LAGUNA LAKE DEVELOPMENT AUTHORITY

National Ecology Center, East Avenue

Diliman, Quezon City
Tel. Nos.: 332-2346, 376-4039, 376-4072, 376-4049, 376-4061

APPLICATION FOR DISCHARGE PERMIT

NEW RENEWAL REVALIDATION INDIRECT DISCHARGER

Expiration Date of latest DP: ___July 20, 2023______________

A. APPLICANT INFORMATION
Name of Establishment/Project: __Philippine Normal university_____________________________
Business Activity: _____School/Educational Facilities_______________________________________
Tax Identification Number (TIN): __001-002-946_________ Year Established: ___1901___________
PSIC Code: _________________________________________ Establishment ID: __MNL19481__________
Location of Establishment/Project:
Number and Street: _Ayala Blvd. cor. Taft Ave._________ Barangay: _________659-A____________________
City/Municipality: ___Manila________________________ Province: __________________________________
Tel. # :_53171768 loc 779_Fax #: _____________ GPS Coordinates: (N) ____14O35'11.74"_(E)___120 58'58___

Applicant’s Pollution Control Officer/Contact Person:

Name: ___Rhowel Tibay________________ LLDA Cert. of Accreditation No.:___OBT-2217-91________
Cel. #: _____09296926388________________email add: __________________________________________
B. Employment and Operation Information
Total manpower/occupants: _____________________ No. of Guests/day: ______________________
No. of hours of operation/day: ___10____ No. days of operation/month: __20__ No. of days with discharge/month: ___30____

C. Water Sources, Consumption and Wastewater Generation

Wastewater Discharge (m3/day)
Sources of Water Daily Ave. Daily Ave. Contained in Treated by
Generating Process Lost by Effluent Discharge
Supply Vol. (m3) Vol. (m3) Lagoons, Ponds, Service
Evaporation to the Environment
Septic Tanks Provider
Process Wastewater
MWSI, MWCI 150 150
Washing (cleaning of
Local Water District equipment/kitchen wastes 75
from restaurants)
Deepwell Domestic Wastewater 75
Surface Water (lake, Cooling tower or boiler
river, creek, etc.) blowdown
Others (drinking water,
Others (specify) gardening, product
component, etc.)

Total 150 Total 150

D. Wastewater Information
Location & Name of the Receiving *Estimated BOD Estimated Ave. Rate Mode of Schedule of
Description of the Body of water / conc. (mg/l) of Discharge (m3/day) Discharge Discharge
Outlet Classification (Date and Time)
HRD Compound Estero De Balete 46 50 Direct Discharge 1-30-2024
Main Campus City Drain 46 100 Direct Discharge 1-30-2024

TOTAL 150
*Results of laboratory analysis of actual effluent collected and analyzed by LLDA or from outside/in-house laboratory or projected effluent quality stated in the documents of the
treatment plant of facility

E. Wastewater Treatment System Information

Septic Tank/s ( ) Wastewater Treatment Facility ( ) Sewage Treatment Plant ( ) Others: ____________ None ( )
3
Capacity _150___ (m /day) Total Capital Investment in treatment system: PhP__40,469,494.4____________

F. Flow Meter Information

Is flow meter installed? Yes ( ) No ( ) Type (specify):___Screw Type__________________________
G. Hazardous Waste Management
Method of disposal (specify): _______Other Form__________________________________________________________
DENR ID Number as Hazwaste Generator: __________________________________ Date issued: __________________

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LLDA-CPD-Form 11 Issue Date: August 2022 Issue No. 05

H. Sketch of Sampling Station

I. Vicinity Map

J. Compliance with Previous Discharge Permit Issued

Permit Condition Applicable? Submission Date:

(Y/N)
Self-Monitoring Reports (SMR) Q1 - ___________, Q2 - ____________, Q3 - ___________, Q4 _____________
Certificate of atleast Four (4)
Hours LLDA PCO Training _________________ (Date of training: _______________)
Proof of Transactions with
DENR accredited Hauler/Treater ______________________________________________________________
 Above-mentioned compliance shall be presented/submitted upon filing of this application

We hereby certify that the information above are true, complete and accurate to the best of ourknowledge.

____________Rhowell Tibay____________________________ _______Dr. Bert J. Tuga________________

Name & Signature of the Pollution Control Officer/Representative Name & Signature of the Chief Executive Officer

Date: ________1/24/24_______________________ Date: ___1/24/24________________________

SUBSCRIBED AND SWORN to before me a NOTARY PUBLIC, this ______ day of ________________, affiant exhibiting to
me his/her government issued ID _________________ issued at ________________ on ___________________.

NOTARY PUBLIC
Doc. No. ________
Page No. ________
Book No. ________
Series No. ________

All information contained in this application form will be held strictly confidential.

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LLDA-CPD-Form 11 Issue Date: August 2022 Issue No. 05