, 503-283-0013, fax 283-0785. M-F 7am-5pm CONCENTRA AIRPORT WAY: 12518 NE Airport Way #110, 503-256-2992, fax 258-0717. M-F 7am-5pm THE PORTLAND CLINIC : 5005 NE Sandy Blvd, Portland. 503-233-6940, Fax 503-236-2676. M-F 7:30-5pm



Lab Form #4


CLIENT # 4956 Bricklayers, Cement Masons, Carpenters and Laborers NAME SS# Date Time

Home Mailing Address ____________________________________________________________________________________

Employer_______________________________________________ Jobsite________________________Union Local_________

COMPANY: CONSTRUCTION INDUSTRY Reason for test: Random ____ Pre-employment ____ Post-accident ____ Other ____ TESTING: LEGACY LAB SERVICES/METROLAB (Client #4956)Please bring this form with you at the time of your

specimen collection. Please remember the lab will need to see picture identification. Please make sure the collection site gives you your copy of the chain of custody form as you will need to give a copy to the Union or your Employer.

LEGACY LAB CORNELL: 1960 NW 167th Place, Ste 203, Beaverton, M- F 8:30-5:00 closed for lunch 12:30—1:30- 503-672-6111 Fax 503-672-6112. AFC URGENT CARE: 14278 SW Allen Blvd, Beaverton. 503-305-6262, fax 503-430-1278. 8am,-8pm CONCENTRA TANASBOURNE: 2225 NW Town Center Dr, Bvtn. M-F 8-5:30, 503-726-1021, Fax 726-1039 OREGON OCC MED; 19365 SW 65th Ave, Ste 100, Tualatin. M-F 8-5. 503-563-5382, Fax 503-563-5382 LEGACY TUALATIN: 7587 SW Mohawk St, Tualatin M-F 8:30am–4:30pm, 692-2700.Fax 503-692-4546 OREGON OCC MED: 1200 NE 48TH Ave, Ste 1000, Hillsboro. M-F 8-5, 971-470-3275, Fax 596-2182 PROVIDENCE OCC HEALTH: 18610 NW Cornell Rd, Ste 204, Hillsboro. 503-216-0216, Fax 503-216-0211. M-F 7am – 5:30pm

LEGACY LAB ST. HELENS GOOD SAMARITAN MEDICAL MALL: 500 N Columbia River Hwy. St Helens (503)397-1802, Fax 1-503-366-3484, Hours: M-F 8:00am - 5:00pm CONCENTRA MEDICAL CENTER-SOUTHWEST: 6405 SW Rosewood, Suite B, Lake Oswego 503-675-7603 M-F 7am to 5pm Fax 503-675-7611

AFC URGENT CARE: 17437 Boones Ferry Rd, Lake Oswego 503-305-6262, Fax 503-305-6078, M-F 8am-8pm, Weekends 9am -6pm AFC URGENT CARE: 25 NW 23rd Place, 503-305-6262, fax 503-227-6262, M-F 8am – 8pm



Lab Form #5 Please Attach This Form To All Paper Work Going To Lab

CLIENT # 4956 (Bricklayers, Carpenters, Cement Masons, Laborers)

NAME SS# Date Time


COMPANY: CONSTRUCTION INDUSTRY Reason for test: Random ____ Pre-employment ____ Post-accident ____ Other ____

TESTING: LEGACY LAB SERVICES/METROLAB (Client #4956)Please bring this form with you at the time of your

specimen collection. Please remember the lab will need to see picture identification. Please make sure the collection site gives you your copy of the chain of custody form as you will need to give a copy to the Union or your Employer.

MCMINNVILLE IMMEDIATE CARE: 207 NE 19th St, #102, McMinnville. M-F 8am – 4pm Phone 503-435-1077 Fax 503-883-5831.

