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<br />DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE <br />REQUIREMENTS <br /> <br />N"me ~~C~'f <br /> <br />l\Jame of Contractor: (~51 ~~ C"X4U-C" ~t".:.. L-d'-II-....-- <br /> <br />Contractor Number: <br />Date: 11/1/0r- <br /> <br />The Contractor shall insert in the space provided below the site(s) expected to be <br />used for the performance of work under the contract covered by the certification: <br /> <br />Place of Performance (include street address, city; county; state; zip code for each <br />site) : <br /> <br />1S /$C;~3 ;If I["W~>(;'L; 1f;L~~.-, CA <br />B Y1L1C~A.--' ,u' ~~. //-'"~~ -rt~'-vZ/~-<J,>j- ti~ <br />,Ci-~ /.,;/'0... 1'[3D a..t- +W"~L t~, f,A-.~r <br />, t 6 <br /> <br />12-Jt1 / <br /> <br />Ceo7-<-~('.:: <br />U <br />