GENERAL INFORMATION SHEET

3rd Quarter 2020

Name of the
MH BOSS OIL SERVICE STATION
Establishment/Facility

Establishment/Facility Street # & Street Name: ML Quezon St.

Address Barangay: San Gabriel City/Municipality: Teresa, Rizal
(NOT the company of head
office) Province: Rizal
Name of
M.H. BOSS GAS STATION
Owner/Company
Street # & Street Name: Marcos Highway,
Address
(if address is not the same as Barangay: Cainta City/Municipality: Cainta
previous address)
Province: Rizal

Phone Number 0917-8316010 Fax Number

e-mail address rizza_rose@yahoo.com

Philippine Standard Industry Classification Code No. 50500

Type of Business/
Philippine Standard Industry Descriptor: Retail Sale of Automotive Fuel
Industry Classification

CEO/President. Rizza Rose Kuan Ko

Tel #: 0917-8316010 Fax #: N/A
e-mail address: rizza_rose@yahoo.com
Responsible Officer/s:
Station Manager: Rizza Rose Kuan Ko
Tel #: 0917-8316010 Fax #: N/A
e-mail address: rizza_rose@yahoo.com

Name. Rizza Rose Kuan Ko

Pollution Control
Tel #: 0917-8316010 Fax #: N/A
Officer
e-mail address: rizza_rose@yahoo.com

x single proprietorship  partnership

Legal Classification  private domestic corporation  government corporation
 Multi-national Cooperative

We hereby certify that the above information is true and correct.

MEYNARD C. KO MARIA LOURDES DOLOT

Owner/Proprietor Pollution Control Office

1
 QUARTERLY SELF-MONITORING REPORT

MODULE 1: GENERAL INFORMATION

Name of the Plant M.H. BOSS OIL SERVICE STATION
The gasoline station located at ML Quezon St. Barangay San Gabriel, Teresa, Rizal, is purely a Filling station.
We Do not offer mechanical service such as, mechanical repair, change oil, grease oil and car wash.

DENR Permits/Licenses/Clearances
Environmental
Permits Date of Issue Expiry Date
Laws
A/C No. LC-02b-008-00024 11.Mar. 2018
P.D 984
PO No.
ECC 1 ECC-R4A-1304-0264 24.May 2013
PD 1586 ECC 2 N/A
ECC 3 N/A
DENR
Registry ID
GR-04-58-0340 07.Feb.2014
CCO Registry N/A
RA 6969 Importer
Clearance No
N/A
Permit to
Transport
N/A
A/C No.

RA 8749
PO No. With ongoing application

Operation
Operating hours/day Operating days/week # of shift/day

12 hours/ day 7 days/week

Average 720 hrs./month 30 days/month 3 shift/day
2160hrs/quarter 90 days/quarter

24 hrs/day 7 days/week
Maximum 720 hrs/month 30 days/month 3 shift /day
2160 hrs/quarter 90 days/quarter

Operation/Production/Capacity:
Average Daily
1500.00 Total Output this Quarter 135000.00
Production Output
Total Water Consumption Total Electric
this Quarter (cubic 108.00 Consumption this Quarter 45,000 kwh
meters) (KWH)
Please use additional sheet/s if necessary

2
MODULE 2: RA 6969

A. CCO Report (please accomplish this section for each chemical/substance)

Common Name/IUPAC/CAS Index Name. Not Applicable

CAS No.: Not Applicable
Trade Name: Not Applicable

For importers only : N/A

Import
Quantity Date of Quantity Country of Country of
Clearance Port of Entry
Requested Arrival Received* Origin Manufacture
No.

Total Quantity Requested Total Quantity Received

(annual) (annual)

For distributors (importers/non-importers) N/A

Name of Client License No. Quantity Date of Distribution

Total Quantity Distributed

For non-importer users: N/A

Name of Distributor Quantity Date of Purchase

Total Quantity Purchased from Distributor

3
For producers: N/A
Average Daily
Total Output this Quarter
Production Output
Quantity of Stock Quantity of Stock
Inventory (Start of Inventory (End of
Quarter) Quarter)
Name of Buyer Quantity Date of Purchase
Not Applicable Not Applicable Not Applicable

Total Quantity Sold Not Applicable

Used in Production (please fill up only if chemical/substance is not main product)

