DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES

ENVIRONMENTAL MANAGEMENT BUREAU REGION 8

DENR Compound, Brgy. 2, Tacloban City

PCO ACCREDITATION FORM (RENEWAL)

Please attach
Pollution Control Officer (PCO) Accreditation
your 1” x 1”
Application Form (Renewal) picture here

Instructions:
Fill in all the data needed. If the blanks are not applicable, write N.A.
PROFILE
Last Name First Name Middle Name Sex: Citizenship:
Casino Megino / Male Filipino
Jerome Carlo
Female
Home Address (Number & Street, Town/City, Employment Current Position:
Province, Zip Code) Status: PPO Staff
/ Full-time No. of Years in
902 Platinum 2000, #7 Annapolis St., Greenhills,
San Juan, Metro Manila Part-time Current Position:

Others <1 Year

Telephone No.: Cellular Phone No.: E-mail Address:

N.A. 09688810390 jeromemcasino@xs.edu.ph
Name of Establishment: Name of Managing Head:
Xavier School, Inc. Ronald Demegillo
Greenhills San Juan

Employment Address (Number & Street, Nature of Establishment

Town/City, Province, Zip Code) Business of the Category based
Establishment: on DAO 20AA-
64 Xavier St., Greenhills, San Juan, BB:
Metro Manila 1500 School
Category A
Telephone No.: Fax No.: Website:
N.A. www.xs.edu.ph
Type of Professional License received (if any):
N.A.
PRC License No.: N.A. Date Issued: Validity:
N.A. N.A.
TRAININGS/SEMINARS ATTENDED (AS PARTICIPANT) (Use additional sheet if
necessary. Please attach photocopy of certificate.)
Title of Training/ Venue Conducted by Date/s No. of Certificate No.
Seminar Hours
Appreciation Course Synergized
Maynilad Water Mar 2011 Cert. No. 005146
on IMS Standards. Macro Solutions
Continuing Environmental
Education Program for PCOs
Maynilad Water Mar 2011 40

Orientation on ESH-Related Synergized Macro

Laws and Regulations. Maynilad Water Apr 2011 Cert. No. 005137
Solutions, Inc.
Pollution Control Officer Manilad Water COA No.
(Water Network Office) 2012-NCR-231

FM-CPD-10 00 10-01-17
 Pollution Control Officer (PCO) Accreditation Application Form
(Renewal)
TRAININGS/SEMINARS CONDUCTED (AS TRAINOR/SUBJECT MATTER EXPERT)
(Use additional sheet if necessary. Please attach photocopy of certificate.)
Title of Training/ Venue Conducted by Date/s No. of Certificate No.
Seminar Hours
2012 Pollution Control May 2012
Officers - Continuing Education

Course on Effective Synergized Macro

Internal IMS Auditing Maynilad Water Solutions, Inc. Oct 2011 Cert. No. 006695
Occupational Camelot Hotel, Safety House
Safety and Health Quezon City INC. Dec 2011 SN-2011120694

OTHER REQUIREMENTS (Please attach the following requirements)

Letter of appointment/designation as PCO of the establishment

Curriculum vitae with ID Picture of the appointed/designated PCO

Notarized Affidavit of Joint Undertaking of the PCO and the Managing Head

For the Managing Head, Certificate of Training for eight (8) hours on
environmental management

Do you have any pending

a) Administrative case Yes No b) Criminal case Yes No

If you have any, give details of the case _________________________________________

I certify that all the information stated above are true and correct.

_________________________________________
Name and Signature of Applicant / Date

Verified by:

_____________________________________________
Name and Signature of EMB Personnel / Date

FM-CPD-10 00 10-01-17