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Attachment L <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 />If a telephone update was conducted instead of site visit, please check box ❑ <br />The individuals signing above certify that a Hazards Analysis site visit was conducted on the 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 />35 <br />