Average Daily
Not Applicable Total Output this Quarter Not Applicable
Production Output
Average Quantity Used Not Applicable Total Quantity Used this Not Applicable
per month Quarter
Describe any changes in Production/Process/Operations:

NONE

Stock Inventory/ Waste Chemical Generated: N/A

Not Applicable Total Quantity of Waste Not Applicable

Average Quantity of Chemical Generated this
Waste Chemical Quarter
Generated per month
Quantity of Stock Not Applicable Quantity of Stock Not Applicable
Inventory (Start of Inventory (End of
Quarter) Quarter)

Other Information:
Manner of handling  storage on-site  Treatment on-site
hazardous wastes  storage off-site  Treatment off-site

Changes in Safety  Yes (please attach copy of revised plan)

Management System  No

Chemical Substitute  Yes (please attach copy if not submitted/included in previous report/s or had been revised)
Plan  No

4
B. Hazardous Wastes Generator

HW Generation:
Remaining HW from
HW HW Generated
HW No. HW Class HW Nature Previous Report
Cataloguing
Quantity Unit Quantity Unit

1-101 Liquid Flammable 30 Liters 25 Liters

D-409 Solid Toxic 5 Pcs. 5 Pcs.

Waste Storage, Treatment and Disposal: (Please fill-up one table per HW) N/A
HW No.: 110l (used oil, Rags with Oil and Fuel

HW Details Qty of HW Treated: 25 Unit: Liters

TSD Location: On site

Name: On Site
Storage
Method: with proper containment and labelling

ID: - Name:
Transporter
Date:

ID: - Name:
Treater
Method: Date:

ID: - Name:
Disposal
Date: Date:

HW No.: D49
HW Details Qty of HW Treated: 5 Unit: pcs.
TSD Location:

Name:
Storage Method: with proper containment and labelling

ID: - Name:
Transporter
Date:

ID: - Name:
Treater
Method: Date:

ID: - Name:
Disposal
Date: Date:

5
On-Site Self Inspection of Storage Area:
Corrective Action Taken
Date Conducted Premises/Area Inspected Findings & Observations
(if any)
in good condition
July 31, 2020 STORAGE AREA NONE
in good condition
Aug. 14, 2020 STORAGE AREA NONE

Sept 20, 2020 STORAGE AREA in good condition NONE

Hazardous Wastes Treated/Recycler

C. HW Stored and/or Untreated as of End of Quarter: N/A

Type of
Transport Storage Time Table
Wastes Date of
HW Number Permit/Date Valid until Quantity Container/ for
Generator Transport
of Issue # of Treatment
containers

HW Treated and/or Recycled as of End of Quarter:

Type &
Type of
Transport Quantity of
Type of Wastes Date of Treatment or
HW Number Permit/Date Quantity Recycled or
Wastes Generator Transport Recycling
of Issue Treated
Process
Product

Residual Wastes Generated from the Treatment and/or Recycling Operation: N/A
Process by Type of
Type of which the Storage Disposal Time Table for
HW Number Quantity
Wastes Wastes is Container/ Option Disposal
Generated # of containers

6
 MODULE 3: P.D. 984 (Water Pollution)

Water Pollution Data: LLDA Regulation

Domestic wastewater Process wastewater
1.2 cu.m./day None
(cubic meters/day) (cubic meters/day)
Cooling water Others: ___________
0.8
(cubic meters/day) (cubic meters/day)
Wash water, equipment Wash water, floor
0.3 cu.m/ day 0.1
(m3/day) (cubic meters/day)

Record of Cost of Treatment (Separate entries for separate facilities)

Month 1 Month 2 Month 3
Person employed, (# of
employees)
Person employed, (cost)
Cost of Chemicals used
by WTP
Utility Costs of WTP
(electricity & water)
Administrative and
Overhead Costs
Cost of operating in-
house laboratory

New/Additional
Investments in WTP
(Description)

Cost of New/Add
Investments

WTP Discharge Location

Outlet
Location of the Outlet Name of Receiving Water Body
Number
1 DRAINAGE UNKNOWN CREEK
2
3
4
5

7
Detailed Report of Wastewater Characteristics for Conventional Pollutants
Outlet No. LLDA Jurisdiction

Effluent Oil & ________

BOD TSS Temp rise (name)
DATE Flow Rate Color pH Grease
(mg/L) (mg/L) (ºC)
(m3/day) (mg/L)
(unit)

Please fill-up/accomplish separate form/s for other outlet/s.

