t Bhs Lo Reap ANNEX 2:74 PROJECT ENVIRONMENTAL MONITORING AND AUDIT PRIORITIZATION SCHEME (PEMAPS) QUESTIONNAIRE 1 _frayeee | fect Node Por Meoiial Puegne, = @ Project Name Project Location ECC Reference No. Proponent Pollution Control Officer Tel. No/Fax NoJEmail Project Type Project Status 1. PROJECT CONSIDERATIONS 1.1 Size and Type 1.1.4 Size based on number of employees. Specify number of employees: 112 Type ECP (in ether ECA of Non-ECA) Non-ECP but in ECA Non-ECP and Non-ECA z ie 1.2. Waste Generation and Management 4.21 Enumerate Waste Type and Specify Quantity of Wastes generated in your facility. (Identify (Enumerate) Quantity [ (units MiTiye) Category Hazardous | Non-Hazardous Tunis iy 1.3. Pollution Control System (PCS) 43.1 Enumerate PCS or Waste Management Method Used in your facilty ((dentify /Enumerate) dissoy [ PCSMaste Management Method | Primary Liquid ‘Secondary erliny Solidfea + ANNEX 2-70 PROJECT ENVIRONMENTAL MONITORING AND AUDIT PRIORITIZATION ‘SCHEME (PEMAPS) QUESTIONNAIRE PATHWAYS 2.1. Prevailing wind towards barrio or city? (mark he coresponding pol) Yes _No_ 22 Rainfall (pacts surface & groundwater pathways) 22.1. Average annual net rainfall: Specify amount: (units: mm) 2.2.2 — Maximum 24-hour rainfall: ‘Specify amount: units: mm) 23 Terrain select one and mark) Flat_/Sieop_ 24 Isthefacity located in a flod-prone area? (set oe and mat) Yes_“ No 25. Ground Water Depth of groundwater table (meter) (select one and mark) Otoless than 3 310 10 ene Greater than 10 Il, RECEIVING MEDIARECEPTORS 3.4. Air (Distance to nearest commuriy) (select one and mark) 0 toless than 0.5 km 0.5101 km =n Greater than 1 km. 3.2. Receiving Surface Water Body 3.2}1 Distance to receiving surface water: (select one and mark) | Oto ess than 0.5 km 08 to 1 km Greater than 1 km 3.212 Size of population using receiving surface water ‘Specify number: 32.3. Fresh Water 3231 Classification ofesh water _(Gelect one and mark) aA iA 8 c vip D 32.32 Size of fresh water body Specify size (units: km?): ANNEX 2-74 PROJECT ENVIRONMENTAL MONITORING AND AUDIT PRIORITIZATION ‘SCHEME (PEMAPS) QUESTIONNAIRE. 32.33 Economic value of water use (may select more than one ofthe etesa below) | Drinking 2 | Domestic ae | Recreational | Fishery Industrial | Aayiulturl | 32. Salt water | 324.1. Classification of saltwater (select one and mark sa SB sc Nip so 3242 Economic value of wateruse (may select more than one of the criteria below) Fishery Tourist zone or park Recreational ao Industrial 3.3. Ground Water | 3.3.1 Distance to nearest recharge area (select one and mark) | Oto less than 0.5 km 0.510 1km Greater than 1 km 3.32 Distance to nearest well used (select one and mark) 010 less than 0.5 km 05 t01km ee Greater than 1 km 33.3 Groundwater use within the nearest well (may select more than one ofthe criteria below) Drinking SS | Industrial | Agricultural pe aa 34 Lal Uh Indicate curenVactual land uses within 0.5 km radius: (may select more than one ofthe lea below) |, Residential a CommerciaVinstuional eee Industrial ‘AgiculturalRecreational aoa Protected Area 193ANNEX 2.76 PROJECT ENVIRONMENTAL MONITORING AND AUDIT PRIORITIZATION, SCHEME (PEMAPS) QUESTIONNAIRI | 3.4.2 Potentiaiproposed land uses within 0.5 km (may select more than one ‘ofthe enteria below) Residential roll i ‘Commerciainnstitutional emanate | Industral | Agricultural/Recreetional seaman Protected Area 343 Number of affected Environmentally Critical Areas within + ke: | ‘Specify number: | 3.44 Distance to nearest ECA (select one and mark) Oto ess than 0.5km 0.5101 km aT Greater than 1 km eh IV. ENVIRONMENTAL PERFORMANCE : Pow Ree K 35. Compliance (pls. take note that this will be double-checked with PCD files) Von |—_HSDE sactiaiSEMET —Ttey | saan | va eect CS retasar mm Rima] Mine | Reonsas any) Discharge Ambient | impact | ECC Violation | of Compliance | mene — 1 AUT t ASE t Oe a 36 Number of Valid Complaints Citizen and NGOS Specify number: Others (other Gout. Agencies, Private Insitui ‘Specify number: 3et 362 Uh i Hon) a 134: ANNEX 2.74 PROJECT ENVIRONMENTAL MONITORING AND AUDIT PRIORITIZATION ‘SCHEME (PEMAPS) QUESTIONNAIRE ‘This is to certify that all information in the submitted Project Environmental Monitoring) And Audit Prioritization Scheme (PEMAPS) Questionnaire of i located at is true, Zocurate and complete. Should | team of any information, which makes this inaccurate, | shall bring said information to the appropriate Environmental Management Bureau Regional Office. In witness whereof, | hereby set. out my hands this day of 200_at | PROJECT PROPONENT | | : SUBSCRIBED AND SWORN to before © me this | day of 200__ at AAffant exhibiing 1 me hisiher Community Tax Cerificate No. issued on Doo. No. Page No. Book No. Series of 200_ 135