NATIONAL WATER RESOURCES BOARD

8th Floor NIA Bldg., EDSA, Quezon City

Telefax No.: (02) 920-26-54
Website: nwrb.gov.ph

SUMMARY RECORD OF QUARTERLY GROUNDWATER /

SURFACEWATER WITHDRAWAL
PERIOD: April-20 TO: June-20
(Month, Year) (Month, Year)

Permittee/ Grantee: VILLAGES WATER SUPPLY SYSTEM INC.

Mailing Address: Block 8 lot 14, Mansfield Residences , Brgy. Sto. Domingo, Angeles City, Pampanga
Contact Person: Ms. Michelle Legaspi E-Mail Address: mitch.hldc.legal@gmail.com
Tel. No/s.: 322-2294/625-7112 Mobile No.: 0922-853-1152 Fax No/s.:

X Conditional Water Permit No.: 11-25-15-015 X Water Permit No.: 023781 Purpose: Municipal
Name of Source: DEEPWELL Amount of Water Granted(lps): 12 Date Issued: 4/28/2016
Location of Source: B21, L1-8, FC-CASTILLEJOS, BRGY. DEL PILAR, CASTILLEJOS, ZAMBALES
NWRB Tag No.: Latitude: 14°55'25.65” Longitude: 120°12’55.58"

Measuring Device (Production Meter / Flow Meter )

Brand: ULTRASONIC FLOWMETER Serial No.: Size: 150MM
Is the Meter Tested? Yes No Test Result: Date Tested:
Nameand Address of Testing Laboratory:

M E T E R R E A D I N G
(Every End of the Month) C O N S U M P T I O N
MONTH
INITIAL FINAL (Cubic Meter)
(Cubic Meter) (Cubic Meter)
APRIL 1-13 73526 84983 11,457.00

APRIL 14-31 n/a n/a 3,860.00

MAY n/a n/a 10,396.50

JUNE N/A (not active) N/A (not active) N/A (not active)

Prepared by: Submitted by:

Engr. John Baquing

Signature Over Printed Name

PROJECT OFFICER Planning Engineer

Position Position Position

NOTE:
1. INSTALLED PRODUCTION METERMUST BE TESTED BY NWRB OR ITS AUTHORIZED TESTING LABORATORY.
2. ANY REPLACEMENT OF METER MUST BE REPORTED TO NWRB WITHIN FIVE(5) DAYS INDICATING THE FOLLOWING:
PRODUCTION METER SERIAL NO. READING DATE REPLACED

3. ALL RECORD OF MONTHLY WATER WITHDRAWALS PER SOURCE MUST BE SUBMITTED EVERY THREE(3) MONTHS BY THE PERMITEE
TO: THE CHIEF, MONITORING AND ENFORCEMENT DIVISION
NATIONAL WATER RESOURCE BOARD

This form may be reproduced by the permitee. Keep this record on file. MED FORM 2014