Department of Environment and Natural Resources

Environmental Management Bureau

Reference No:

(to be filled up by DENR only)

GENERAL INFORMATION SHEET

Name of the
NUTRI-TECH PRODUCTS MFG. INC.
Establishment/Facility

Establishment/Facility Street # & Street Name: Lodlod Avenue ___

Address Barangay: Lapo-lapo 1st City/Municipality: San Jose___
(NOT the company of head
office) Province: Batangas
Name of
Owner/Company
Street # & Street Name: ___
Address
(if address is not the same as Barangay: City/Municipality: ___
previous address)
Province:

Phone Number 043-726-61-98 Fax Number

e-mail address nutri.tech @yahoo.com.ph

Philippine Standard Industry Classification Code No. ___

Type of Business/
Philippine Standard Industry Descriptor: Mini Mixing Plant ___
Industry Classification

CEO/President. Mr. Nicasio L. Lantin ___

Tel #: 043-726-61-98 Fax #: ___
e-mail address: nutritechproducts1997@gmail.com ___
Responsible Officer/s:
Plant Manager: Florian V. Morfi ___
Tel #: 043-784-76-08 Fax #: ___
e-mail address: flor_morfi2002@yahoo.com___

Name. Conrado A. Rosales Jr. ___

Pollution Control
Tel #: 09336241681 Fax #: ___
Officer
e-mail address: rconrado2005@yahoo.com___

 single proprietorship  partnership

Legal Classification  private domestic corporation  government corporation
 Multi-national √ Private Corporation___

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

NICASIO L. LATIN CONRADO A. ROSALES JR.

Name/Signature of CEO/President Name/Signature of PCO
Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
Department of Environment and Natural Resources
Environmental Management Bureau

QUARTERLY SELF-MONITORING REPORT

MODULE 1: GENERAL INFORMATION

Name of the Plant NUTRI-TECH PRODUCTS MFG. INC.
Please provide the necessary revised, corrected or updated information not contained in your General
Information Sheet

(use additional sheet/s if necessary)

DENR Permits/Licenses/Clearances
Environmental
Permits Date of Issue Expiry Date
Laws
A/C No. N/A
P.D. 984
PO No. 2009-DB-BA-03-120 Feb. 3,2005
ECC 1 ECC-4A-2004-1181-3909
PD 1586 ECC 2 R4A-1108-0075 August 22,2011
ECC 3 N/A
DENR
Registry ID N/A
CCO Registry N/A
RA 6969 Importer
Clearance No N/A
Permit to
Transport N/A
A/C No. N/A
RA 8749
PO No. DP-R4A21-01653 3-20-21 3-20-22

Module 1: General Information page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
Operation
Operating hours/day Operating days/week # of shift/day
Average 8 5 1
Maximum

Operation/Production/Capacity:
Average Daily
100 kgs Total Output this Quarter 12680
Production Output
Total Water Consumption Total Electric
this Quarter (cubic 20 Consumption this Quarter
meters) (KwH)
Please use additional sheet/s if necessary

Module 1: General Information page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
MODULE 2: RA 6969

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

Common Name/IUPAC/CAS Index Name. ___

CAS No.: ___
Trade Name: ___

For importers only:

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

Total Quantity Requested Total Quantity Received

(annual) (annual)
* attach copy/s of Bill of Lading

For distributors (importers/non-importers)

Name of Client License No. Quantity Date of Distribution
N/A N/A N/A N/A

Total Quantity Distributed

For non-importer users:

Name of Distributor Quantity Date of Purchase

Total Quantity Purchased from Distributor

For producers

Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
Average Daily
Production Output N/A Total Output this Quarter N/A
Quantity of Stock N/A Quantity of Stock N/A
Inventory (Start of Inventory (End of
Quarter) Quarter)
Name of Buyer Quantity Date of Purchase

