Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
Regional Office VIII
Northern Leyte Provincial Office
Mahaplag Fire Station
Independence St. Poblacion Mahaplag, Leyte
Cellphone Number: 09470608806/ 09069281531

FSCCHMCCV NO. RO8-2022 -01- 001 May 17, 2022

DATE

FIRE SAFETY CLEARANCE

CONVEYANCE OF HAZARDOUS MATERIALS AND CHEMICALS IN CARGO VEHICLES

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008 and its
Implementing Rules and Regulations (IRR), this CLEARANCE is hereby issued for the Transportation / Conveyance
of Hazardous Materials and Chemicals in Cargo Vehicles to K.I.S LPG Trading
(Name of Building/Structure/Facility)
located at Brgy. San Isidro, Mahaplag, Leyte and owned by Kurt Ian G. Soriano
(Addtress) (Name of Owner/Representative)

Type of Vehicle Motorcycle With Side Car Plate Number DA21700

Motor Number KYY20E000189 Chassis Number KYY20000182
Name of Driver Abellanosa, Fredo Samberi License Number H02-05-001845
If with trailer, TRAILER NUMBER N/A
Quantity & Description LPG Liquefied Petroleum Gas
Volume Capacity (Kilogram/s) (4 Cylinder) 94 kg

Violation of Fire Code provisions shall cause this Clearance null and void after appropriate proceeding and shall hold
the contractor liable to the penalties provided for by the said Fire Code.

This certificate is valid until 15 /May/ 2024.

Date Month Year

Fire Code Fees: RECOMMEND APPROVAL:

Amount Paid: 1,049.00
O.R. Number: 6932764
Date: May 17, 2023 FO3 Maila T Lleve
CHIEF, FSES

APPROVED:

SFO3 Glenn Antonio M Solis

MUNICIPAL FIRE MARSHAL

NOTE: “This Clearance is accompanied with AFTER INSPECTION REPORT CHECKLIST and does not take the place of any license required by
law and is not transferable.”

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN”

DISTRIBUTION:
Original (Applicant/Owner’s Copy)
Duplicate (BFP Copy)

BFP-QSF-FSED-038 REV.01 (07.05.19)