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Attachment F <br /> • <br /> FLORIDA STATE EMERGENCY RESPONSE COMMISSION FOR HAZARDOUS <br /> MATERIALS <br /> HAZARDS ANALYSIS SITE VISIT CERTIFICATION FORM <br /> Facility Name ( Please print) <br /> Street Address , City & Zip Code ( Please print) <br /> County ( Please print) <br /> Name of Facility Representative ( Please print) <br /> Facility Representative Signature Site Visit Date <br /> Site Visit Performed by ( Please print) <br /> Signature Site Visit Date <br /> The individuals signing above certify that a hazards analysis site visit was conducted on the <br /> above date . <br /> Notes : <br /> ❑ Check if facility representative was informed about using E-Plan ( https : //erplan . net/eplan/login . htm ) for EPCRA <br /> on-line filing <br />