Department of Environment and Natural Resources

Environmental Management Bureau

Reference No:

(to be filled up by DENR only)

GENERAL INFORMATION SHEET

Name of the
Establishment/Facility
MC & JOLLI FOODS

Establishment/Facility Street # & Street Name: 123 Maria Makiling St.

Address Barangay: Silangan City/Municipality: Rosario ___
(NOT the company of head
office) Province: Cavite
Name of
Owner/Company
UNITED FOODS, IN

Street # & Street Name: 123 Maria Makiling St. ________

Address
(if address is not the same as Barangay: Silangan City/Municipality: Rosario ___
previous address)
Province: Cavite

Phone Number 046-1234567 Fax Number N/A

e-mail address operations@unitedfoods.com

Philippine Standard Industry Classification Code No. 107 ___

Type of Business/
Philippine Standard Industry Descriptor: Food Manufacturing
Industry Classification
___

CEO/President. Analea de Guzman

Tel #: 046-1234567 Fax #: N/A ___
e-mail address: analea.deguzman@unitedfoods.com
Responsible Officer/s:
Plant Manager: N/A ___
Tel #: N/A Fax #: N/A ___
e-mail address: N/A ___

Name. Ryan Reyes ___

Pollution Control
Tel #: 046-7654321 Fax #: N/A
Officer
e-mail address: ryan.reyes@unitedfoods.com

 single proprietorship  partnership

Legal Classification ̷ private domestic corporation  government corporation
 Multi-national  ___

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

Analea de Guzman ______ Juvilino Alamis Jr

Name/Signature of CEO/President Name/Signature of PCO
Name of Plant:
Reference No:

Department of Environment and Natural Resources

Environmental Management Bureau

QUARTERLY SELF-MONITORING REPORT

MODULE 1: GENERAL INFORMATION

Name of the Plant MC & JOLLI FOODS CORPORATION
Please provide the necessary revised, corrected or updated information not contained in your General
Information Sheet

(use additional sheet/s if necessary)

DENR Permits/Licenses/Clearances
Environmental
Permits Date of Issue Expiry Date
Laws
A/C No.
P.D. 984
PO No. DP-2201-0987 10/10/2021 9/30/2026
ECC 4A-2016-1234-
ECC 1 04/22/2020
0987
PD 1586 ECC 2

ECC 3
DENR
Registry ID OL-GR-4A-12-45678 05/25/2021
CCO Registry
RA 6969 Importer
Clearance No
Permit to
Transport 2021-POA-0123-999 06/14/2021 06/13/2026
A/C No.
RA 8749
PO No.

Module 1: General Information page ____ of ____

Name of Plant:
Reference No:

Operation
Operating hours/day Operating days/week # of shift/day
Average 16 6 3
Maximum 20 6 3

Operation/Production/Capacity:
Average Daily
Production Output
18.5 MT Total Output this Quarter 74 MT
Total Water Consumption Total Electric
this Quarter (cubic 1987 cu.m. Consumption this Quarter 29,520 kwH
meters) (KwH)
Please use additional sheet/s if necessary

Module 1: General Information page ____ of ____

Name of Plant:
Reference No:

MODULE 2: RA 6969

A. CCO Report (please accomplish this section for each chemical/substance)

Common Name/IUPAC/CAS Index Name. ___

CAS No.: ___
Trade Name: ___

For importers only:

Import
Quantity Date of Quantity Country of Country of
Clearance Port of Entry
Requested Arrival Received* Origin Manufacture
No.

Total Quantity Requested Total Quantity Received

(annual) (annual)
* attach copy/s of Bill of Lading

For distributors (importers/non-importers)

Name of Client License No. Quantity Date of Distribution

Total Quantity Distributed

For non-importer users:

Name of Distributor Quantity Date of Purchase

Total Quantity Purchased from Distributor

Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:
Reference No:

For producers
Average Daily
Total Output this Quarter
Production Output
Quantity of Stock Quantity of Stock
Inventory (Start of Inventory (End of
Quarter) Quarter)
Name of Buyer Quantity Date of Purchase

Total Quantity Sold

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

Average Daily
Total Output this Quarter
Production Output
Average Quantity Used Total Quantity Used this
per month Quarter
Describe any changes in Production/Process/Operations:

Stock Inventory/Waste Chemical Generated:

Average Quantity of Total Quantity of Waste
Waste Chemical Chemical Generated this
Generated per month Quarter
Quantity of Stock Quantity of Stock
Inventory (Start of Inventory (End of
Quarter) Quarter)

Other Information:
Manner of handling  storage on-site  Treatment on-site
hazardous wastes  storage off-site  Treatment off-site

Changes in Safety  Yes (please attach copy of revised plan)

Management System  No

Chemical Substitute  Yes (please attach copy if not submitted/included in previous report/s or had been revised)
Plan  No

Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:
Reference No:

B. Hazardous Wastes Generator

HW Generation:
Remaining HW from
HW HW Generated
HW No. HW Class HW Nature Previous Report
Cataloguing
Quantity Unit Quantity Unit
I101 Used Oil Steel LIQUID 160 kg 560 kg
drums
H802 Grease Plastic SOLID 100 kg 200 kg
wastes drums
D407 Busted Plastic SOLID 9.20 kg 9.20 kg
fluorescent drums
bulbs
J201 Waste and Wooden SOLID 20.85 kg 20.85 kg
contaminated Crate
containers and
pallet
M506 WEEE Wooden SOLID 1.00 kg 1.00 kg
crate

Waste Storage, Treatment and Disposal:(Please fill-up one table per HW)
HW No,: I101 ___
HW Details Qty of HW Treated: 560 Unit: kg ___
TSD Location:

Name: HW Storage Area

Storage Method: securely stored and labelled
___

ID: 2021-0943 Name: XYZ Corp

Transporter
Date: 04/06/2022

ID: 2021-1234 Name: ABC Corp

Treater
Method: Chemical Treatment Date: 04/07/2022

ID: 2021-1234 Name: ABC Corp

Disposal
Date: 04/07/2022

HW No,: H802 ___

HW Details Qty of HW Treated: 200 Unit: kg_
TSD Location: ___

Name: HW Storage Area

Storage
Method: securely stored and labelled

Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:
Reference No:

ID: TRC# 2021-0943 Name: XYZ Corp

Transporter
Date: 04/06/2022

ID: 2021-1234 Name: ABC Corp.

Treater
Method: Chemical Treatment Date: 04/07/2022

ID: 2021-1234 Name: ABC Corp

Disposal Date: 04/07/2022 Date: 04/07/2022

On-Site Self Inspection of Storage Area:

Corrective Action Taken
Date Conducted Premises/Area Inspected Findings & Observations
(if any)
Leaking Containers, Schedule for disposal
15th day of each month Storage Area
Worn out labels and replace labels

Module 2B: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:
Reference No:

C. Hazardous Wastes Treater/Recycler

HW Stored and/or Untreated as of End of Quarter:

Type of
Transport Storage Time Table
Wastes Date of
HW Number Permit/Date Valid until Quantity Container/ for
Generator Transport
of Issue # of Treatment
containers

HW Treated and/or Recycled as of End of Quarter:

Type &
Type of
Transport Quantity of
Type of Wastes Date of Treatment or
HW Number Permit/Date Quantity Recycled or
Wastes Generator Transport Recycling
of Issue Treated
Process
Product

Residual Wastes Generated from the Treatment and/or Recycling Operation:

Process by Type of
Type of which the Storage Disposal Time Table for
HW Number Quantity
Wastes Wastes is Container/ Option Disposal
Generated # of containers

Module 2C: RA 6969 (Hazardous Wastes Treater/Recycler) page ____ of ____

Name of Plant:
Reference No:

MODULE 3: P.D. 984 (Water Pollution)

Water Pollution Data

Domestic wastewater Process wastewater
(cubic meters/day)
7 cu.m/day (cubic meters/day)
2 cu.m per day
Cooling water Others: ___________
(cubic meters/day) (cubic meters/day)
Drinking 3 cu.m day
Wash water, equipment Wash water, floor
(m3/day) (cubic meters/day)
10 cu.m day

Record of Cost of Treatment (Separate entries for separate facilities)

Month 1 Month 2 Month 3
Person employed, (# of
employees)
Person employed, (cost) 60,000 60,000 60,000
Cost of Chemicals used
5,000 5,000 5,000
by WTP
Utility Costs of WTP
800 800 800
(electricity & water)
Administrative and
2,400 2,400 2,400
Overhead Costs
Cost of operating in-
house laboratory

New/Additional
Investments in WTP
(Description)

Cost of New/Add
Investments

WTP Discharge Location

Outlet
Location of the Outlet Name of Receiving Water Body
Number
Left Side of Property, Along of JP Rizal
Temp-2 0 , BOD -48,TSS-50 Oil and
1 Street discharging via Timugan Creek
Grease 2.5
draining to manila bay.
2
3
4
5

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:
Reference No:

Detailed Report of Wastewater Characteristics for Conventional Pollutants

Outlet No.

Effluent Oil & ________

BOD TSS Temp rise (name)
DATE Flow Rate Color pH Grease
(mg/L) (mg/L) (ºC)
(m3/day) (mg/L)
(unit)
April to
June 48 50 2.5 2º
2022

Please fill-up/accomplish separate form/s for other outlet/s.

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:
Reference No:

Detailed Report of Wastewater Characteristics for Other Pollutants

Outlet No.