8
Detailed Report of Wastewater Characteristics for Other Pollutants
Outlet No. LLDA Jurisdiction

Effluent ________ ________ ________ ________ ________ ________ ________

(name) (name) (name) (name) (name) (name) (name)
DATE Flow Rate
(m3/day)
(unit) (unit) (unit) (unit) (unit) (unit) (unit)

Please fill-up/accomplish separate form/s for other outlet/s.

Please use additional sheet/s if necessary.

9
MODULE 4: R.A. 8749 (Air Pollution)

Summary of APSE/APCF
Process Equipment Location # of hrs of operations
Driveway
24 hrs/day
1.6000 gallons UGT for Diesel
720 hrs./month
2160 hrs./quarter

24 hrs/day
2. 6000 gallons UGT for Premium Diesel
720 hrs./month
Driveway 2160 hrs./quarter

24 hrs/day
3. 6000 gallons UGT for Unleaded Diesel
720 hrs./month
Driveway 2160 hrs./quarter

4. 3 (MPD) w/ Eighteen (18) Filling 24 hrs/day

Nozzle/Hoses 720 hrs./month
Pump Island 2160 hrs./quarter
5.
Fuel Burning Quantity # of hrs of
Equipment Location Fuel Used Consumed operations
Just in case
1.Generator (20kw)
Mechanic Room Diesel 5 liters of Brownout

Pollution Control facility Location #of hrs of Operation

Cost of Treatment: N/A

Month 1 Month 2 Month 3
Cost of Person employed,
(salary)
Total Consumption of
Water (cubic meters)
Total Cost of chemicals
used (e.g., activated
carbon, KMnO4)
Total Consumption of
Electricity (khs)
Administrative and
Overhead Costs
Cost of operating in-
house laboratory, if any
Maintenance of the
Improved modified
Cost of improvement of
modification

10
Detailed Report of Air Emission Characteristics
Description/Location
of PCF
________ ________ ________ ________
Flow Rate CO NOx Particulates (name) (name) (name) (name)
DATE
(Ncm/day) (mg/Ncm) (mg/Ncm) (mg/Ncm)
(mg/Ncm) (mg/Ncm) (mg/Ncm) (mg/Ncm)

Please fill-up/accomplish separate form/s for other PCF/s.

Please use additional sheet/s if necessary.

11
MODULE 5: P.D. 1586

Ambient Air Quality monitoring (if required as part of ECC conditions)

Description/Location
Within the project vicinity
of Monitoring Station
Noise ________ ________ ________ ________
SO2 NO2 Particulates (name) (name) (name) (name)
DATE Level
(mg/Ncm) (mg/Ncm) (mg/Ncm)
(dB) (mg/Ncm) (mg/Ncm) (mg/Ncm) (mg/Ncm)

(Please accomplish one table per monitoring station.)

Ambient Water Quality monitoring (if required as part of ECC conditions)

Description/Location
LLDA REGULATION
of Sampling Station
________ ________ ________ ________ ________ ________ ________ ________
(name) (name) (name) (name) (name) (name) (name) (name)
DATE
(unit) (unit) (unit) (unit) (unit) (unit) (unit) (unit)

(Please accomplish one table per sampling station.)

12
Other ECC Conditions
Status of Compliance
ECC Condition/s Actions Taken
Yes No

I. OPERATION PHASE
1. The ECC covers the operation of Gasoline no expansion from the
Refilling Station. Which consist of four (4) existing operation
Underground Storage Tank, with capacity
of 22000 liters each within the total area of 
300 square meters. Any Modification from
the approved project scope shall be
officially relayed to this office for its
information, evaluation and approved;
Our company comply
2.The proponent shall insure that the in the mitigating
commitment appropriate mitigating measure measures contained in
and monitoring requirements especially those the EMMoP)
contain in EMMoP in EIA reports , its  Environmental
modification and additional information as Management Plan Shall
approved by the DENR during the EIA report be Properly
shall be institute and strictly implemented implemented during
throughout the project implementation and after the project
development.
Undertake and
continuing information,
education and
3. Undertake the continuing IEC program to
Communication (IEC)
explain to stakeholders the final approved
Program. We Already
EMMoP and the conditions in the ECC as
have done it during our
well as an update of project status 
construction period,
including any significant changes on the
and we don’t encounter
EMMoP and overall performance against
problem in the
the ECC
construction phase that
will affect the
environment.
4. That the project proponent shall allow In case of inspection,
DENR –EMB personnel with proper inform our Supervisor
identification card and Travel/ mission or any personnel to tour
order to conduct inspection/monitoring in  the inspector with
the entire premises without prior notice to proper Identification
oversee compliance to ECC Conditions card.

