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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: <br /> <br />~ s Tt02.- <br /> <br />8l ~ /VIe Ne:1ZN,çy <br />T*~~ $4rJ -JOS£ <br /> <br />Name of Contractor: <br /> <br />Contractor 'Number: <br /> <br />7!¡q /04- <br /> <br />Date: <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 />"6D LJV l ~'/ <br />~AfJ7A frN'A I Q2-70 I <br />, <br /> <br />3/0 PDl NS12:.l1 (A <br />SA-NTA ~, CjZ70 I <br />