Departmental Quality Form

SUBIC BAY METROPOLITAN AUTHORITY

ECD-RPD-01
ECOLOGY CENTER Rev.No.: 04
Regulatory Bldg. Labitan St. cor. Rizal Ave.,
Effectivity Date: 06/24//2015
Subic Bay Freeport Zone, Philippines 2222
Tel 047.252.4059/4435/ Fax 047.252-4157
Visit us at http://www.mysubicbay.com.ph
APPLICATION FOR ENVIRONMENTAL CLEARANCE FOR ACCREDITATION:
General Information: (To be filled out by the Applicant)
New Application (submit Company Profile or Personal Data Sheet)
Date of Application: ______________________________________________ Renewal (submit copy of newly-“Expired” Certificate of Accreditation
Name of Company or Person: ______________________________________________________________________________________________________________
Nature of Business/Accreditation Applied for: _______________________________________________________________________________________________
Company Address: ______________________________________________________________________________________________________________________
Contact Person: ___________________________________________Designation _________________________ Tel./Fax. No.___________________________
Description of Operation/Activity: ___________________________________________________________________________________________________________

Target Client/s: ______________________________________________________________________________________________________________ __________

(This portion to be filled out

APPLICANT TO by Ecology Center)
DETERMINE WHICH OF DATA REQUIREMENT EVALUATOR’S REMARKS/NOTES
THE FOLLOWING (Applicant to provide all pertinent details related to the activity or operations)
APPLIES TO HIS/HER Evaluated by: _____________________
(PLS. USE ADDITIONAL SHEET, IF NECESSARY)
PARTICULAR TYPE OF Date Evaluated: _____________
ACTIVITY OR
BUISNESS
A. For all applicants With vehicles or trucks, etc. to be used (If w/ vehicles/trucks, specify make & plate For those with vehicles to use inside SBF, copy of
(Suppliers, Service during operations inside the Subic no, example, Isuzu Fuego Plate No. 0794. “PASSED” emission test results attached?
Contractors, etc.) Freeport? If no service vehicle, indicate as Not YES NO N.A.
YES Applicable or N.A.)
For list of vehicles attached, w/ corresponding
NONE. No service vehicle.
“PASSED” emission test results)
A copy/ies of “PASSED” emission test YES NO N.A.
results is/are required to be submitted as
attachment/s to this application.
For Companies with numerous vehicles to
use, attach List of Vehicles with
corresponding emission test results)
Will use generator sets or other smoke- (Specify genset capacity, make/model Informed on need to secure PTO for APSI if equipment
emitting device/equipment/machine during number, quantity, other pertinent details, etc.) will be used for 1-year or more?
operations? YES NO YES NO N.A.
B. For those Will provide manpower during (Specify possible sources of pollution and Informed on need to secure Environmental Clearance
engaged in the construction? YES NO how addressed by the Company. Example, prior to start of any activity w/ significant impact or if
construction business for those w/ personnel onsite, domestic pollution-generating:
inside the Subic sewage, portalets are used) YES NO N.A.
Freeport if relevant, informed on SBMA’s marine-related
Will provide services to marine vessels? (Specify type of services provided to vessel, guidelines or policies
C. For those
YES NO N.A.
engaged in seaport- YES NO including possible sources of pollution and
how addressed by the Company. Example, For renewal, ok w/ HWdBase (c/o MLRR) and
related operations inside
for ship’s stevedoring services w/ personnel SewagedBase(c/o FMC),COT req’t, complied?
the Subic Freeport
onsite, domestic sewage, portalets are used; YES NO N.A.
for oil- or paint-contaminated containers or Informed on SBMA’s Tipping Permit System for garbage
rags, disposal thru hazwaste transporter, disposal, & the SBMA Waste Mgt Guidelines , R.A.
etc ) 6969, e-waste,
D. For scrap hauling Will also engage in the hauling of garbage (Specify scrap materials/recyclables to be BFLs, etc.
(SH) and other solid (solid waste) outside the Subic Freeport? hauled) Note: Electronic wastes and busted YES NO N.A.
waste –related YES NO fluorescent lamps (BFLs) are classified as For renewal, ok w/ ScrapdBase? (c/o MLRR)
operations hazardous waste under Republic Act No. YES NO N.A.
6969)
E. For hazardous waste- The following copies of permits are required (Specify type of hazwaste allowed by DENR Copy of all required DENR Permits attached and
related operations and as attachments: to handle and name of hazwaste (TSD) Informed on use of PTT, HWTR, SBFZPTT-ESS, &
sewage disposal For HW transporter, facility utilized for treatment or disposal) timely COT submission
activities Transporter Registration Certificate (TRC) YES NO N.A.
For HW treater, TSD Registration For renewal, ok w/ HWdBase and SewagedBase,COT
Certificate, ECC for the hazwaste req’t, complied?
treatment facility. YES NO N.A.
For those engaged in A copy of the Company’s (Specify type of oil or chemical or petroleum Is the Company’s Oil/Petroleum/Chemical Spill
the Oil/Petroleum/Chemical Spill Contingency products handled and what specific permits Contingency Plan -Sufficient in data?
oil/petroleum/chemical- Plan is always required as attachment. were issued by other government agencies. YES NO N.A.
hauling/handling Example, for the petroleum products ethanol, Implementable? (w/ 117 Emergency Assistance No.?)
business within the permit from Dept. of Energy attached, etc ) YES NO N.A.
Subic Freeport
Are you willing to cooperate with the SBMA/Ecology Center’s programs on environmental management, example: Tree Planting; Beach/River Clean-up; No Plastic
Policy for retail establishments? YES NO
I. INFORMATION ON BUSINESS ACTIVITY: (To be filled out by the Applicant)
If Authorized Representative only, with Letter of Authorization? YES NONE. Commits to provide by this date: ________________

Applicant’s Printed Name & Signature: ____________________________________________________________ Date: _______________

EVALUATOR’S RECOMMENDATION: Grant Clearance Deny Clearance Remarks: ________________________________________
Result of Evaluation Noted by (Pls. print name and sign): _____________________________________________ Date: _______________
APPLICANT’S CONFORME: I hereby indicate my agreement w/ the result of evaluation and commitments as shown above,
CONFORME: ____________________________________________________ DESIGNATION: ______________________________________
(Printed Name & Signature of Authorized Representative) Date: _______________
O.R. # _______________________________ Amount Paid : _____________________ Processed by: ____________________