MODULE 1: GENERAL INFORMATION Reference No. :86437 Year :2022 Quarter: 4 Name of Plant : J.C.A. POWER FUEL STATION Notes : Discharge Permit and Permit to Operate is acquired this quarter and has been displayed to the office wall DENR Permits/Licenses/Clearances Environmental Laws Parmita Date issued Expiry Date B75 DE Neo DEROSZO OS BORO PERE ECCIGNC No FOC-OL ROG DOTO-O10S DOSES BH DENR Ragety D, ZOOOOTOT Zoo] Transporter Registration Z000501-01 2000-01-01 “TSD Registrabon 2000-01-01 2000.01.01 (COO Registy 2000-07-01 Zo0c01-01 Trapotaton Clearance No. 2000-01-01 2000001 Permit fo Transport 20000701 01 Sirall Quantity Importation 2000-01-08 2000-01-01 Pronty Chemical List, 2000-01-01 2000-01-01 PMPIN 2000-07-01 2000-01-01 oe FON. POOL ROS DOD OETA POET BOTT Operation Sarat ck Fat srinday verge + Maximum x Operation/Production/Quality ‘Average Dany Production OuipuT “Total Water Consumption this Quarter om 7 Total Output this Quarter 3a045.467 Total Electric Consumption 1560MODULE 2: RA 6969 A. CCO Report CEO Tem No] COO Substance | Common CASNo. | Trade Name ended Use [Ouantiy Tssved [7] IvamentuPAcicas| 00) Index Name Tevecoris und For importers only ‘CEORem | importation] Guantly | Guaniiy | Date ot [Porto Enty] County at | County ot] Total —] Tota No. | Clearance Jssued (in ic] Imported | Aral Origin [Manufacture] Quantity | Quantity No. Requested | Received (ennual) | (annual) No records | found For Distributors (importers/non-importers) ohana eae Date of [Country of | Country of] Total Guantiy Distribution Origin _| Manufacture | Distributed No records | ‘found For non-importer users ‘SCOTem No. Name of Distibutor Guantty Date of Purchase | Total Quantiy Purchased from Distributor No records found | For Producers COO Tem No. Output [Average Daly Producton] Total Output ths Quarter ‘Guantiy of Stock ‘Guantiy of Stock No records found Javentory (Start, sete: (End of Quarter ‘COO Tem No. Total Quanity Soe Tio records found | Name of Buyer “Quantity Used in Production (please fill up only if chemical/substance is not main product) | Date of Purchase SCO Tem No, Output [Average Daly Production] Total Output ths Quarter ‘Average Quanity Used | Total Quantity Used ths per month ‘Quarter Tio records found - Describe any changes in Production/Process/Operations ‘Stock Inventory/Waste Chemical GeneratedSCO Tem No. fiverage Quantity of Wastd Total Guantty of Waste ‘Chemical Generated per Chemical Generated this, ‘month ‘Quarter Quantity of Stock Inventory(Start of quarter) Guanty of Stock Inventory(End of quar No records found Other Information Manner of Handing Hazardous Wastes [Changes in Safely Management System = i ‘Chemical Subst je Pan B. Hazardous Wastes Generator HW Generation TW No, FW Cass No records {found aS SaRig Tat [Gian = Waste Storage, Treatment and Disposal(please fill-up one table per HW) On-site self Inspection of Storage Area Date Conduck Promises/Area Inspected C. Hazardous Wastes Treater/Recycler HW Stored and/Untreated as of End of Quarter Findings and Observations Corrective Action Taken “Type of Waste | HW Number | Wastes Date of Transport | Guantily [Type of Storage] Time Table for Generator | Transport | PermivDate of Containeri# of | Treatment Issue Containers HW Treated and/or Recycled as of End of Quarter Type of Waste] HWNumber | Wastes Date of Transport] auantiy Type of | —Guantiy oF Generator | Transport | Permi/Date of Treatment of | Reoycied or Issue Recycling [Treated Product Process Residual Wastes Generated from the Treatment and/or Recycling Operation Type of Waste FW Number Process by which the Waste is ‘Guantty Type of Storage Containers Disposal Option Time Table for DisposalGeneratedMODULE 3: RA 9275 Water Pollution Data Domestic wastewater (cubic a | Process wastewater (cubic a metersiday) mmetersiday) Cooling water (cubie meters/day) a others Wesh water, equipment (cubic nla | Wash water, floor (cubic ia ‘metersday) mmetersiday) Record Cost of Treatment Wont Monn [ours Parson employed, ot a 7a a employers) [Berson employed feos) | — (EE TE wa Ta (ost of Chemicals used by WIP] a wa a Uulty Costs of WTP {electro &] a We ve water) Ranistatve and Overhead wa Wa we Costs Tost of operating house Wa Wa we Iaboratar WewAddtional investment is wa 7 we WTP (description) [ Goaicorhownd testers Ta wa [eer coat WTP Discharge Location ‘Suet Namber Tocation of he Outet Tame of Recering wale body i THSIDE THE estabishment Tawaan ver Detailed Report of Wastewater Characteristics for Conventional Pollutants Outlet No, wa DATE 2000-07-01 Aluent Flow] BOD (mg/L)] TSS(malL)] Color Ph [Ors Grease] Temp Rise | Unt Rate | (mot) «cy (m3iday) na Ta Te wa | wa om Wa wa, Detailed Report of Wastewater Characteristics for Other Pollutants ‘OulletNo | DATE fEMiuent Fr Rate (mraiday i Taina | naive Waive | Warne wa [2000-07-07 na nla a nla a]MODULE 4: R.A. 8749 (Air Pollution) Summary of APSE/APCF Process Equprent Toeaton Tot hours of operation forthe quarter UNDERGROUND TANK PREMIUM 1 | WITHIN THE VICINITY OF THE FUEL 1280 STATION UNDERGROUND TANK UNLEADED: ‘WITHIN THE VICINITY OF THE FUEL 1260 STATION, CROERROOROTANRDESELS_ | WIFI THE ViciWIy CF WE FUEL | 280 STATION ees ae eam en eee Te STATION, CROERRORD TNR GESTS | WITH Te WoRWTY OF NE FOEL | 7260 STATION Fuel Burning Equipment Tocation Fuel Used (naicate % Fluantty Consumed for iq of hours of operations To} mixed composition uarter the quarter (Patton Conver Feary I Tosation [fot hours of operation forthe quarter —] Record Cost of Treatment [ als Month 7 I Month 2 I Month 3 ] Detailed Report of ion Characteristics ee ene NOx [Partcuates | (Nervday) | (mg/Nem) | (rma/Niem) | (mg/cm) 2000-07-01MODULE 6: OTHERS Accidents & Emergency Records 2000-01-01 2000-01-01 Personnel/Staff Training Course/Training Description 40 HRS BASIC TRAINING COURSE FOR, ae POLLUTION CONTROL OFFICER e 2000-01-01Thereby certify that the above information are true and correct. Done this in GUIVAN, EASTERN SAMAR, M. CABILAN JR SUBSCRIBED AND SWORN before me, a Notary Public, this day of JAN 05 2023 jn Tocloban Oty affiants exhibiting to me their Community Tax Receipts Name ID No. Issued at Issued on JERRYSONC — -294-977-266- BORONGAN EASTERN ; __BORONGAN EASTERN DANILO M, Ho4-20- N saab 2b, He ATTY RO es 0K Ne NG) RIE oe ui arTor Wet MEMBE NOLO EA ASAE