R.

A 9275 Water April May June Total

Pollution

Water
Consumption
(cubic meters)

Electrical
Consumption
(kWh)

Domestic Wastewater Discharge D.W.D

(cubic meters per day)

Computation:

D.W.D = Total Water Consumption this quarter / No. of days in this quarter

R.A. 8749 Air Pollution

1. ___Hp of Diesel Engine as prime mover coupled to ___kVa Electric Generator

April May June Total

Diesel
Consumption
(liters)

No. of hrs. of
genset operation

(no. of power
interruption this
quarter)
R.A 6969 Hazardous Waste Management

Haz Waste Material April May June

Used Gen Set Oil __ liters ___ liters ___ liters

(depending on the
scheduled month of
change oil)

Busted Bulbs

(Flourescent Lamps, Fluorecent ___ Fluorscent __ Fluorescent __

Cfl bulbs)
T5 tube ___ T5 tube ___ T5 tube ___
please specify the
CFL bulbs ___ CFL bulbs ___ CFL bulbs ___
type and wattage
Total __ Total ___ Total __

Discarded Gen-set __unit __ unit ___unit

lead acid battery

Discarded Computer __unit ___unit ___unit

Component parts and
__pcs ___pcs ___pcs
No. of busted LED
Bulbs

Vegetable Oil ___liters __liters __liters

R.A 9003 Solid Waste Management

Average Quantity of Solid Wastes gemerated Total Quantity of Solid Wastes generated
per month this quarter (April,May & June)

_____kilograms Total ____kilograms

Entity in Charge of Collecting solid wastes name:

company:

Brief Description of Solid Waste

Management Plan (waste
reduction,segregation,recycling)