Effluent ________ ________ ________ ________ ________ ________ ________

(name) (name) (name) (name) (name) (name) (name)
DATE Flow Rate
(m3/day)
(unit) (unit) (unit) (unit) (unit) (unit) (unit)

Please fill-up/accomplish separate form/s for other outlet/s.

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:
Reference No:

Please use additional sheet/s if necessary.

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:
Reference No:

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

Summary of APSE/APCF
Process Equipment Location # of hrs of operations
1. Fuel Tank Back of genset room 1,800
2. 120 KVA Genset Genset room 990
3.
4.
Fuel Burning Quantity # of hrs of
Location Fuel Used
Equipment Consumed operations
Fuel at the back of Diesel
1. Standby Genset Genset room with 120 liters 11 hours
continuous operation
2. 120 KVA Genset Genset room Diesel 10,800 990
3.
4.
5.
6.
Pollution Control Facility Location # of hrs of operations
1.
2.
3.
4.

Cost of Treatment
Month 1 Month 2 Month 3
Cost of Person employed,
(salary)
Total Consumption of
Water (cubic meters)
Total Cost of chemicals
used (e.g., activated
carbon, KMnO4)
Total Consumption of
Electricity (KwH)
Administrative and
Overhead Costs
Cost of operating in-
house laboratory, if any

Improvement or
modification, if any.
(Description)

Cost of improvement of

Module 4: RA 8749 (Air Pollution) page ____ of ____

Name of Plant:
Reference No:

modification

Module 4: RA 8749 (Air Pollution) page ____ of ____

Name of Plant:
Reference No:

Detailed Report of Air Emission Characteristics

Description/Location
of PCF
________ ________ ________ ________
Flow Rate CO NOx Particulates (name) (name) (name) (name)
DATE
(Ncm/day) (mg/Ncm) (mg/Ncm) (mg/Ncm)
(mg/Ncm) (mg/Ncm) (mg/Ncm) (mg/Ncm)

Please fill-up/accomplish separate form/s for other PCF/s.

Please use additional sheet/s if necessary.

Module 4: RA 8749 (Air Pollution) page ____ of ____

Name of Plant:
Reference No:

MODULE 5: P.D. 1586

Ambient Air Quality Monitoring (if required as part of ECC conditions)
Description/Location
of Monitoring
Station
Noise ________ ________ ________ ________
CO NOx Particulates (name) (name) (name) (name)
DATE Level
(mg/Ncm) (mg/Ncm) (mg/Ncm)
(dB) (mg/Ncm) (mg/Ncm) (mg/Ncm) (mg/Ncm)

(Please accomplish one table per monitoring station.)

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

Description/Location
of Sampling Station
________ ________ ________ ________ ________ ________ ________ ________
(name) (name) (name) (name) (name) (name) (name) (name)
DATE
(unit) (unit) (unit) (unit) (unit) (unit) (unit) (unit)

(Please accomplish one table per sampling station.)

Module 5: P.D. 1586 (EIS System) page ____ of ____

Name of Plant:
Reference No:

Other ECC Conditions

Status of Compliance
ECC Condition/s Actions Taken
Yes No

1.
2.
3.
4.
5.
6.
Please use additional sheet/s if necessary.

Environmental Management Plan/Program

Status of
Enhancement/Mitigation Measures Implementation Actions Taken
Yes No

1.
2.
3.
4.
5.
6.
Please use additional sheet/s if necessary.

Solid Waste Characterization/Information:

Average Quantity of 400 kg Total Quantity of Solid 1,200 kg
Solid Wastes Generated Wastes Generated this
per month Quarter
Average Quantity of 200 kg Total Quantity of Solid 600 kg
Solid Wastes Collected Wastes Collected this
per month Quarter
Entity in charge of
Disposal Facility/SLF
collecting solid wastes

Brief Description of Composting, segregation and collection and waste recycling

Solid Waste and recovery
Management Plan (e.g.,
waste reduction,
segregation, recycling)

Module 5: P.D. 1586 (EIS System) page ____ of ____

Name of Plant:
Reference No:

MODULE 6: OTHERS

Accidents & Emergency Records

Findings and
Date Area/Location Actions Taken Remarks
Observation

Personnel/Staff Training
# of Personnel
Date Conducted Course/Training Description
Trained

June 15, 2022 Solid Waste Mgt training 10

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

Done this _________________________, in ________________________.

Ryan Reyes
Name/Signature of PCO
Analea de Guzman
Name/Signature of CEO

SUBSCRIBED AND SWORN before me, a Notary Public, this ________ day of
______________________, affiants exhibiting to me their Community Tax Receipts:

Name CTR No. Issued at Issued on

_____________________ _____________ _______________ ______________
_____________________ _____________ _______________ ______________

Module 5: P.D. 1586 (EIS System) page ____ of ____