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Attachment J <br /> i <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) SERC ID# <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 /> CJ Check if facility representative was informed about using E-Plan(https./lerplan.net/eplan/login.htm)for EPCRA <br /> on-line filing <br /> 33 <br /> 239 <br />