NOTE: This checklist need not to be accomplished by an accredited preparer. This can be done by the proponent or any of his or her authorized representative. The CENRO may also assist the proponent in accomplishing the checklist. INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST for fPFRFIVED, i O/s31-08 SEPM | teue | ORGI- pay GASOLINE STATION PROJECT ECO 1.0 GENERAL INFORMATION 1.1 Project Name/Title: PROPOSED DELER CONTROLLED SERVICE STATION 1.2 Proponent/Company: GEN. ARTUROC LOMIBAO & GLADYS VERGARA DE VERA Address: #58 Upper QM Baguio City (complete address: st /sitio, brgy. city/mun,, prov.) Tel./Fax: |) E-mail: AEE ee ese esses cee ceceeceeeeeem een) 1.3 Project Location: Caranglaan District, Dagupan City 1.4 Project Objectives: To provide income generating activity for the city To convert an idle land for business To cater the motorists’ need in transporting goods and people 1.5 Project Ownership: Type of Owners: [ ] Single Proprietorship L ] Corporation [/] Partnership/Joint Venture [ ] Cooperative [ ] Others, pis. specify:1.6 Project Cost: Total Project Cost [P5.0M 1.7 List of Owners (for partnership /co:poration) GEN. ARTURO C LOMIBAO 1.8 Authority from the corporation to apply ECC in their behalf 2.0 PROJECT DESCRIPTION 2.1 Project Area Coverage (attach photocopies of documents as Annex) } Total Land Area (m2/ha) 1,605 sqm 2.2 Land Ownership Ownership of the land by virtue of OCT/TCT # Stewardship of Land by virtue of : Lease of Land by virtue of lease contract Pending Application for: Others, pls. specify: 2.3 General Land Classification [ ] Public land [ ]AandD 24 Present Land Use Classification (based on the approved land use/zoning ordinance of the city /municipality) {| Agricultural [ ] Residential [ ] Tourism [| Industrial [| Forest Land [_] Institutionalapis yiou) Aynuora ayerpeurut sy pue ay1s yoelosd aug Jo mara oRuesoed yeHY[Attach panoramic view of the project site and its immediate vicinity (Gouth side view) 3.0 PROJECT COMPONENTS 3.1 Services Services ‘No. | Area | Capacity] No.of | Chemical | Vol. Of of | (M2) Res- tobe | Water Unit ponsible used | tobe Person Used Body washing Hone Engine Washing Under Chassis Washing ‘Automatic Car Nene Wash ‘Change Oil ‘Complete wash7 Vacuum, Greasing NeneChange Coolant | Nene Tune-up ina ‘Wheel Alignment __| Nene Free Service (Air and Water) | 2 Titeys/day Others, Pls. specify 3.2 Facilities Facility No. Of Unit |” Area (M2) Capacity | Service Bay Nene iping/ Refilling Station 7 jispensing Pump for fueling Position £ Fuel Storage Area a Wash Bay Nene ‘Convenience Store i i Stand-By Power Utilities Parking Area Office Bldgs. Others, Pls. Specify (Attach facilities/lay-out plan General lay-out plan of the gasoline station. 3.3 Utilities and Infrastructure 3.3.1 Water a. Water Demand Estimated daily water requirements of the proposed gasoline station? b. Water Allocation Services Water Demand Allocation (m3) Body Washing Engine Washing Under chassis washing Change Oil Complete wash with vacuumGreasing wa VJs ‘Change coolant WA Nk Tune-up wh /a ‘Wheel Balancin; Wa w/a Wheel Alignment wWa__p/A Free Services (Air & Water) 299. TitqeeZeey ao. Others, Pls. Specify = c. Water Supply/Sources © Existing Public Water Water Source Yes | No Remarks Existing Public Water 7 Da Dagupan Water District | © Surface Water Water | Nameof | Location | Distance ] Modeof | Volume Source Water dev’t. or of Body distribution | Extraction ‘Creek Sprin; ‘Stream, River Others © Deep Well Water No. of Location Depth (m) | Discharge Sources | Wells/Hand (liter/sec) Pump/Tanks Deep well with Manual! ypiia~ Hand Pump Deep well with electric] rene or Motor fan Pump © RainwaterWater Source No. of Tanks/Reservoir Capacity Collected in Sto1 n caer Sere] peng Collected in Reservoir Nene : d. Water Treatment Is there provision for water treatment of your independent water source? YES No If yes, what type of water treatment? Chlorinated Filtration Others (specify) 3.4 Drainage System (Attach approved drainage layout plan as Annex) Type of drainage: a) Major Roads: opencanal —j“¢losed/underground drainage b) Other roads: open canal closed /underground drainage Where does the drainage system drain? Public drainage system natural outfall/water body What water body (e.g, river/stream) will serve as the outfall of the sewage and drainage systems? EK Where is the located: yew ery 3.5 Power Supply Source of Power: Local Electric Cooperative Own Generator Capacity: 14" "784. Others, pls. specify 3.6 Sewage Disposal System+ Sewage System {ndividual Septic Tank Communal Septic Tank * Sewage Design _v2~ chamber septic tank w//leaching © Sewage Disposal 2- chamber septic tank w/o leaching | 3- chamber septic tank w/ leaching 3 - chamber septic tank w/o leaching 4- chamber septic tank w/ leaching 4. chamber septic tank w/o leaching, Others, pls. specify [AGischarge to an existing public sewerage system [_] treated in a community disposal plant or communal septic tank [ ] treatment in the individual septic tank with disposal by absorption field or leaching pit [ ] Others: | (Specify). 