Department of Environment and Natural Resources
Environmental Management Bureau
Reference No:
(to be filled up by DENR only)
G E N E R A L I N F O R M AT I O N S H E E T
Name of the DELTA LIGHTING PHILS. CORP
Establishment/Facility
Establishment/Facility Street # & Street Name: 5063 MODESTO ST.
Address Barangay: MAPULANG LUPA City/Municipality: VALENZUELA
(NOT the company of head
office) Province: METRO MANILA
Name of
Owner/Company
Address
(if address is not the same
as previous address)
Phone Number 445-06-10 Fax Number 983-38-29
e-mail address cchp@delta-lighting.com
Philippine Standard Industry Classification Code No. 5210
Type of Business/
Industry Philippine Standard Industry Descriptor: ___
Classification
___
CEO/President. ___
Tel #: Fax #: ___
Responsible e-mail address: ___
Officer/s: Plant Manager: ___
Tel #: Fax #: ___
e-mail address: ___
Name. HILARIO DOROTHEO M. TIBAYAN
Pollution Control
Tel #: 09175994740 Fax #: N/A
Officer
e-mail address: laritibs@yahoo.com
single proprietorship partnership
Legal Classification private domestic corporation government corporation
Multi-national ___
We hereby certify that the above information are true and correct.
HILARIO DOROTHEO M.TIBAYAN
Name/Signature of CEO/President Name/Signature of PCO
COA No. 2018-NCR-0014-VZ
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
Department of Environment and Natural Resources
Environmental Management Bureau
Q U A R T E R LY S E L F - M O N I T O R I N G R E P O R T
MODULE 1: GENERAL INFORMATION
Name of the Plant DELTA LIGHTING PHILS. CORP
Please provide the necessary revised, corrected or updated information not contained in your
General Information Sheet
(use additional sheet/s if necessary)
DENR Permits/Licenses/Clearances
Environmental
Permits Date of Issue Expiry Date
Laws
A/C No. N/A N/A N/A
P.D. 984
PO No. N/A N/A N/A
CNC-OL-NCR-2018-06-
ECC 1 JUNE 13, 2018 N/A
01181
PD 1586 ECC 2 N/A N/A N/A
ECC 3 N/A N/A N/A
DENR
Registry ID
M-GR-NCR-75-00170 OCT 30, 2018 N/A
CCO Registry N/A N/A N/A
RA 6969 Importer
Clearance No
N/A N/A N/A
Permit to
Transport
N/A N/A N/A
A/C No. N/A N/A N/A
RA 8749
PO No. N/A N/A N/A
Module 1: General Information page ____ of ____
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
Operation
Operating hours/day Operating days/week # of shift/day
Average 8 6 1
Maximum 10 7 1
Operation/Production/Capacity:
Average Daily Total Output this
N/A N/A
Production Output Quarter
Total Water Total Electric
Consumption this 299 cu.m Consumption this 10411 KwH
Quarter (cubic meters) Quarter (KwH)
B. Hazardous Wastes Generator
Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
HW Generation:
Remaining HW from
HW HW HW Generated
HW No. HW Class Previous Report
Nature Cataloguing
Quantity Unit Quantity Unit
D407 BUSTED SOLID TOXIC 0.7 MT 0 MT
FLUORESCENT
LAMP
D406 USED LEAD SOLID CORROSIVE 0.005 MT 0 MT
ACID LIQUID TOXIC
BATTERIES
M506 USED SOLID TOXIC 0 MT 0 MT
ELECTRONIC
DEVICES
M506 LED LIGHTS SOLID TOXIC 0 MT 0 MT
Waste Storage, Treatment and Disposal: (Please fill-up one table per HW)
HW No,: D407
HW Details Qty of HW Treated 0 Unit: 0 MT
TSD Location: ON-SITE TEMPORARY STORAGE
Name: ON-SITE TEMPORARY STORAGE
Storage Method: PUT IN A BOX / DRUM CONTAINER WITH PROPER LABELED
AS HAZARDOUS WASTE AND STORED IN DESIGNATED STORAGE
AREA
ID: Name: ___
Transporter
Date: ___
ID: Name: ___
Treater
Method: Date: ___
ID: Name: ___
Disposal
Date: Date: ___
HW No,: 406 ___
HW Details Qty of HW Treated: Unit: ___
TSD Location: ___
Name: ___
Storage
Method: ___
ID: Name: ___
Transporter
Date: ___
ID: Name: ___
Treater
Method: Date: ___
Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
ID: Name: ___
Disposal
Date: Date: ___
On-Site Self Inspection of Storage Area:
Premises/Area Findings & Corrective Action Taken
Date Conducted
Inspected Observations (if any)
Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
C. Hazardous Wastes Treater/Recycler
HW Stored and/or Untreated as of End of Quarter:
Type of
Transport Storage Time Table
HW Wastes Date of
Permit/Date Valid until Quantity Container/ for
Number Generator Transport
of Issue # of Treatment
containers
HW Treated and/or Recycled as of End of Quarter:
Type of Type &
Transport Treatment Quantity of
Type of HW Wastes Date of
Permit/Date Quantity or Recycled
Wastes Number Generator Transport
of Issue Recycling or Treated
Process Product
Residual Wastes Generated from the Treatment and/or Recycling Operation:
Type of
Process by
Storage
Type of which the Disposal Time Table
HW Number Quantity Container/
Wastes Wastes is Option for Disposal
# of
Generated
containers
Module 2C: RA 6969 (Hazardous Wastes Treater/Recycler) page ____ of ____
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
MODULE 3: P.D. 984 (Water Pollution)
Water Pollution Data
Domestic wastewater Process wastewater
3.17 N/A
(cubic meters/day) (cubic meters/day)
Cooling water Others: ___________
N/A N/A
(cubic meters/day) (cubic meters/day)
Wash water, equipment Wash water, floor
N/A N/A
(m3/day) (cubic meters/day)
Record of Cost of Treatment (Separate entries for separate facilities)
Month 1 Month 2 Month 3
Person employed, (# of
N/A N/A N/A
employees)
Person employed,
N/A N/A N/A
(cost)
Cost of Chemicals
N/A N/A N/A
used by WTP
Utility Costs of WTP
N/A N/A N/A
(electricity & water)
Administrative and
N/A N/A N/A
Overhead Costs
Cost of operating in-
N/A N/A N/A
house laboratory
New/Additional
Investments in WTP N/A N/A N/A
(Description)
Cost of New/Add
N/A N/A N/A
Investments
WTP Discharge Location
Outlet
Location of the Outlet Name of Receiving Water Body
Number
1
2
3
4
5
Module 3: P.D. 984 (Water Pollution) page ____ of ____
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
Detailed Report of Wastewater Characteristics for Conventional Pollutants
Outlet No.
Effluent Oil & ________
BOD TSS Temp rise (name)
DATE Flow Rate Color pH Grease
(mg/L) (mg/L) (ºC)
(m3/day) (mg/L)
(unit)
Please fill-up/accomplish separate form/s for other outlet/s.
Detailed Report of Wastewater Characteristics for Other Pollutants
Module 3: P.D. 984 (Water Pollution) page ____ of ____
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
Outlet No.
Effluent ________ ________ ________ ________ ________ ________ ________
(name) (name) (name) (name) (name) (name) (name)
DATE Flow Rate
(m3/day)
(unit) (unit) (unit) (unit) (unit) (unit) (unit)
Please fill-up/accomplish separate form/s for other outlet/s.
Please use additional sheet/s if necessary.
Module 3: P.D. 984 (Water Pollution) page ____ of ____
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
MODULE 5: P.D. 1586
Ambient Air Quality Monitoring (if required as part of ECC conditions)
Description/Location
of Monitoring Station
_______ _______
________ ________
Noise CO NOx Particulates (name) _ _ (name)
DATE (name) (name)
Level (dB) (mg/Ncm) (mg/Ncm) (mg/Ncm)
(mg/Ncm) (mg/Ncm)
(mg/Ncm) (mg/Ncm)
(Please accomplish one table per monitoring station.)
Ambient Water Quality Monitoring (if required as part of ECC conditions)
Description/Location
of Sampling Station
________ ________ ________ ________ ________ ________ ________ ________
(name) (name) (name) (name) (name) (name) (name) (name)
DATE
(unit) (unit) (unit) (unit) (unit) (unit) (unit) (unit)
(Please accomplish one table per sampling station.)
Module 5: P.D. 1586 (EIS System) page ____ of ____
DELTA LIGHTING PHILS. CORP. Reference No:
5063 Modesto St. Mapulang Lupa Valenzuela City
Telefax: 445-06-10
Other ECC Conditions
Status of Compliance
ECC Condition/s Actions Taken
Yes No
1.
2.
3.
4.
5.
6.
7.
Please use additional sheet/s if necessary.
Environmental Management Plan/Program
Status of
Enhancement/Mitigation Measures Implementation Actions Taken
Yes No
1.
2.
3.
4.
5.
6.
7.
Please use additional sheet/s if necessary.
Solid Waste Characterization/Information:
Average Quantity of Total Quantity of Solid
Solid Wastes Wastes Generated this
Generated per month Quarter
Average Quantity of Total Quantity of Solid
Solid Wastes Collected Wastes Collected this
per month Quarter
Entity in charge of
collecting solid wastes
Brief Description of
Solid Waste
Management Plan
(e.g., waste reduction,
segregation, recycling)
Module 5: P.D. 1586 (EIS System) page ____ of ____
Procedural and Reference Manual for DAO 2003-27
MODULE 6: OTHERS
Accidents & Emergency Records
Findings and
Date Area/Location Actions Taken Remarks
Observation
N/A N/A N/A N/A N/A
Personnel/Staff Training
# of Personnel
Date Conducted Course/Training Description
Trained
I hereby certify that the above information are true and correct.
Done this _________________________, in ________________________.
Name/Signature of PCO
Name/Signature of CEO
SUBSCRIBED 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
_____________________ _____________ _______________ ______________
_____________________ _____________ _______________ ______________
