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ATTACHMENT K <br /> FLORIDA STATE EMERGENCY RESPONSE COMMISSION FOR HAZARDOUS <br /> MATERIALS <br /> HAZARDS ANALYSIS SITE VISIT CERTIFICATION FORM <br /> PLEASE PRINT <br /> Facility Name <br /> Street Address, City & Zip Code <br /> County SERC ID # <br /> Name of Facility Representative <br /> Facility Representative Signature Site Visit Date <br /> Site Visit Performed by <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 /> I Check if facility representative was informed about using E-Plan (https://erplan.net/eplan/lodin htm)for EPCRA <br /> on-line filing <br /> 34 <br />