Self- Monitoring Report in the Philippines

7/28/2019 Self- Monitoring Report in the Philippines

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GENERAL INFORMATION SHEET

Name of the

Establishment/ Facility

Establishment/Facility

Address (Not the

company of head

office)

Name of

Owner/Company

Address (if address is

not the same as

previous address)

Phone Number Fax Number:

e-mail address

Type of

Business/IndustryClassification

Responsible Officer/s

Pollution Control

Officer

Legal Classification

We hereby certify that the above information are true and correct

Name/Signature of CEO Name/Signature of PCO


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Department of Environmental and Natural Resources

Environmental Management Bureau

QUARTERLYSELFMONITORIGNREPORT1st QUARTER 2009

MODULE 1: GENERAL INFORMATION

Name of the PlantPlease provide the necessary revised, corrected or updated information not contained in your

General Information Sheet

The Lazland Mini-Sawmillis the owner of a sawmill plant which will process

unproductive gemilina trees and other legally cut planted trees into commercial cut

Lumber using locally assembled sawmilling equipments which are provided with thecorresponding air pollution control divice to safeguard the environmental during

operations.

(use additional sheet if necessary)

DENR Permits/Licenses/Clearances

Environmental

Laws

Permits Date of Issue Expiry Date

PD 984A/C No.

PO No.

PD 1586

ECC 1

ECC 2

ECC 3

RA 6969

DENR

Registry IDCCO Registry

Importer

Clearance No

Permit to

Transport

RA 8749A/C No.

PO No.


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Operation

Operating

Hours/day

Operating

days/week

# of shift/day

Average 8Hrs 6 -Maximum 8Hrs 7 -

Operation/Production/Capacity:

Average Daily

Production Output 4.5 Tons/day

Total Output this

Quarter 250 Tons

Total Water

Consumption this

Quarter (cubic

meters)

None

Total Electric

Consumption this

Quarter (KWH)

18,000 Kw-Hrs

MODULE2: RA 6969A. CCO Report (please accomplish this section for each chemical/substance)

Common Name/UPAC/CAS Index Name ___________________________________

____________________________________Case No. _________________________

Trade Name: __________________________________________________________

For importers only:

QuantityRequested

ImportClearance

Date ofArrival

QuantityReceived

Port ofEntry

Counterof Origin

Country ofManufacture

None

Total Quantity

Requested (annual)

Total Quantity

Received (annual)

*attach copy/s of Bill of Lading

For distributors (importers/non-importers)

Name of Client License No. Quantity Date of Distribution

None

Total Quantity Distributed


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For non importer users:

Name of Distributor Quantity Date of Purchase

None

For Producers

Average Daily

Production Output

Total Output this

Quarter

Quantity of Stock

Inventory (Start ofQuarter)

Quantity of Stock

Inventory (end ofQuarter)

Name of Buyer Quantity Date of Purchase

Total Quantity Sold

Use and Production (please fill up only if chemical/substance is not main product)

Average Daily

Production Output

Total Output this

Quarter

Average Quantity

Used per month

Total Quantity

Used this month

Describe any changes in Production/Process/operations:

Stock Inventory/Waste Chemical Generated:

Average Quantity

of Waste Chemical

Generated per

Month

Total Quantity of

waste Chemical

Generated this

Quarter

Quantity of Stock

Inventory (stock of

Quarter)

Quantity of Stock

Inventory (end of

Quarter)


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Other information:

Manner of Handlinghazardous waste

Storage on site Treatment on siteStorage off site Treatment off site

Changes in safety

Management System

Yes(please attach copy of revised plan)

No.

Chemical Substitute Plan

Yes (please attach copy if not submitted/included in

report/s or had been revised)

No.

B. Hazardous Wastes Treater/ Recycler

HW No.HW

Class

HW

Nature

HW

cataloguing

Remaining HW

from previousreport

HW Generated

Quantity Unit Quantity Unit

Waste Storage, Treatment and Disposal: (please fill up one table per HW)

HW Details

HW No.

Qty of HW Treated: UnitTSD Location:

Storage

Name: None

Method:

Transporter

ID: Name

Date:

Treater

ID: Name

Method

Disposal ID: Name

Date:


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MODULE 2C: RA 6969 (Hazardous Wastes Treater/Recycler)

C. Hazardous Wastes Treater/Recycler

Date Conducted Premises/Area

Inspected

Findings &

Observations

Corrective Action

taken (if any)

HW Stored and/or Untreated as of end of Quarter

HW

Number

Wastes

Generator

Date of

Transport

Transport

Permit/Dateof issue

Valid

UntilQuantity Quantity

Type of

Storage

Container/# of

containers

Time

Table forTreatment

HW Treated and/or Recycled as of End of Quarter

Types

ofWastes

HW

Number

Wastes

Generated

Type of

Transport

Transport

Permit/Dateof issue

Quantity

Type ofTreatmen

t orRecycling

Process

Type of

Quantityof

Recycledor

TreatedProduct

Residual Wastes Generated from the Treatment and/or recycling Operation

Types of

Wastes

HW

Number

Process

by which

the wastes

is

Generated

Quantity Type of

Storage

Container/#

of

containers

Disposal

Option

Time

Table for

Disposal


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MODULE 3: P.D. 984 (WATER POLLUTION)

Water Pollution Data

Domesticwastewater (cubic

meters/day)

Process wastewater(cubic meters/day)

Cooling water

(cubic meters/day)

Others:___________

(cubic meters/day)

Wash water,

equipment

(m3/day)

Wash water, floor

(cubic meters/day)

Record of Cost Treatment (separate entries for separate facilities)

Month 1 Month 2 Month 3Person employed,(#

of employees)

Person employed,

(cost)

Cost of Chemicals

used by WTP

Utility Costs of

WTP (electricity &

water)

Administrative andOverhead Costs

Costs of Operating

in-house laboratory

New/Additional

Investment in WTP

(Description

Cost of New/Add

Investments

WTP Discharge LocationOutlet Number Location of the Outlet Name of Receiving Water

Body

1

2

3

4

5


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DetailedReportofWastewaterCharacteristicsforotherPollutants

OutletNo.

