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Attachment J <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 />30 <br />