Total Quantity Sold

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

Average Daily
Production Output
N/A Total Output this Quarter N/A
Average Quantity Used N/A Total Quantity Used this N/A
per month Quarter
Describe any changes in Production/Process/Operations:

Stock Inventory/Waste Chemical Generated:

Average Quantity of N/A Total Quantity of Waste N/A
Waste Chemical Chemical Generated this
Generated per month Quarter
Quantity of Stock N/A Quantity of Stock N/A
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

B. Hazardous Wastes Generator

Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter

HW Generation:
Remaining HW from
HW HW Generated
HW No. HW Class HW Nature Previous Report
Cataloguing
Quantity Unit Quantity Unit
D407 Busted Bulb Solid 1 1 pc

Waste Storage, Treatment and Disposal:(Please fill-up one table per HW)
HW No,: D407 Busted Bulb ___
HW Details Qty of HW Treated: Unit: ___
TSD Location: on site ___

Name: ___
Storage
Method: boxes ___

ID: Name: ___

Transporter
Date: ___

ID: Name: ___

Treater
Method: Date: ___

ID: Name: ___

Disposal
Date: Date: ___

HW No,: ___
HW Details Qty of HW Treated: Unit: ___
TSD Location: ___

Name: ___
Storage
Method: ___

ID: Name: ___

Transporter
Date: ___

ID: Name: ___

Treater
Method: Date: ___

ID: Name: ___

Disposal
Date: Date: ___

On-Site Self Inspection of Storage Area:

Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
Corrective Action Taken
Date Conducted Premises/Area Inspected Findings & Observations (if any)
July Storage & Production Properly Maintained
Area
August Storage & Production Properly Maintained
Area

Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
C. Hazardous Wastes Treater/Recycler

HW Stored and/or Untreated as of End of Quarter:

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
N/A N/A N/A N/A N/A N/A N/A N/A

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
N/A N/A N/A N/A N/A N/A N/A N/A

Residual Wastes Generated from the Treatment and/or Recycling Operation:

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
N/A N/A N/A N/A N/A N/A N/A

Module 2C: RA 6969 (Hazardous Wastes Treater/Recycler) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter

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

Water Pollution Data

Domestic wastewater Process wastewater
1CUBIC METER N/A
(cubic meters/day) (cubic meters/day)
Cooling water Others: ___________
(cubic meters/day) (cubic meters/day)
Wash water, equipment Wash water, floor
(m3/day) (cubic meters/day)

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

Month 1 Month 2 Month 3
Person employed, (# of
N/A N/A N/A
employees)
Person employed, (cost) N/A N/A
Cost of Chemicals used
N/A N/A
by WTP
Utility Costs of WTP
N/A N/A
(electricity & water)
Administrative and
N/A N/A
Overhead Costs
Cost of operating in-
N/A N/A
house laboratory
New/Additional
Investments in WTP None None None
(Description)
Cost of New/Add None None None
Investments

WTP Discharge Location

Outlet
Location of the Outlet Name of Receiving Water Body
Number
1 Septic Tank None
2
3
4
5

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter

Detailed Report of Wastewater Characteristics for Conventional Pollutants

Outlet No.

Effluent Oil & ________

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

04/26/2019 <1 <2

12/12/2019 <1 <2
03/09/2021 <2 <2
02/24/2022 <4 <2

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

Detailed Report of Wastewater Characteristics for Other Pollutants

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
Outlet No.

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.

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
MODULE 4: R.A. 8749 (Air Pollution)

Summary of APSE/APCF
Process Equipment Location # of hrs of operations
1.250kg horizontal mixer Production Area 6 hrs
2.50kg horizontal mixer Production Area 6 hrs
3.
4.
Fuel Burning Quantity # of hrs of
Location Fuel Used
Equipment Consumed operations
1.
2.
3.
4.
5.
6.
Pollution Control Facility Location # of hrs of operations
1.Dust Collector Warehouse 6 hrs

2.Air Filter Bag Warehouse 6hrs

3.
4.

