INSTRUCTIONS

1. Fully accomplish this form and complete all the supporting documents indicated hereunder.
Submit all documents in duplicate copies to our Air & Water Permitting Section of the Clearance
and Permitting Division for screening and assessment of fees.
2. Proceed to the Accounting Section for the issuance of “Order of Payment”. Thereafter, pay to the
Cashier Section the corresponding amount indicated in the “Order of Payment”
3. Submit your application together with the official receipt to the Records Section and ask for your
receiving copy.

Your application shall be acted upon within thirty (30) working days and you shall be informed of our
action accordingly.

Types of Application Documents Required

 New Item Nos. , , , , , & 
 Renewal Item Nos. , , ,  & 

Supporting Documents
 Engineer’s Report with at least containing the following:
 Nature of project or business;
 Brief description of manufacturing process involved;
 Production capacity, quality or volume and the generic name of the products;
 The nature and character of the applicant’s wastewater and its physical and chemical
composition;
 Total daily volume of discharge of raw wastewater;
 Treatment process and estimated treatment efficiency; The expected quality of the effluent
and other discharge shall meet the Effluent standards of the DENR;
 The total daily volume of water consumption and discharge of final treated wastewater
effluent;
 The name of receiving body of water and its official water classification and in case of land
discharge, the nearest receiving body of water and its official water classification;
 Information on flow measurement equipment and procedure;
 Pollution prevention/Environmental Management System plan or program;
 DENR ID Number as hazardous waste generator (if applicable); and
 State the cost incurred in the installation and maintenance of wastewater treatment facility; if
any.

 Drawing requirements in 50cm x 90 cm paper signed by the President/General Manager

and duly signed and sealed by a Registered Chemical or Sanitary Engineer.
 Vicinity Map of the Plant;
 The wastewater line layout from the wastewater sources to the WTF; and
 Plan and elevation drawings of the WTF as built with complete specifications.

 Copy of the Certificate of Accreditation of the Pollution Control Office, or

appointment/designation as such by the Managing Head.

 Environmental Compliance Certificate (ECC) or Certificate of Non-Coverage (CNC) copy.

 Official receipt for the payment of applicable fees.
 Water billing statement for the whole year.
 Copy of the latest Wastewater Discharge Permit;
 Copy of the results of sampling analysis of the establishment’s wastewater
characteristics for four quarters in the previous year together with the Self Monitoring
Report;

 Proof of compliance to permit conditions (if required).

FM-CPD-AW11 00 10-15-17