Republic of the Philippines

Government of Cebu City

Cebu City Environment and Natural Resources Office
Tel No. 253-6362 / 411-0142
ENVIRONMENTAL SUSTAINABILITY ACTION PLAN
(Year:__________)

SKETCH MAP OF BUSINESS ESTABLISHMENT

RELEASED BY: RELEASE DATE:

SUBSCRIBED AND SWORN to before me, this_________________________,by _____________________who exhibited

to me (his / her) Community Tax Certificate No._______________________issued at ______________________________
Philippines on _______________________________.

Notary Public

Doc. No. __________;

Page No.__________;

Book No.__________;

Series Of__________;
PLEASE CHECK THE TYPE OF APPLICATION
PERMIT NO:
New Renewal
REQUIREMENTS Rebublic of the Philippines OR NO:
CTO Assessment Sheet Government of Cebu City
NORTH SOUTH
Original Receipt Cebu City Environmental and Natural Resources Office
Esap Compliance of Tel. No. 253-6362 / 411-0142
BARANGAY:
Previous Year (If for Renewal) ENVIRONMENTAL SUSTAINABILITY ACTION PLAN
Sketch Map (at the back of the form) (Year:___________) PERMITTEES COPY CCENRO COPY

PLEASE FOLLOW THE INSTRUCTIONS CAREFULLY BEFORE FILLING OUT THIS FORM PRINT ALL INFORMATION IN CAPITAL LETTERS
NAME OF BUSINESS (BUSINESS NAME:) DATE APPLIED:

NAME OF BUSINESS ESTABLISHMENT (TRADE NAME): OPERATING HOURS:

BUSINESS ADDRESS: (RM/FLR/UNIT NO. BLDG. NAME) (LOT & BLK. NO.) (STREET NAME) (BARANGAY) (CITY)

NATURE OF BUSINESS: NO. OF EMPLOYEES: Sole Proprietorship Partnership

Corporation Cooperative
NAME OF OWNER: (FAMILY NAME) (FIRST NAME) (MIDDLE NAME) CONTACT NUMBER:

TO BE FILLED OUT BY CCENRO EMPLOYEES ONLY

RECEIVED BY: DATE RECEIVED:
CHECK APPLICABLE PERIOD OF
STATUS REMARKS
PROGRAMS IMPLEMENTATION
1. LAND
1.1 Tree Planting / Tree growing
1.2 Soil Conservation
1.3 Vegetation Programs
2. AIR
2.1 Implemention of Anti-Smoking Ordinance (C.O 2286, 2241) MANDATORY

2.2 Implementation of Emission Standards for Motor Vehicles;

Permit to Operate - Generator (R.A. 8749)
2.3 Establishment of Bike Racks
3. WATER
3.1 Waste Water Discharges / Treatment (septage Treatment)
MANDATORY
Discharge Permit (R.A. 8749)
3.2 Establishment of Rain Water Catchment / Cistern
3.3 Coastal Clean-up Program
3.4 Adopt-a-River Programs
4. WASTE MANAGEMENT
4.1 Waste Segregation MANDATORY
4.2 Composting
4.3 Recycling
4.4 Plastic Regulation MANDATORY
4.5 Waste Reduction
4.6 Programs on Reuse of Recyclables
4.7 Provision of Waste Receptacle Outside of Establishment
5. ENERGY CONSERVATION PROGRAM
5.1 Use of Light Emitting Diodes/CFL MANDATORY
5.2 Wise Use of Electricity Advocacy
5.3 Use of Renewable Source of Energy
5.4 Eco Friendly Building Design
6. INFORMATION EDUCATION CAMPAIGN
6.1 Awareness Campaign
6.2 IEC Materials
7. OTHERS
7.1 Hazwaste Generator ID (RA 6969)

NAME OF INSPECTOR: DATE OF INSPECTION:

CONFORME:
By signing below, I am agreeing to the Cebu City Government Data Privacy Notice and giving my consent to the collections and
processing of my personal data in accordance thereto.

__________________________________________________ _____________________________
Signature Over Printed Name of Owner / Representative DATE
 Republic of the Philippines
Government of Cebu City
Cebu City Environment and Natural Resources Office
Tel No. 253-6362 / 411-0142
ENVIRONMENTAL SUSTAINABILITY ACTION PLAN
(Year:__________)

SKETCH MAP OF BUSINESS ESTABLISHMENT

RELEASED BY: RELEASE DATE

SUBSCRIBED AND SWORN to before me, this_________________________,by _____________________who exhibited

to me (his / her) Community Tax Certificate No._______________________issued at ______________________________
Philippines on _______________________________.

Notary Public

Doc. No. __________;

Page No.__________;

Book No.__________;

Series Of__________;
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Excel 97-2003