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Attachment L <br />{ FLORID"- STATE EMERGENCY. RESPONSE. COMMISSION FOR HAZARDOUS <br />j MATERIALS' <br />( HAZARDS ANALYSIS SITE VISIT CERTIFICATION FORM <br />PLEASE PRINT <br />Facility Name <br />Street Address, City & Zip Code <br />County <br />Name of Facility Representative <br />Facility Representative Signature <br />Site Visit Performed by <br />Signature <br />SERC ID # <br />Site Visit Date <br />Site Visit Date <br />If a_telephone update was conducted instead of site visit, please check bolt ❑ <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.netteblan/looin.htm) for EPCRA <br />on-line filing <br />35 <br />112 <br />