‘o1msycors022-coco APPLICATION FOR SECURING CERTIFICATE OF COMPLIANCE (COC) business Name: - ————— (GET W DTUSETCDR RegaovOnT Name of Dealer/Owner: Start of Operation: Complete Address of Establishment: “Telephone No. Cell Phone No, Fax No. emai adress: “Type af Ownership: 1 sinote Proprietorship 1 Portnership 1 cororation cost of Investment: (Peace attached detail of Project Cost) Please write COMPLIED or NOT COMPLIED in the space provided Compliance to environmental laws by DENR-EMB. Compliance to local Zoning Ordinance Compliance ta Fire Cade of the Philippines No Above-ground tank(s) a Dispensing fuels through the use of preserbed dispenser(s), with no "bote- bote” or similor containers in use Comaliance to local Building Code 2 you have Tak Trck( for Hang guid Fuels (Own-use)? [I] Yes wo EYES lnc atiach adore equrement) a a Suppliers): In Case of Corporation, Authorizes Representative(s) Name of Owner/Partner(s) address = ps “Telephone No, CellPhone No Fax No. Email adress: ‘ignature aver Printed Name of Applicant) — Before me, the undersigned authority, on this day personally appeared of Known to me to be the person whose names subscribed to the foregoing instrument, consisting of ___ attachments including this page on which this acknowledgement is written, Sna'upon his/her oath acknowledged to'me that he/she executed the same for the purposes and consideration therein, ‘expressed and in the capacity therein stated. Given under my hand and seal of office this _day of 201. NOTARY PUBLIC Doc. No, Page No. Bo0k No. Series of