MGB Form No.

13-1A

Republic of the Philippines

Mines and Geosciences Bureau, Regional Office No. 6
Department of Environment and Natural resources
Queen City Garden Mall, J. de Leon St., Iloilo City

PROJECT DESCRIPTION
(Accredited Trader/Dealer/Retailer of Mineral Products and or By-Products)

1. General information:
1.1. Name of Project : Trading of Minerals/Mineral Products/By-Products
1.2. Proponent : __ ___
Name
: . ___
Home Address

: ___
Office/Business Address

: ______________________________
Telephone/Facsimile Number(s)

: ________________ _______ ____

2. Project Description:
2.1. Project Details
2.1.1.Location Of Stockpile Area/Processing Plant: __________________________________
2.1.2.Accessibility (Pls. check) :
( ) National Provincial Road
( ) Municipal Road
( ) Barangay Road
( ) Access Road
Contact Person/Designation
PUROK II, BRGY. NARAUIS, HINIGARAN, NEGROS OCCIDENTAL
: kms. from town proper
: kms. from town proper
: kms. from town proper
: _______________ kms. from town proper

2.1.3.Stockpile Area (has./sq.m.) : __________

2.1.4.Capacity of Stockpile Area (processing plant if applicable) in cubic meters : __________
2.1.5.Mineral Commodity (ies), Pls. check :
( ) Raw SAG ( ) 3/4" ( ) Washed Sand
( ) G-1 ( ) 3/8" ( ) Others, pls. specify _________________________
2.1.6.Method of Mineral Processing, if applicable (Pls. check)
( ) Sizing/Washing Operations ( ) Others, pls. specify _________________________
( ) Batching Operation
2.1.7.Estimated Monthly Purchase of SAG, Lupa, Limestone, etc.
Date Estimated Total
Permit Holder/Supplier Permit No. Quantity Cost/Cubic Meter Monthly Purchase
Approved Expired (Type of Materials Purchased)
(PhP)

TOTAL

2.1.8.Estimated Monthly Sales :

Type of Materials Estimated Volume Cost/Cubic Meter Estimated Sales

TOTAL

2.1.9.List of Equipment/Machineries and Implements (use separate sheet, if necessary)

KIND DESCRIPTION NO. OF UNITS

__________________________
Signature of the Proponent/Applicant