BIO MED TESTING SERVICE: 3110 25th Street SE, Salem, 503-585-6654. F 503-315-8995, M-F 7am-5:30pm API GLOBAL: 2535 25th Street SE, Salem. 503-362-8378, Fax 503-362-4123, M-F 8am-5pm A WORKSAFE SERVICE: 1696 Capitol St NE, Salem. 503-391-9363, Fax 503-316-9110, M-F 8am-5pm NEWBERG URGENT CARE: 2880 Hayes St, Newberg. 503-537-9600, Fax 503-537-0105 M-F 9-6pm

SAMARITAN OCCUPATIONAL MEDICINE: 2615 Willetta St C-2, Albany, OR 541-812-5600, M-F 7:30-5:30 Fax 541-812-5523 ALBANY FAMILY MEDICINE: 1705 Weaverly Dr SE, Albany, OR M-F 8am-5pm, Walk-in (541) 928-6421. Fax 541-758-2743 CORVALLIS CLINIC OCCUPATIONAL MEDICINE: 2350 NW Century Drive, Corvallis, OR. M - TH 7:30am -5:30pm, Fri 8am – 5pm, (541) 753-1786, Fax 541-753-1787

CASCADE HEALTH: 2650 Suzanne Way Suite 200, Eugene, OR. M - F 7am - 6pm, Walk-in OK Appt Preferred (541)228-3100, Fax 541-228-3185. CHEMICAL TESTING MOBILE SERVICES: 2025 West 12th Ave Eugene, (corner of 12th and Garfield). M - F 8am- 5pm, Walk-in. (541) 686-2550, Fax 541-686-3022 ANY LAB TEST NOW – 1733 Pearl St, Ste A-2, Eugene. M-F 9-6, Sat 9-2. 541-343-2398, Fax 541-344-4597

LEBANON COMMUNITY HOSP. OCC. HEALTH: 55 Twin Oaks Ste D2, Lebanon, OR M-F 8:00AM-5PM CLOSED for Lunch 12:00-1:00pm Walk-in, 541-451-7505 Fax 541-451-7019 JUNCTION CITY MEDICAL: 355 W 3rd Avenue, Junction City OR. 541-998-6750. M-F 8-3pm, Sat 9-12





NAME SS# Date Time Home Mailing Address______________________________________________________________________________________ Employer_______________________________________________ Jobsite________________________Union Local_________

COMPANY: CONSTRUCTION INDUSTRY Reason for test: Random ____ Pre-employment ____ Post-accident ____ Other ____ TESTING: LEGACY LAB SERVICES/METROLAB (Client #4956)


EVERGREEN OCCU HEALTH: 2570 NW Edenbower, Roseburg, OR. M-F 8am-5pm, Walk-in (541) 677-7477, Fax 541-677-7478.

ASANTE/ROGUE VALLEY OCCUPATIONAL HEALTH: 781 Black Oak #102, Medford, OR M-F 7:30am – 4:30pm Walk-in (541) 789-2729, Fax 541-789-4060

PROVIDENCE-BUSINESS HEALTH SERVICES: 1390 Biddle Road Suite 101, Medford, OR. (Behind Barnes & Noble Bookstore) M-F 8am – 4:30pm Walk-in 541- 732-5554 Fax 541-732-5939

ASANTE OCCUPATIONAL HEALTH: 625 SW Ramsey Ave, Ste A, Grants Pass, M-F 7:30am – 5pm M-F not open weekends (541) 472-7000, Fax (541) 507-2291. INTERPATH LABS: 700 SW Ramsey, Ste 210, Grants Pass 541-471-0460. M-F 7:30-5:30

INTERPATH LABS: 124 NW Midland, Suite M, Grants Pass 541-479-2977. M-F 8-5 (closed 12-1) BASIN IMMEDIATE CARE: 3737 Shasta Way, Klamath Falls, OR 97603 (541) 883-2337 Fax 541-883-2504 M-F 8am–7pm, Sat 9am-6pm, Sun 9am-3pm. NORTH STATE ALLIANCE: 120 North G Street, Lakeview, OR 97630. 541-947-2566, Fax 541-947-2569. Mon-Fri 8:30 – 4:30