3.7 Wastewater Treatment Facility: . Capacity of oil water separator: 9 alabae pte ‘Attach Flowchart on liquid waste management Attach lay-put/detailed plan - Liquid waste facility-main component - Wastewater treatment facilities 3.8 Used Oil Collection and Disposal System ‘* Collection System No. of Drums/month:Volume: Storage Area: © Disposal System L] Recycled [ ] _ Burning/Incinerator [L.] Solid to re-cycles 3.9 Solid Waste Disposal System * Collection System [_ ] Association/project-maintained garbage collection system [1 Integrated into the municipal garbage collection system [ ] Others, (specify): © Will there be a waste sorting/ segregation system to be employed prior to disposal? [1 YES [1NO * Disposal System —[_] Burning atopen dumpsite in the project site [ ] Sludge cleaning [ ] Open dumpsite outside of the project site [AMunicipal/city landfill area [ Others, specify: * Location of the waste disposal site: _~\wadiasGa\ Silap BURP SUT Attach flow pan of the solid waste management - collection to disposal. 3.10 Manpower and Employment (provide listing of manpower requirements as Annex) * How many people will be employed by the proposed gasoline and service station during: a) Pre-Construction Period: 75 satyedén, t b) Operation and Maintenance period: aE3.11 Project Schedule (attach schedule of development activities from pre- construction; construction; operation phase) 4.0 DESCRIPTION OF EXISTING ENVIRONMENT A. Physical Environment ‘Components/ Parameters ‘YES NO Remarks. 1. What is. the general elevation of the proposed gasoline and refueling station? < 100 mast 100-300 mast 301-500 masl 501-1,000 mast 1,000-1,5000 masl >1,500 masl (To determine elevation, refer to the topographic map where the elevation per contour line is indicated) (indicate the area per elevation range or estimate the % to total area) Zim ate 2. Slope and Topography of the area Terrain is flat or level (0- 3% slope Gently sloping to undulating (3-8% slope) Undulating to rolling, (8-18% slope) Rolling to moderately steep (18-30% slope) Steeply rolling (30- 50% slope) Very steep to mountainous (50% slope) Indicate the area per slope category or estimate the % to total area) \% % 3._Are areas in the site where ‘Causes of erosion:~ indications| of soil erosion are occurring? If yes, what vy |£ | Heavy Rains activities | are causing [ ] Unstable Slopes | erosion? [ ] Others, pis. specify | 4 Do you know of any Cause of landslide: landsliding occurring or | that has occurred in the Y |[ ] Earthquake site? [ ] Unstable slopes | [ ] Barthmovi ioving [ ] Others, pls. specify Attach photo g the areas topography (choose the view//perspective which shows contours areas with slopes) A. Physical Environment ‘Components/Parameters | YES | NO Remarks 5. Has the area experienced Period(s) flooding: any flooding during the wet or typhoons? If yes, when was the last time Cause of flooding: the area was flooded? [ low area What caused the flooding? [AY poor drainage | [ ] water logged areas | 6. Soil type of the area: ‘Other soil types: [ ] Sandy soil [ ] Clayey|soil [Sandy loam soil 7. Are there| existing water ‘Name of water bodies: bodies found near or within the site e.g. creeks _ near or Streams? If yes, please enumerate them in the opposite space and indicate their location(If they have no names, indicate the number of water bodies) © these water bodies should be shown in the topographic map What are the present uses of the waterbodies within or near the project site? ] Fishing ] Source of Drinking ‘water [ ] Recreation (swimming, boating, etc.) [ ] Others: [ [ | Washi [ [ 8 Is there an access road going to the project site? If yes, what is its distance to the site km. Type of access road: 9. What is the present land use of the area wherein the proposed gasoline and refueling station be located? [ ] Prime agricultural land (productive/irrigated) [_ ] Prime agricultural land (idle/abandoned) [ ] Grassland [ ] Built up [ ] Orchard [ ] Marshall/Mangrove [ ] Fishpond [4Others, pls. specify Pemmereial aredDoes the site conform to the approved land use of the city /municipality? 