You are on page 1of 1

BASIC AND REFRESHER TRAINING COURSE FOR

POLLUTION CONTROL OFFICERS (PCOs) REGISTRATION FORM


PARTICIPANT INFORMATION Please fill out completely for logistic purposes

NAME___________________________________________________________________________________NICKNAME_____________________________
PRINT (LAST) (FIRST) (M.I.)

SEX_____________ CIVIL STATUS____________________ DATE OF BIRTH_________________________

NAME OF OFFICE/COMPANY_____________________________________________________________________POSITION__________________________
OFFICE/COMPANY ADDRESS___________________________________________________________ __________PHONE NO._________________________
FAX_________________________________ EMAIL______________________________________________ ___CELLPHONE _______________________

EDUCATIONAL ATTAINMENT: (Name of School, Degree Attained, Year Graduated)


College_________________________________________________________________________________________________________________________

NATURE OF PLANT/BUSINESS OPERATIONS


 Automotives (manufacturing / assembly / distribution / services)  Metal (steel manufacturing, etc.) / Ship Building Construction &
 Canning Infrastructure (including contractors)
 Chemical / Pharmaceuticals / Cosmetics  Mining / Cement / Ceramics / Tiles / Glass
 Consultancy / Services (TSDs) / Laboratories (non-medical labs)  Paper / Printing / Textile {manufacturing of garments) / Tannery /
Education / NCOs Rubbery / Plastics (moulding) / Wood
 Electrical (manufacturing / assembly / distribution of cables, transformers, etc.)  Petrochemicals / Petroleum / Refineries (depots / gas stations)
 Electronics / Semi-Conductor (manufacturing / assembly / distribution)  Power Generation & Distribution (power plants / grids, etc.)
 Food & Beverages (manufacturing)  Real Estates (subdivisions, residential buildings or condominium,
 Hospital and Health care institutions (including clinics, funeral memorial parks) / Recreational Facilities (hotel, resorts)
parlors, columbaria, crematorium, diagnostic labs, etc.)  Sugar / Distillery / Ethanol (manufacturing)
 IT Facilities & Services (telecom, cell sites, etc.)  Vegetable Oil (Oil Mills, manufacture of cooking oil) / Detergent Wax
 LGUs (departments/PGENRO,MENRO, City ENRO, Local WD, etc.)  Warehousing and Logistics (including port operations)
 Livestock / Poultry / Feeds / Agriculture  Others, specify:

CATEGORIZATION:
 Chemical Usage, Storage and/or Handling:
Using, storing, and/or handling chemicals which are not listed in PCL: ___YES ___NO
 Hazardous Waste Generated: ___Small generator ___Large generator
 Air Emissions: ___Stack sampling required ___Stack sampling not required
 Solid Waste Generated: ___Generates less than 30kg/day ___Generates more than 30kg/day
 Wastewater Discharged: ___Discharges less than 30m3/day ___Discharges more than 30m3/day
 Sludge Generated: ___None ___Contracts a TSD

TRAINING FEE (inclusive of meals, training kit, training module, e-copy of presentation materials and training certificate)
Live-Out @ Php 7,000.00
Meal Inclusion: Three (3) Lunch meals and Six (6) AM/PM Snacks
MODE OF PAYMENT
 Cash
 Cheque: Payment will be done during the training
Please prepare check payable to MIT Center for Sustainable Resource Management
 Deposit through Bank:
Account Name : MIT Center for Sustainable Resource Management
Account No. : 010998000631
Name of Bank : Banco de Oro (BDO)
Branch : Davao - Calinan

You might also like