NAME SS# Date Time



Please bring this form with you at the time of your specimen collection. Please remember the lab will need to see picture identification. Please make sure the collection site gives you your copy of the chain of custody form as you will need to give a copy to the Union or your Employer. BIO-MED: Mobile Unit, call for appointment and they will come to any jobsite. LaGrande , 8am-3pm, (541) 624-5222, Fax (541) 624-5223 INTERPATH: 2011 4th Street, LaGrande OR -541-963-9630, Fax 541-963-5073 M-F 7:30 – 5pm. PROVIDENCE HEALTH: 917 11th Street, Hood River, OR. M - F 8am-5pm Walk-in 541-387-6383.Fax 541-387-6298 MID COLUMBIA HEALTH : 1815 E 19th Street #2, The Dalles. 541-296-7811 Fax 541-296-4710. M-F 8-4:30, closed for lunch 12-1:00 INTERPATH LABORATORY: 1210 Dry Hollow Road, Suite 5, The Dalles, M-F 8am-5pm, lunch from 12 to 1:00, 541-296-4262, Fax 541-769-0517 MOUNTAIN MED-IMMEDIATE CARE: 1302 NE 3rd St, Bend. M-Sat 8 - 7, Sun 10-6 (541) 388-2561 Fax 541-317-0533 OCCUPATIONAL MEDICINE AT THE CENTER: 2200 NE Neff Rd, Ste 200, Bend OR. (541)-322-2213 Fax (541)-382-1681. Hours M-F 8am – 4pm. INTERPATH: 1100 Southgate, Pendleton, OR M - F 7am - 5:30pm Walk-in. (541) 278-4730. HEALTH OPTIONS: 645 W Orchard Ave, Hermiston, OR. M – Th 8am - 5pm Friday 8am-3pm (Closed 12-1) Walk-in. (541) 567-2600, Fax (541) 567-2690

MT VIEW HOSP. LAB: 470 NE A St, Madras, OR 97741, (541) 475-3882 9am-5pm

HIGH DESERT MEDICAL CENTER: 559 W Washington St, Burns OR. (541) 573-2074 M - F 8am – 4pm PIONEER MEM./ST CHARLES : 384 SE Combs Flat Rd, Prineville . (541) 447-6254 Fax (541) 447-8728 M-F 7:30 -3pm



Lab Form #8


CLIENT # 4956




TESTING: LEGACY LAB SERVICES/METROLAB (Client #4956)


CONCENTRA (formerly US Healthworks): 3850 South Meridian-, Puyallup, WA 98373, Ph: (253) 840-1840 Hours: M-F 8am-6:30pm. Sat & Sun 9am-5pm INTER ISLAND MEDICAL CENTER: 550 Spring Street W., Friday Harbor WA 98250, Phone 360-378-2141. Hours: M-F 8:00am – 5:00 pm CONCENTRA (formerly US Healthworks) : 4320 196th Street SW, Suite D, Lynwood WA. Phone 425-774-8758. Hours: M-F 8am-6pm. Sat 9am-5pm. ARC POINT LABS : 2414 SW Andover St #E130, Seattle 206-504-1681, Fax 206-866-5367. Hours M-F 8:30-5:30, Saturday 8:30 –Noon AMERICAN DIAGNOSTICS : 650 S Orcas St, Ste 125, Seattle 206-762-4456, Fax 206-762-4456 M-F 8-4 SKAGIT CLINICS – 1400 E Kincaid St, Mt Vernon WA. 360-848-4150, Fax 360-848-4169. M-F 8-4:30



Lab Form #9


CLIENT # 4956





Grittman Medical Center : 700 South Main, Moscow ID 83843. Phone 208-883-6241. Hours for drug testing: Monday 11:00-4:00, Tuesday 8:00-11:00, Wed-Thurs 8:00-4:00, Friday 8:00-4:00. Valley Medical Services : 2425 Hwy 2 East, Kalispell MT 59901. Phone 406-300-7065, fax 406-257-3264.



