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<br />DIVISION OF EMPLOYMENT SERVICES <br /> <br />PLACE OF PERFORMANCE <br /> <br />FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS <br /> <br />Name: Kt-fko, f-li r-sci-, <br />Name of Contractor: ~~ <br /> <br />Contractor 'Number: <br /> <br />La.....; 0oj(~n ForM; Iv <br />/ <br />Fe) :co # '?s-- 3?S"QR'3/ <br /> <br />Date: <br /> <br />:Tvly..2..6 2.00'1 <br />( I <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 />/ / / / C. (IV'., ke /1 0. VIA Are., 5 ,,; te. G... s... vt-h.. ~c.. OVQt/1 '7e {~c..4- 'l:z.. 7 CJ S- <br />, . ' v <br />