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DMSION OF EMPLOYMENT SERVICES <br /> <br />PLACE OF PERFORMANCE <br /> <br />FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS <br /> <br />Name: <br /> <br />The Pacific Institute, Inc, <br /> <br />Name of Contractor: <br />Contractor Number: <br /> <br />Date: May 1, <br /> <br />The Pacific Institute, Inc. <br /> <br />20O3 <br /> <br />The Contractor shall insert in the space provided below the site(s) expected <br />to be used for the performance of work under the contract convered by the <br />certification: <br /> <br />Place of Performance (include street address, city, county, state, zip code <br />for each site): <br /> <br />220 S. Daisy Ave., Bldg. A (City Yard) <br />Santa Aha, CA <br /> <br /> <br />