Lab Form #10


CLIENT # 4956


NAME SS# Date Time Home Mailing Address______________________________________________________________________________ Employer_______________________________________________ Jobsite________________________Union Local_________



Yakima Valley Memorial Hospital-OCC Hlth: 2811 Tieton Drive, Yakima, WA 98902. Ph: (509) 575-8633. Working Hours: 24 Hours ER Central Washington Occupational Medicine: 111 South 11th Avenue, Suite 320, Yakima WA. Phone 509-575-5058, Fax 509-573-4546 M-F 7:30-4:30pm

ADDS: 507 Nanum Room 111, Ellensberg, WA 98926 Mon, Tues, Thur, Fri 8:30-11:00 & 1:30-4:00pm Wednesday 1:30pm-4:00pm Ph: (509) 925-9821. QUINCY VALLEY MEDICAL CENTER: 908 10TH Avenue SW, Quincy WA. 509-787-3531, Fax 509-787-1361. M-F 6am-5:30pm LOURDES BUSINESS HEALTH SERVICES: 9915 Sandifur Parkway Pasco, WA 99301 Ph: 509-546-2222, Fax 509-546-2202 Hours: M-F 8am-5pm. ST MARY’S: 380 Chase, Walla Walla, WA 98362. Phone 509-522-5895 / 8am-4:30pm, By Appt. only



Lab Form #11


CLIENT # 4956


NAME________________________________________SS# ________________________Date _________Time Home Mailing Address_______________________________________________________________________________ Employer_______________________________________________ Jobsite________________________Union Local_________




PATHOLOGIST REGIONAL LABORATORY: SE 1205 Professional Mall Blvd Suite 107, Pullman, WA 99163. Ph: (509) 332-6412 Hours: M-F 8:30-12:00 and 1:15-3:30 (Right on Bishop, Brown Brick Building) SUMMER HOURS: 7:45AM – 3:30PM Mon thru Fri. (5/22/06)

US HEALTHWORKS: 2005 E 29th Ave, Spokane WA. Phone 509-747-0770, fax 509-624-0620. Hours M-F 8am-7pm, Saturday 10am-5pm OCC MEDICAL ASSOCIATES: 323 East 2nd Ave. Suite 102, Spokane WA. Phone 509-455-5555, fax 509-455-4114. Hours 7:30am-4:45pm



Lab Form #12


CLIENT # 4956


NAME SS# Date Time Home Mailing Address_____________________________________________________________________________________ Employer_______________________________________________ Jobsite________________________Union Local_________




PRIMARY HEALTH, OCC HEALTH: 10787 West Ustick, Boise ID 83713. (208)378-8011. Mon-Sat 8:00-8:00pm, Sun 8:00-6:00pm. PRIMARY HEALTH/BOISE: 1907 S. Broadway #100. Phone 208-345-1222, Fax 208-345-1261 WIENHOFF DRUG TESTING: 1230 N Skyline Dr, Ste A, Idaho Falls, ID 83402. Ph: (208) 528-9000 Fax: (208) 528-9020. *Located In Back of Building* Hours: M-F 8:00-12:00 and 1:00-5:00pm VALLEY DRUG TESTING: 1311 G Street, Lewiston ID 83501. Phone 208-743-5232, Fax 208-743-5401. Hours M-F 8am – 5pm. (closed Noon – 1pm)


Documents

Location Breakdown By Lab Form · 2019. 9. 26. · CONSTRUCTION INDUSTRY DRUG FREE WORKPLACE PROGRAM 9848 E. BURNSIDE PORTLAND, OREGON 97216 (503) 261-0809 TOLL FREE 1 877 210-2654