Republic of the Philippines

Province of Bulacan
Municipality of Pandi
Office of the Barangay Chairman
BARANGAY MAPULANG LUPA, PANDI, BULACAN

JUNKSHOP NAME: ____________________________________________

LOCATION / ADDRESS: ________________________________________

QUANTITY / WEIGHT:

1. PAPEL/KARTON: _____________
2. BOTE: _____________
3. BAKAL: _____________
4. PLASTIC: _____________
5. OTHERS: _____________

REMARKS:

________________________________________________________________
__________________________________________________________.

Prepared by:

_______________________________
Junkshop Owner

Checked by:
Kenji E. Mendoza
Barangay Secretary

Noted by:
Hon.Victor Alegria
Kagawad/Committee on Envireonment