The name and owner of

5. The transfer of ownership and/ or change
the station is still M.H
of name of the project carries the same
Boss Oil Services
conditions in this ECC for which written  Station. In case there is
notification shall be made by herein grantee
a change in name we
to the DENR-EMB –Mainland within Fifteen
will apply it into your
(15) days from such transfer
good office.
6. That this certificate shall be posted in a This Certificate is place
conspicuous location in the administrator’s  in the Cashier booth for
office for easy reference and guideline easy reference.
7. That a report on the results of monitoring
under the EMMoP of the IEE and on  This report is our
compliance with each of the conditions compliance.
shall be submitted to this office annually
8. That a written notification shall be made to  This report is our

13
 the DENR-EMB – Mainland, for approval, compliance.
in case the project proponent cannot
comply with with any conditions for
technical reasons.
9. That in case of abandonment, the project To comply in case of
proponent shall inform this office within abandoning the site
thirty (30) days before abandonment and 
restore the site to its original conditions or
provide safety protective purposes and
prevents adverse environmental impacts.

Environmental Management Plan/Program

Status of
Enhancement/Mitigation Measures Implementation Actions Taken
Yes No
1.Generation of sewage and effluent  We already did it during
construction phase.
We construct a 3 septic
tank.

2.Generation of solid waste  Segregation of recyclable

materials.
Proper collection and
disposal of solid waste
minimization.
Provision of waste
receptacles in strategic
place.
3.Solid Waste Management system will be / Waste Segregation is being
employed. implemented to our plant.
4. Proper storage and regular collection of the The waste generated is
solid waste will be implemented.  being collected by the
Garbage truck by the LGU
of Teresa, Rizal.
5. A-3-chambered septic tank will be utilized This is our standard so that
for the treatment of sewage.  the water that comes out
from our plant is clean.
6. Yearly maintenance will be done to ensure We clean all the necessary
efficient treatment of sewage.  for possible clogging of
our drainage system.
7. maintenance of grease trap / maintained
Please use additional sheet/s if necessary.

Solid Waste Characterization/Information:

Average Quantity of .10 cum/month Total Quantity of Solid .30 cum/quarter
Solid Wastes Generated Wastes Generated this

14
per month Quarter
Average Quantity of .10 cum/month Total Quantity of Solid .30 cum/quarter
Solid Wastes Collected Wastes Collected this
per month Quarter
Entity in charge of Municipal Garbage Collector-Municipality of Teresa, Rizal going to
collecting solid wastes Municipal/ Provincial Sanitary Landfill of Rodrigues, Rizal.
Brief Description of
Solid Waste
Solid wastes generated in our station are commonly papers, plastics, tissues,
Management Plan (e.g.,
plastic bottle and newspaper.
waste reduction,
segregation, recycling)

MODULE 6: OTHERS

Accidents & Emergency Records: No Records of Accident

Findings and
Date Area/Location Actions Taken Remarks
Observation

Personnel/Staff Training: NONE

# of Personnel
Date Conducted Course/Training Description
Trained
March 19 & 20, 2019 PCO/Managing Head Training 1

I hereby certify that the above information is true and correct.

Done this _________________________, in ________________________.

MEYNARD C. KO MARIA LOURDES DOLOT__

Owner/ Proprietor Pollution Control Officer

SUBSCRIBED AND SWORN before me, a Notary Public, this ________ day of
__________________2020, affiants are exhibiting to me their Community Tax
Receipts:

15
 Name CTR No. Issued at Issued on
_____________________ _____________ _______________ ______________
_____________________ _____________ _______________ ______________

16