MODULE 1: GENERAL INFORMATION

Reference No. :139631

Year :2022 Quarter: 4

Name of Plant : THE PERMANENTE HEALTH PLAN CORPORATION

Notes :

DENR Permits/Licenses/Clearances

Environmental Laws Permits Date Issued Expiry Date

RA 9275
DP No. 0 N/A 2000-01-01 2000-01-01
PD 1586
ECC/CNC No OL-R03-2022-14-01919 2022-04-05
RA 6969
DENR Registry ID OL-GR-R3-71-032836 2022-06-16 2000-01-01
Transporter Registration N/A 2000-01-01 2000-01-01
TSD Registration N/A 2000-01-01 2000-01-01
CCO Registry N/A 2000-01-01 2000-01-01
Importation Clearance No. N/A 2000-01-01 2000-01-01
Small Quantity Importation N/A 2000-01-01 2000-01-01
Priority Chemical List N/A 2000-01-01 2000-01-01
PMPIN N/A 2000-01-01 2000-01-01
RA 8749
PO No N/A 2000-01-01 2000-01-01

Operation

Operating hours/day Operating days/week # of shift/day

Average 8 5 2
Maximum 12 5 2

Operation/Production/Quality

Average Daily Production Output N/A

Total Water Consumption this Quarter cm3 259
Total Output this Quarter N/A
Total Electric Consumption 6376

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MODULE 2: RA 6969

A. CCO Report

CCO Item No. CCO Substance Common CAS No. Trade Name Intended Use Quantity Issued (in
Name/IUPAC/CAS CCO)
Index Name
No records found

For importers only

CCO Item Importation Quantity Quantity Date of Port of Entry Country of Country of Total Total
No. Clearance Issued (in IC) Imported Arrival Origin Manufacture Quantity Quantity
No. Requested Received
(annual) (annual)
No records
found

For Distributors (importers/non-importers)

CCO Item No. Name of Client License No. Quantity Date of Country of Country of Total Quantity
Distribution Origin Manufacture Distributed
No records
found

For non-importer users

CCO Item No. Name of Distributor Quantity Date of Purchase Total Quantity Purchased
from Distributor
No records found

For Producers

CCO Item No. Average Daily Production Total Output this Quarter Quantity of Stock Quantity of Stock
Output Inventory (Start of Quarter) Inventory (End of Quarter)
No records found

CCO Item No. Name of Buyer Quantity Date of Purchase Total Quantity Sold
No records found

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

CCO Item No. Average Daily Production Total Output this Quarter Average Quantity Used Total Quantity Used this
Output per month Quarter
No records found

Describe any changes in Production/Process/Operations

Stock Inventory/Waste Chemical Generated

 CCO Item No. Average Quantity of Waste Total Quantity of Waste Quantity of Stock Quantity of Stock
Chemical Generated per Chemical Generated this Inventory(Start of quarter) Inventory(End of quarter)
month Quarter
No records found

Other Information

Manner of Handling Hazardous Wastes Changes in Safety Management System Chemical Substitute Plan

B. Hazardous Wastes Generator

HW Generation

HW No. HW Class HW Nature HW Cataloguing Quantity Unit Quantity Unit

M501 Pathological or Solid Toxic (T) 0 0
Infectious Waste

Waste Storage, Treatment and Disposal(please fill-up one table per HW)

HW Details
HW No.: M501 Qty of HW Treated :0.007 Unit :

Storage
Name : SAFEWASTE INCORPORATED, Method :N/A
CAPAS
Transporter
Name . : SAFEWASTE INCORPORATED, Date :November 23, 2022
CAPAS
Treater
Name . : SAFEWASTE INCORPORATED, Method :N/A Date :December 12, 2022
CAPAS
Disposal
ID .: COT-R3-2022-09-168497 Name:SAFEWASTE INCORPORATED, Method:N/A
CAPAS

On-site self Inspection of Storage Area

Date Conducted Premises/Area Inspected Findings and Observations Corrective Action Taken
--

C. Hazardous Wastes Treater/Recycler

HW Stored and/Untreated as of End of Quarter

Type of Waste HW Number Wastes Date of Transport Quantity Type of Storage Time Table for
Generator Transport Permit/Date of Container/# of Treatment
 Issue Containers

HW Treated and/or Recycled as of End of Quarter

Type of Waste HW Number Wastes Date of Transport Quantity Type of Quantity of

Generator Transport Permit/Date of Treatment of Recycled or
Issue Recycling Treated Product
Process

Residual Wastes Generated from the Treatment and/or Recycling Operation

Type of Waste HW Number Process by which Quantity Type of Storage Disposal Option Time Table for
the Waste is Containers/# Disposal
Generated Number of
Containers

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 MODULE 3: RA 9275

Water Pollution Data

Domestic wastewater (cubic N/A | Process wastewater (cubic N/A

meters/day) : meters/day) :

