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DIVISION OF EMPLOYMENT SERVICES <br />PLACE OF PERFORMANCE <br />FOR CERTIFICATION REGARDING DRUG -FREE WORKPLACE <br />REQUIREMENTS <br />Name: gnna <br />Name of Contractor.,t�i�zt L'6l I Pi_ <br />Contract Number: <br />Date: 6 fib,, <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 />.3/&P RAej A// rove, Cag•fir Me'pcx,'e& <br />r`Yar+rat !:ewn �-tf , ek <br />Address <br />107:II HA <br />