Form 02 GED-3105 Rev.

02

OUTBOUND

GATE PASS
1. PLANTSITE PIERSITE
Flow To: GSSI Security Guard on Duty 2. Date Applied:

This is to inform that CBNC Management allows the person/s, whose name/s stated below, to bring the
Custodian/
Storeman/ following item/s OUTSIDE CBNC Plantsite / Piersite within the valid date/s as well indicated herein.
Employee
3. Purpose for item/s exit: 4. Valid From:

5. Valid Until :

CONTRACTOR'S/ 6. Full Name:

Contractor/
Originator
ORIGINATOR'S 7. Company:
Head TRANSPORTER
8. Position: 9. Company ID No.:
DRIVER 10. Full Name: 12. Driver's License
No.: _____________
11. Company: Expiration Date: ______
DRIVEN VEHICLE 13. Plate No.: 14. Make & Body Type:
CBNC
EMQCS 15. LTO Reg. OR No.: 16. LTO Reg. OR Date:
For Hazardous ITEM/S (to be brought outside CBNC Plantsite / Piersite)
Waste,Scrap Check Appropriate Box Hazardous Waste Others (Pls. Specify):
& Garbage
materials
17. Kind: Equipment/s Material/s Scrap Material
Garbage
Item No. Qty Unit Description Serial No.: Brand Destination
Concerned
CBNC
Department
Manager

CBNC
General
Affairs
Department

Continue on separate sheet/form if necessary.

APPROVAL
Plantsite of
Piersite Gate Prepared by: For Hazardous Waste,Scrap & Garbage Approved by: Noted by:
Security materials, CBNC EMQC Checking and
Approval is a must.
Custodian/ Employee Checked & Approved by:

Originator Head CBNC EMQC Head CBNC Dept. Manager CBNC GAD Manager
INSPECTING GUARD/S

Full Name: _______________________________

Post (Gate): __________ Date: ___________ Time: _______ Signature: ________

Full Name: _______________________________

Post (Gate): __________ Date: ___________ Time: _______ Signature: ________

Distribution: CBNC GAD, EMQC, Concerned Department, Contractor/Originator, Gate Guard