Cost of Treatment
Month 1 Month 2 Month 3
Cost of Person employed,
N/A N/A N/A
(salary)
Total Consumption of
N/A N/A N/A
Water (cubic meters)
Total Cost of chemicals
used (e.g., activated N/A N/A N/A
carbon, KMnO4)
Total Consumption of
N/A N/A N/A
Electricity (KwH)
Administrative and
N/A N/A N/A
Overhead Costs
Cost of operating in-
N/A N/A N/A
house laboratory, if any

Improvement or
N/A N/A N/A
modification, if any.
(Description)

Cost of improvement of N/A N/A N/A

modification

Module 4: RA 8749 (Air Pollution) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter

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)
5/22/19 54.6 4 34(front)
front front
54.8 4 4 101
back back back back

9/03/20 60.8 9 48
front front front
53.3 18 48
back back back

07/29/21 53.6 8
front front
51.6 5
back back

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

Please use additional sheet/s if necessary.

Module 4: RA 8749 (Air Pollution) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
MODULE 5: P.D. 1586
Ambient Air Quality Monitoring (if required as part of ECC conditions)
Description/Location
of Monitoring
Station
Noise ________ ________ ________ ________
CO NOx Particulates (name) (name) (name) (name)
DATE Level
(mg/Ncm) (mg/Ncm) (mg/Ncm)
(dB) (mg/Ncm) (mg/Ncm) (mg/Ncm) (mg/Ncm)
5/22/19 54.6 4 34(front)
front front
54.8 4 4 101
back back back back

9/03/20 60.8 9 48
front front front
53.3 18 48
back back back

07/29/21 53.6 8
front front
51.6 5
back back
(Please accomplish one table per monitoring station.)

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

Description/Location
of Sampling Station
________ ________ ________ ________ ________ ________ ________ ________
(name) (name) (name) (name) (name) (name) (name) (name)
DATE
(unit) (unit) (unit) (unit) (unit) (unit) (unit) (unit)
04/26/19 <1 <2
faucet

08/27/19 <2 <2

03/08/21 7 <2

02/24/2022 <4 <2

(Please accomplish one table per sampling station.)

Module 5: P.D. 1586 (EIS System) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
Other ECC Conditions
Status of Compliance
ECC Condition/s Actions Taken
Yes No

1.
2.
3.
4.
5.
6.
Please use additional sheet/s if necessary.

Environmental Management Plan/Program

Status of
Enhancement/Mitigation Measures Implementation Actions Taken
Yes No

1.
2.
3.
4.
5.
6.
Please use additional sheet/s if necessary.

Solid Waste Characterization/Information:

Average Quantity of Total Quantity of Solid
Solid Wastes Generated Wastes Generated this
per month Quarter
Average Quantity of Total Quantity of Solid
Solid Wastes Collected Wastes Collected this
per month Quarter
Entity in charge of
Disposal Facility/SLF
collecting solid wastes

Brief Description of
Solid Waste
Management Plan (e.g.,
waste reduction,
segregation, recycling)

Module 5: P.D. 1586 (EIS System) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
MODULE 6: OTHERS

Accidents & Emergency Records

Findings and
Date Area/Location Actions Taken Remarks
Observation

Personnel/Staff Training
# of Personnel
Date Conducted Course/Training Description
Trained

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

Done this _________________________, in ________________________.

CONRADO A.ROSALES JR.

Name/Signature of PCO
NICASIO L. LANTIN
Name/Signature of CEO

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

Name CTR No. Issued at Issued on

Nicasio L. Lantin 08471105 Lipa City January
6,2022

Module 5: P.D. 1586 (EIS System) page ____ of ____

Name of Plant:

NUTRI-TECH PRODUCTS MFG.INC./ lapo-lapo 1st,San Jose Bats

Reference No:
Second Quarter
Conrado A.Rosales jr 02197286 San Jose,Bats January
4,2022

Module 5: P.D. 1586 (EIS System) page ____ of ____