Cooling water (cubic meters/day) N/A | Others :

:

Wash water, equipment (cubic N/A | Wash water, floor (cubic N/A
meters/day) : meters/day) :

Record Cost of Treatment

Month 1 Month 2 Month 3

Person employed, (# of N/A N/A N/A
employess)
Person employed, (cost) N/A N/A N/A
Cost of Chemicals used by WTP N/A N/A N/A
Utility Costs of WTP(electricity & N/A N/A N/A
water)
Administrative and Overhead N/A N/A N/A
Costs
Cost of operating in-house N/A N/A N/A
laboratory
New/Additional investment in N/A N/A N/A
WTP (description)
Costs of New/Add Investments N/A N/A N/A

WTP Discharge Location

Outlet Number Location of the Outlet Name of Receiving water body

1 N/A N/A

Detailed Report of Wastewater Characteristics for Conventional Pollutants

Outlet No. DATE Effluent Flow BOD (mg/L) TSS (mg/L) Color Ph Oil & Grease Temp Rise Unit
Rate (mg/L) (C)
(m3/day)
N/A 2000-01-01 N/A N/A N/A N/A N/A N/A N/A N/A

Detailed Report of Wastewater Characteristics for Other Pollutants

Outlet No. DATE Effluent Flow

Rate
(m3/day)
/ / / / / / /
N/A 2000-01-01 N/A N/A N/A N/A N/A N/A N/A N/A

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 MODULE 4: R.A. 8749 (Air Pollution)

Summary of APSE/APCF

Process Equipment. Location # of hours of operation for the quarter

Fuel Burning Equipment Location Fuel Used (indicate % if Quantity Consumed for the# of hours of operations for
mixed composition) quarter the quarter
N/A N/A N/A N/A N/A

Pollution Control Facility Location # of hours of operation for the quarter

N/A N/A N/A

Record Cost of Treatment

Month 1 Month 2 Month 3

Cost of Person employed, (# of N/A N/A N/A
employess)
Total Consumption of Water N/A N/A N/A
(cubic meters)
Total Cost of Chemicals used N/A N/A N/A
(e.g., activated carbon, KMnO4)
Total Consumption of Electricity N/A N/A N/A
(KwH)
Administrative and Overhead N/A N/A N/A
Costs
Cost of operating in-house N/A N/A N/A
laboratory
Improvement or modification, if N/A N/A N/A
any. (description)
Cost of improvement of N/A N/A N/A
modification

Detailed Report of Air Emission Characteristics

FBE No. DATE Flow Rate CO NOx Particulates

(Ncm/day) (mg/Ncm) (mg/Ncm) (mg/Ncm)
N/A 2000-01-01 N/A N/A N/A N/A N/A N/A N/A

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 MODULE 5: P.D. 1586

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

Station DATE Noise Level CO NOx Particulates N/A(mg/Ncm N/A(mg/Ncm N/A(mg/Ncm N/A(mg/Ncm
Description (dB) (mg/Ncm) (ng/Ncm) (mg/Ncm) ) ) ) )
N/A 2000-01-01 N/A N/A N/A N/A N/A N/A N/A N/A
N/A 2000-01-01 N/A N/A N/A N/A N/A N/A N/A N/A

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

Station DATE N/A/N/A N/A/N/A N/A/N/A N/A/N/A N/A/N/A N/A/N/A N/A/N/A N/A/N/A
Description
N/A 2000-01-01 N/A N/A N/A N/A N/A N/A N/A N/A
N/A 2000-01-01 N/A N/A N/A N/A N/A N/A N/A N/A

Other ECC Conditions

ECC Condition/s Status of Compliance Actions Taken

N/A No N/A

Environmental Management Plan/Program

Enhancement/Mitigation Measures/s Status of Compliance Actions Taken

N/A No N/A

Solid Waste Characterization/Information

Recyclable Biodegradable Residual

Average Quantity Generated .006 .022 .002
(tons/ month)
Total Quantity Generated (tons/ .018 .066 .066
quarter)
Average Quantity Collected (tons/ .006 .022 .002
month)
Total Quantity Collected .018 .066 .066
(tons/quarter)
Entity in charge of collection Olongapo City ESMO Olongapo City ESMO Olongapo City ESMO

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

Each offices/rooms in the company has separate designated trash bins for their waste. Each solid
waste are segregated by its type. Generated solid waste are collected by the City in-charge twice in a
week.

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MODULE 6: OTHERS

Accidents & Emergency Records

Date Area/Location Findings & Observation Actions Taken Remarks

Personnel/Staff Training

Date Conducted Course/Training Description # of Personnel Trained

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

Done this , in OLONGAPO CITY, ZAMBALES.

Mary Michelle Shodja

__________________________________
Name/Signature of Managing Head

SUBSCRIBED AND SWORN before me, a Notary Public, this day of

, affiants exhibiting to me their Community Tax Receipts:

Name ID No. Issued at Issued on