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<br />DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE <br />REQUIREMENTS <br /> <br />Name: <br />Name of Contractor: <br />Contractor Number: <br />Date: <br /> <br />/f~ S(J /J1 a,/ e /) J/'r / CL <br />Or c-tl1j e {l tJ IA /J I[ Yc:'>?l M {/ em rn j S:J ./ ~-t <br /> <br />r-/ 9-0 7 <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 />tjtJ/ Sil-A Sfr~ <br />3 a-t.th. /Inti, e /1 Q.:2--7 ~ / <br /> <br />, <br />