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Notarized Application Form DP 2024

Application form sample
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0% found this document useful (0 votes)
81 views3 pages

Notarized Application Form DP 2024

Application form sample
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Page 1 of 3 aa Republic of the Philippines ° Ss & Dopartment of Environmental and Natural Resources ‘Aop No sa Environmental Management Bureau 148377 = Region it APPLICATION FOR DISCHARGE PERMIT BOX A: General Information Type: Now Name of Owner: Acciona Daelim Joint Venture ‘Barangay Malpitik, City Of San Femando, Pampanga, Malpitic, City Of San Femando Office Address: 3 Name of Permittee: Acciona Daelim Joint Venture yin: _502-294-316-00000 PSIC Code: 38210 Year Est. 2020 Barangay Malpiik, City OF San Plant Address No & Street Name: Barangay: Malpitic CITY OF SAN FERNANDO City or Municipality: _ Capital Region Region tt Type of industry ‘Treatment and disposal of non-hazardous waste Name of PCO: Eric DelRosario Accreditation Date: Oot 11, 2021 Tel. No. &Gel.No: 09177050881 Fax No: Legal Classification | Private Corp Ownership forms Private None % Foreign 100.0 % Government None % BOX B: Empioyment and Operation Information Total employment (number of workers) in the factory: | Production: 300 Non Production: 100 Production Time: No of hours/day: 24 No of days/mo: 24 ‘No of month/year: 12 No of days with discharge/mo: 30 BOX C: Sources of Water Supply and Wasterwater Generation Monthly | Daily Estimated Sources of Water Supply ave vol. | ave vol. | Generating Process Flow (may | (may (ma/day) MWS (please attach water bills) 00 [00 _ | Process Wastewater 0.0 Local Water District (please attach water Washing/Cieaning of Process a0 [oo 00 bils) Eqpt. Deep Well 00 [00 | Cooling 00 ‘Surface water (lake, river, ereek, ete.) 00 [00 | Domestic 40 Others 00 | 00 | Recycled/Reuse 00 Others (drinking water, gardening, evaporation, leaks, product 00 components, ete.) vol Total Water Consumption 40 Joo | Total Volume of Pischarge | 4 Wastewater BOX D: Dwelling Units Information (hotels, condominium, restaurants, malls, etc.) Page 2 of 3 Total Floor Area (m2): None No of Bedrooms: None No of Guests/year:None = | Total Area for Dining Units: None [ No of Restaurants/Dining Unis: None | BOX E: Product Information ‘Annual Annual | _| Capacity previous year _| Sox a Outlet | Location and Description aus Fas ofthe Receiving] Ave. BOD, Orcherge of Ave. BOD | umber Outlet Body of Water mg/L milday | Load, kg/day| 1 | ampere rari feo fs0 Total 10 40 [10 Wastewater treatment system existing?: v Yes No I If YES, what is the capacity: 7.2m3/day Is there a primary treatment system?: Yes ¥ No Date primary system installed: Is there a chemical treatment?: Yes v¥No Date primary system installed: Activated Sludge Single Batch Reaction Anaerobic Digestion Oxidation/Stabilization (Pond) Tricking Filtration Rotating Biological Contract Ifothers, specify: N/A [ Noto: -Piease use generic name Nol brand names, In men tons of products excep for the folowing subsaclos Page 3 of 3 NOTARIZED CERTIFICATION We hereby cetity hat he above nirmaton and gee documents ae tue and correct to the best of my knowledge. Done this W 03 W2bsay of 5 ic BA Goxaad Oulalnlluw) ‘Name and Signature of the Pollution Control Chief Exqeutive Officer Officer (Name, Signature and Position) dayot NOV 03 2021, SUBSCRIBED AND SWORN to before me a Notary Public. This afiant exiting to me histher isgued at on = r ea you 6 sear Ro vianisscosens PAGE NO. - ACELES CTY re

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