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DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG -FREE <br />WORKPLACE REQUIREMENTS <br />Name: " /'e '/ 4�_ 4 w'4 F tst F 7- - C_�1 <br />Name of Contractor: ��/�S0� Y � o�( r 'o-t -='-7 <br />Contractor Number: <br />Date: P <br />The Contractor shall insert in the space provided below the site(s) expected to be used <br />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 site): <br />lCi2 ✓/, �Q oY- K 2. G✓G iz.(�' C� Y('�"R.. (r" <br />50- <br />EXHIBIT C <br />