Environmental Management Bureau 128190 Region i APPLICATION FOR DISCHARGE PERMIT Republic ofthe Phiippines Department of Environmental and Natural Resources — —— BOX A: General Information Type New Name of Owner: ‘Ama Poulty Farm Office Address: Santo 9 Lupao, Nueva E Name of Permittee: _AmaPoultryFarm TN: _ 919-298-878. PSIC Code: 4 ee ‘Santo Plant Address No & Steet Name: Barangay: (Clipcochturipaliy,.._ UPA) 1 Su gus Sun ST peer NE eagrn a Type of Industry ‘Animal production Name of PCO: —GRISY.GUZONAcerecttation Date: _May 19,2024 Tel. No. &Cel. No; 00168304086 axa; 00 Legal Classification | Proprietorship Ownership forms. Private 100.0% | Foreion 0.0 % Government 0.0 % BOX B: Employment and Operation Information Total employment (number of workers) in the factory: | Production: 6 ‘Sources of Water Supply MWSS (please attach water bills) Local Water District (please attach water ot oo | Deep Wa za |z0 ‘Surface water (lake, river, creek, et.) oo [oo Others oo [oo ‘BOX D: Dwelling Units Information (hotels, condominium, restaurants, malls, etc) Total Floor Area m2 None T no of Bedrooms: None T No of Guestsivear: None |Page 2 of Total Ares for Dining Uni: None ‘No of Restaurants/Dining Units: None BOX E: Product Information| “Anowat “Annual Product Name Production | Production in the | Type of Process Capacity previous year ‘uve Broder Chicken 7490000 0 heads | 2000000heods | Batch {BOX F: Water Potton Information| Cuter | Location and Description ofthe | Name ofthe Receiving] Ave. 800, | AY" urn ee Number] Outlet Body of Water rofl Discharge, | oad, koMday] mavday Inside the farm vemnty - Open | ° oo 1 None oo 1 Tota 00 10 00 ‘BOX G: Flow Mater information Flow moter installed at ‘etuent Type of flow meter and method used at (iene) ‘rea Velo Method ‘BOX Hi information onthe Wastewater Treatment System Wasiewaterreatment system edsing?, [ves [No | WES, whatis the capority 6 Omday ‘Vaue of capital investentn the wastowater veatmet plant Php 0000.0 te ttere a primary vestment system? — Yes No. Date primary system instaled: Month: 1 Year: 2021 11Y¥es, whats the compositon of the physical veatment system 1 seenen ceutrton Connon \Wothers, please specity: 3 Water Car sepenin Pesto) Seman Pray Seay Tr Lena (etapa wetweacencatmamen? Yeu M0 Oteprmay stented 1 satan connnon tb chr bane sto: sexton ian Frcatencsaton net te sc WA Went wrt ys a pry ae jeowind Seige «Se Buh Reaion ArseieDgson Ona Sion end “Trecking Fitraton Rotating Biological Contract others, specify: WA Tow’ “Pinus se generic ame. Not band ames, in metic tons of produc except forthe flowing subsectors top rng (head) carbonated dks and beers (2), avghterngpreserwng meat ton LAK. eectopiating (72)NOTARIZED CERTIFICATION Fr taney ty 8 are itn knowledge. Done tis = re) \ ahaa revert ALAS Chet ac Oc uae, Sapare sn Poston) gp No. 06 2 IBF RAN TARLAC RULL MO.ST222