10. Is the land allocation and alignment of the various utilities integrated with the existing networks and projects outside of the boundaries of the project site? 1. Are there _ existing structures or developments around the project site? If yes, please list them in the ‘opposite space ene B. Biological Environment Components/Parameters Yes Remarks. Are there existing trees and other types of vegetation in the site? If yes, pls. provide examples. Are there birds and other forms of wildlife found in the area? Pls. provide examples. Nene | ‘Are there fishery resources in the water bodies found near or within the site? Pls. provide examples. ene Is the site near or within a watershed or _forest reservation area? NeneIfnear, only, how near? m or km If near, only, how near? | _morkm If within, indicated name of the watershed or _ forest reservation area 5. Is the gasoline station adjacent to a natural ecosystem? [ ] Forest [ ] Coastal/Marine [ ] Grassland [ ] Man, ea C. Socib-Economic Environment ‘Components/Parameters No Remarks gasoline land refueling station? If yes, indicate the number off (within 100m radius) " Households/Families: _># Legitimate landowners: 38 Tenants | ‘Squatters: 2 What the total population of _ the community in the project site? |. aryee Pel “0 GO 3. Average family size: | Tele © CvO T 4, What are their sources(s) of livelihood?, valsineas/varkere/helere![ “Pc | Bouly and [Avending/ By Buy and Sell [7 Sari-sari (Others Fs ses: — “ie 5 a many of the total population] have reached the: Elementary level: _ 160%. High School level: _180%_ College lev 95g 6. Are tee] other existing local organizations in the area? 7. Are there! existing social infrastructure inthe meer" feat ehe (Attach photo) || Nw 6.0 IMPACT ASSESSMENT AND MITIGATION A. PRE-CONSTRUCTION/CONSTRUCTION PHASE Project Activities Affecting the Physical Environment Yes No Impact Description Mitigation/ Enhancement Measures 1 |. Will there be land vegetation | clearing? If yes, what is the total area to be cleared? (ha) Will there be trees to be affected during the clearing? If, yes, how many and what . Will there be demolition of existing structures: If =] Will there be topsoil removal and replacement? If yes, how mu of the removed topsoil will be replaced? [_] Entire volume |T 1 Partial only 5. If partial only, where will the rest of the topsoil be deposited? If no, what will happen to the excavated topsoil? 6 Will there be earthmoving activities, eg. excavation work, cut and fill, etc.? If, yes, how deep is the excavation and how much is the estimated volume of cut and fill? Average depth of excavation (m):_ w._ Estimated Volume of cut and fill (cum):_\30 Source of |__ filling. materials: Nangpléen (Pasepeinas 7. Will tees and ornamentals be planted in the site? Total # of trees to be planed: sc Species of trees to be planted: Ave. height of trees to be planted: 8 Will there be stockpiling of soil, sand and gravel] materials. in the project area? 9. Will there be drillings, hammering | / and boring activities?Sil 10. Will theré be any slope modifications or ground leveling to be done? 11.Is there a need to construct access road going to the site? If yes, what type of access road: [ ]all weathered road length (m)__width _ [J concrete U Jasphale 12. Will temporary quarters or barracks and a field office be provided | for construction workers within the project site? Project Activities Affecting the Biological Environment Impact Description Mitigation/ Enhancement Measures 1. Will there be vegetation tlearing? 2. Will clearing activities affect any critical wildlife habitats? 3. Will clearing activities affect any rare, threatened or endangered plant and animal species? “4, Will there be trees to be affected (eg. cut down; remove) during the clearing? If yes, how many andwhat these species of trees? ~ j | Project Activities | Yes | No Impact Mitigation/ Affecting the Socio- Description Enhancement Cultural and Economic Measures | Environment | 1. Will there be settlements to be affected? If _ yes, how many househoag will be v affected? Total No. of Hi Id Famili 2, How will they be handled? Payment of | property owners Temporary _felocation te site to be provided Permanent relocation site to be established Eviction without compensation Others, Pls. specify: | | | 3, Will thel project encroach on ve ancestral domain ‘4. Will there! be locals~ | increase in economic activity in the area or arise in associated Project? v 6 Will the project cause an increase in . traffic in major routes | Musefninsnen due to the entry and exit of construction equipment? 