DATEEffluent

flow rate

(m3/day)

(name)

(unit)

(name)

______

(unit)

(name)

_____

(unit)

(name)

(unit)

(name)

(unit)

(name)

(unit)

(name)

(unit)

Please fill up/accomplish separate forms for other outlet/s

Please use additional sheet/s if necessary


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Detailed Report of Wastewater Characteristics for Conventional Pollutants

Outlet No.

No discharge of waste water treatment facilities .

DATE

Effluent

flow

Rate

(m3/day)

BOD

(mg.L)

TSS

(mg/L)Color PH

Oil &Grease

(mg/L)

Temprise

(oC)

(name)

(unit)

02/29/08 260 132 55 9.1


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MODULE 4 R.A. 8749 (Air Pollution)

Summary of APSE/APCF

Process Equipment Location # of hours of Operation1.

2.

3.

4.

Fuel Burning

Equipment

Location Fuel Used Quantity

Consumed

# of hours of

Operation

1.

2.

3.

4.Pollution Control Facility Location # of hours of Operation

1.

2.

3.

4.

Cost of Treatment

Month 1 Month 2 Month 3

Cost of Person

employed, (salary)

Included in the

payroll

Included in the

payroll

Included in the

payroll

Total Consumption

of water (cubic

meters)

3-95-tons 2.42-tons 5.48-tons

Total cost of

chemicals used

(e.g., activated

carbon, KmnO4)

Total Consumption

of Electricity

(KwH)

Administrative and

Overhead Costs

Cost of Operating

in-house laboratory,

if any

Improvement or

modification, if

any. (Description)

Cost ofimprovement of

modification


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Detailed Report of Air Emission Characteristics

Description/

Location of PCF

DATEFlowRate

Ncm/day

CO(mg/N

cm)

NOx

(mg/Ncm)

Particulates

(mg/Ncm

)

(name)(mg/Nc

m)

(name)(mg/Nc

m)

(name)(mg/Nc

m)

(name)(mg/Nc

m)

(name)(mg/Nc

m)

Ambient Water Quality Monitoring (if required as part of ECC conditions)

Description/Location

of Monitoring

Station

DATE(name)

(unit)

(name)

(unit)

(name)

(unit)

(name)

(unit)

(name)

(unit)

(name)

(unit)

(name)

(unit)

(name)

(unit)

(please accomplish one table per sampling station


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Other ECC Conditions

ECC ConditionsStatus of Compliance Action Taken

Yes No1. Adequate

wastewater

treatment

2. Facilities shall be

properly designed.

3. Utilized and

maintained at all

times

4. Hog manure

shall be properlycollected and

disposed

Environmental Management Plan/Program

Enhancement/Mitigation

Measures

Status of Compliance Action Taken

1. Disposal of solid

waste at proper

designated place

2.

Please use additional sheet/s if necessary

Solid Waste Characteristics/Information

Average of solid

Waste Generated

per month

Total Quantity of

Solid Wastes

Generated this

Quarter

Average Quantity

of Solid Wastes

collected per month

Total Quantity of

Solid Wastes

Collected this

QuarterEntity in charge of

Collecting solid

wastes

Brief description of

Solid Waste

Management Plan

(e.g., waste

reduction,

segregation,

recycling)


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MODULE6: OTHERS

Accidents & Emergency/Records

Date Area/LocationFindings and

ObservationAction taken Remarks

No cases of

accidents &

Emergency

cases for the

past quarter.

Personnel/Staff Training

Date Conducted Course/Trainingdescription

# of Personnel Trained

No training seminar for

this quarter

I hereby certify that the above information are true and correct.

Done this ______________________________ in Brgy. San Isidro, Koronadl

City , Philippines.

Name/Signature of CEO Name/Signature of PCO

SUBSCRIBE AND SWORN before me, a Notary Public, this ___________ day of

_____________, affiants exhibiting to me their Community Tax Receipts:

Name CTR No. Issued at Issued on

_________ _________ _________

Doc No. ________

Page No. ________

Book No. _______

Series No. _______


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FRANCISCA PIGGERY FARM 11Brgy. Santa Cruz , Tampakan, South Cotabato

October 10,2008

DATU TUNGKO M. SAIKOL

Regional Director

Environmental Management Bureau

Department of Environment and Natural Resources

Regional Office XII

Koronadal City

THRU: ENGR. RONIE L. SALMON

Chief, Pollution Control Division

EMB-DENR R-XII

S i r :

Respectfully submitted to your office is the 2nd Quarter Self Monitoring

Report (SMR) for CY 2008.In compliance to DAO 26 series of 1991.

Thank you

Very truly yours,

MS. MARY ANN BARROSO

ManagerFrancisca Piggery Farm 11

Self- Monitoring Report in the Philippines

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