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DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG -FREE WORKPLACE <br />REQUIREMENTS <br />Name: u- )tcJIP,n N (?x) <�Cwa <br />Name of Contractor: W&skeh! A GoSCA /V <br />Contractor Number: <br />Date: C1 �2tr r <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 />Place of Performance (include street address, city, county, state, zip code for each <br />site): <br />loub e, can -a Ag-a 6 \vC\ 20-0 <br />�On -a Nrea, CA gaa D I <br />CA CkV1 C_raay\\E- <br />EXHIBIT C <br />