6.2 Operation and Maintenance Phase Project Activities Yes | No Impact Mitigation/ Affecting the|Physical Description Enhancement Environment Measures 1. Will there be an increase jis solid ee v Waanans | waste and sewage generation? Will there be an increase in water demand? Mavoans ( . Will there be an improved | drainage and water supply system? | . Will there be an increase in surface run-of from the concreting of roads and soil surfaces? . Will there be reduces infiltration rate due to impermeable structured | over the ground?| 6. Is the | available domestic | water supply enough to meet the maximum projected water consumption of the gasoline station? Project Activities Affecting the Biological Environment No Impact Description Mitigation/ Enhancement Measures 1. Will the sewage out fall and | drainage system drain into the nearby or adjacent surface water body? 2 Will the waste disposal | site be adequate to meet the projected solid wastes in the area? Project Activities Affecting the Socio- Cultural and Economic Environment Yes No Impact Description Mitigation/ | Enhancement Measures T. Wil the project cause or increase traffic in the areas? 2 Will the| | easoline station a Sgicnt nese in | existing Sar of the area? Myrusser! 3 Are there existing transport | services/ facilities routing the areas?eae! 4 Is there a [prevailing water shortage or V water supply Problems inthe area? 5. Are theré already 6.3 Abandonment and Rehabilitation Phase Project Activities | Yes | No Impact Affecting the Socio- Description Cultural and Economic Environment | Mitigation] | Enhancement Measures T. Will the) _ project 5 cause or| increase vw traffic in the areas? 2 Ts the gasoline station create a significant) increase in’ the existing] ¥ population) of the area? 3, Are there existing transport services/facilities | V/ routing the areas? 4. Is there a prevailing water shortage or J water | supply problem in the area? 5. Are there alread existing commercial establishments y within the vicinity of the project area? PROPONENT’S/DEALER’S COMMITMENT1/We, am/are committing to. | T. Comply with existing environmental rules and regulations. Guidelines and criteria; | | 2. Comply with all mitigation enhancement measures that have been identified in the report; 3. Support mlulti-partite monitoring efforts to be organized; | | 4. Construct) maintain and properly operate and adequate and appropriate oil- PPTOPI water tor the liquid wastes; | 5. Construct] maintain and properly operate an adequate and appropriate septic tank for the liquid wastes; 6. Maintain the cleanliness of the general surroundings; 7. Participaté or contribute towards a communal cleaning effort; 8. Strictly implement a risk management plan and safety program; I 9. Organize and conduct information, education and communication (IEC) activities on environmental, health and other civic issues; | 10. Others, please specify 9.0 ATTACHMENTS/ANNEXES ‘A. Government Permits and Clearances (Attach photocopies of documents) PERMITS/CLEARANCES ‘YES NO Location Map/ Vicinity Map Barangay and Municipali/City Indorsement Photocopy of TCT/OCT /TD_ Design/Plan of the Gasoline Station Locational Cléarance from HLURB UNITY NWRB PermitACCOUNTABILITY STATEMENT This to certify that all the information and commitments in this Initial Environmental Examination (IEE) Report are true, accurate and complete. Should I/we learn of any information to the attention of the appropriate DENR Regional Office. 1/We hereby bind myself/ourselves jointly and solidarily for any penalties that may be imposed from any mis representations or failure to state material information in the IEE. In witness whereof, I/we tout hands this? SAAS, ereby set arm Fastin Veuggin: desc LADS VERGARA Ot IERA Project Proponent Title/ DesignationACKNOWLEDGEMENT BEPORE ME this" sil oS of ____ 19 MANGALDAN, PANGASINAN personally appeared with Community Tax Certificate No, 1806 8803 issued on _I-$-2008 at Paguio Fy , in his/her capacity as of and acknowledged to me that this IEE Report is his voluntary act and deed, and the voluntary act and deed of theentity he/she represents. This document, which consist of pages, including the page on which this acknowledgment is written, is an Initial Environmental Examination Report Checklist. Doc. No. __ 25 __ PTR NO.34059 alco: a2. bg Page No._/@ TIN NO. 174-870- 4: Book No. __/70 Series of __ 2008 _