cenro@mandauecity.gov.

ph /
AEC NO. ______
APPLICATION FOR ENVIRONMENTAL CLEARANCE (EC)

1. TYPE OF APPLICATION
RENEWAL
NEW APPLICANT

2. BASIC INFORMATION
BUSINESS / COMPANY NAME : _______________________________________
Business Address : _______________________________________
Business Owner : _______________________________________
Nature / Type of Business : Manufacturing Industry
Commercial
Others, please specify: _____________
Business Engagement : _______________________________________

3. SUBMITTED DOCUMENTS:
Notarized / Verified Application form Others, please specify:
Tax Order Of Payment ___________________ ___________________
OR of payment for EC ___________________ ___________________
4. GENERATES / DISCHARGES / EMISSION OF POLLUTANTS:
4.1. Are you generating commercial / 4.2. Are you using generator set, furnace, boiler,
industrial, institutional wastewater? Yes and other machineries? Yes No
No
5. SOLID WASTE MANAGEMENT:
5.1. Has this firm practice Mandatory 5.3. Has this firm established Materials Recovery Facility
Segregation of Solid Waste as mandated under (MRF) as mandated under par. B., Section 5 of City Ord.
Section 21 of RA 9003? Yes No # 14-2016-1109? Yes No N/ A

5.2. Monthly Estimated Volume of Generated Solid Waste (MEVGSW) may be computed on the basis of the
formula indicated below:

Total number of Personnel X 0.627 kg. / day / person X 30 days = ______________

6. TYPE AND ESTIMATED VOLUME OF 7. STATUS OF GENERATED

GENERATED HAZARDOUS WASTE PER ANNUM. HAZARDOUS WASTE

Type of wastes Annual vol. Disposed to _______________

Busted lamp _______ Stored at ____________
Damaged Batteries _______
Used Oil _______ Other remarks: __________
Note: For other type of hazardous waste, please refer ___________________________
to table 1, IRR of RA 6969 / DAO 29, series of 1992

I hereby certify that the above written data, information and report is true and correct. I further certify that
____________________________________located at ________________________, Mandaue City is compliant with all
environmental standards, rules, regulations and policies. Any false statement / disclosure to this effect, and being non-compliant
with any environmental standard / document / permit conditions shall be considered as a legal ground for the denial / disapproval
of my application and or cancellation of my Environmental Clearance.

(Signature Over Printed Name)

Business Owner / Authorized Representative

SUBSCRIBED AND SWORN TO before me this ___________ day of ____________________, 2021, at

____________________________, with affiants showing to me his Community Tax Certificate and valid I.D with picture and
signature as competent evidence of identity under the 2004 RULES OF NOTARIAL SERVICE.

Doc No.____
Page No.____
Book No.____
Series of 2021
Series of 2020
LGU-MC-ENR-PCM-F2B Rev.017 01/09/2021

Tel Nos. (032) 346-4800 & 253-8415

CSWS Compound, Burgos St., Barangay
Centro, Mandaue City
PHILIPPINES 6014