GENERIC IEE Checklist Form

GENERIC INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT for

Project name or Title

This Generic IEE Checklist Report shall be used as the interim pro-forma interim pro-forma EIA Report requirement for projects types here a customi!ed IEE Checklist Report "orm has not yet been de#eloped but are required IEE Checklist Report "orm or IEE Report per the Re#ised Procedural $anual for %A& '(()-)(

For ECC applications t!is IEE C!"c#list R"port s!all $" s%$&itt"' it! Proof of Compatibility ith the e*istin+ ,and se Plan Proof of Authority o#er the Project .ite Accountability Accountability .tatements .tatements of Proponent Proponent /see attached attached form0 form0 and the the Preparer Preparer /if any1 folloin+ Anne*es '-'' of Re#ised Procedural $anual for %A& '(()-)(0 Photo+raphs or plates2#icinity map of the project site shoin+ impact areas and affected areas and communities %uly Accomplished Project En#ironmental $onitorin+ 3 Audit Prioriti!ation .cheme /PE$AP.0 4uestionnaire /see Anne* '-5d of Re#ised Procedural $anual for %A& • • •

•

•

'(()-)(0 (No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14)

Read the questions carefully and rite the required information on the blank spaces pro#ided or otherise check / 0 the appropriate bo*es 6 or parenthesis / 07 8o*es ith check marks / 0 are automatically required7 se additional sheets if necessary and indicate this in the appropriate space7

Project proponents are stron+ly 'isco%ra*"' to en+a+e the ser#ices of consultants2facilitators2preparers to accomplish2fill-up the IEE Checklist Checklist Report "orm7 The Report "orms ha#e been desi+ned to be user-friendly7 "urthermore1 E$8 Re+ional &ffice is required to complete the processin+ of an ECC application usin+ the IEE Checklist Report ithin tenty /'(0 orkin+ days upon receipt for completed2dulyaccomplished form7 Misleadin Misleading g or erroneous erroneous answers answers are basis basis for legal actions actions and/or denial of ECC issuance.

PRO+ECT FACT SHEET

Pro,"ct Na&" Pro,"ct Location

9999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999

Total Pro,"ct Lan' Ar"a

9999999999999999999999999999999999999999999999999999999

Total Pro,"ct-.%il'in* Footprint Ar"a /Area actually utili!ed0 Pro,"ct Propon"nt O//ic" A''r"ss Contact P"rson 0"si*nation

9999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999

IEE Checklist Report for Commercial, Institutional, Land Transport Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities Facilities

Contact N%&$"r-s

I3

Lan'lin"

9999999999999999999999999999999999999999999999999999999

Fa1 N%&$"r

9999999999999999999999999999999999999999999999999999999

Mo$il"

9999999999999999999999999999999999999999999999999999999

E2&ail A''r"ss

9999999999999999999999999999999999999999999999999999999

PRO+ECT 0ESCRIPTION

434 PRO+ECT LOCATION AN0 AREA .treet :ame1 8aran+ay1 and $unicipality2City1 Pro#ince

9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999 .ee attached #icinity map2s and photo+raphs of the project site and site de#elopment2layout plan7 Geo+raphic coordinates of the project area /Preferably use ;G. <= datum1 otherise specify datum used07 P"ri&"t"r-.o%n'ar5 points Lon*it%'" Latit%'" ($as"' on OCT-TCT-"tc)

436 PRO+ECT COMPONENTS Faciliti"s

No3 o/ 7nits

Ar"a (s83 &3) Capacit5

Sp"ci/ication0"scription - R"&ar#s

.upport "acilities /e7+7 emer+ency +enerators1 boilers1 etc70 Admin support /e7+71 canteen1 office1 clinic1 quarters1 etc70 ;ater source 2 supply ;aste ater mana+ement "acility .olid aste mana+ement facility %raina+e system (lease list !acilities b" module#$roupin$% &se additional sheets i! needed)

439 7TILITIES-RE:7IREMENTS /&peration Phase0 7tiliti"s Poer2Electricity

So%rc"

Esti&at"' 0"&an'-Cons%&ption >;h

IEE Checklist Report for Commercial, Institutional, Land Transport Terminal, Motels, Hotels, Condominiums/Apartelles, and Storage Facilities

(Total) Poer2Electricity (Fro& R"n"a$l" En"r*5 So%rc"s) ;ater (Total) /"ill-up table belo if ater is not obtained from the local ater utility0 ;ater (Rainat"r Coll"ction S5st"&)

>;h

Cubic meters2day

Cubic meters2day

;ater .ource ? @ +round ater ? @ .urface ater

? @ ell

? @ sprin+

? @ ri#er

? @ lake

? @ others 9999999999999999999999999999 ? @ others 9999999999999999999999999999

,ocation of ater source 99999999999999999999999999999999999999999999999999999999999999999999999999 ('itio#one *aran$a" Municipalit"#Cit" ro+ince Re$ion)

En"r*5-;at"r E//ici"nc5 7tiliti"s

Esti&at"' Sa
Poer2Electricity

Propos"' E//ici"nc5-Cons"r
>;h

;ater

Cubic meters2day

43= MANPO;ER a3 Constr%ction P!as" Manpo"r R"8%ir"&"nt

E1p"rtis"-S#ills

Total

$3 Op"ration P!as" Manpo"r R"8%ir"&"nt

E1p"rtis"-S#ills

Total

43> IN0ICATIVE PRO+ECT COST Project Cost /PhP0 999999999999



II3

ENVIRONMENTAL IMPACTS AN0 MANAGEMENT PLAN

Possi$l" En
.as"lin" En
Pr"<"nti<"- Miti*atin* M"as%r"s

Monitorin* Para&"t"rsI&pl"&"ntation

Cost o/ Miti*ation- Monitorin*

,A:%



Consistency ith land use

Current land use 2in Bkm radius /as per !onin+ ordinance0



Residential



Commercial2 Institutional



Industrial

  



.ee attached proof of compatibility ith land use

A+ricultural2 Recreational Protected Areas &thers1 specify 9999999999999999999

Actual land uses 2in Bkm radius



Residential



Commercial2 Institutional



Industrial

   

%isturbance to ildlife due to #e+etation clearin+

A+ricultural2 Recreational Protected Areas &thers1 specify 9999999999999999999

E*istin+ #e+etation in the area



"orestland



$arshland



Compliance ith conditions of %E:R2,G



.,P1 Tree Cuttin+ Permit1 R&;1 PCA Permit



Annual inspection of area



replanted2 re#e+etated

Cost inte+rated in the construction 2operation cost

,imit land clearin+ as much as possible


Possi$l" En
.as"lin" En


Grassland



$an+ro#e



;etland






Chan+e in surface landform2 topo+raphy2 terrain2slope



.oil Erosion



flat /(-)D0



+ently slopin+ to rollin+ /)-B


steep /B

Pro#ide temporary fencin+ for #e+etation that ill be retained



Promote restoration of dama+ed or destroyed #e+etation here possible /e7+71 tree plantin+0



&thers1 specify 99999999999999999999 .lope




Pro#ide erosion control and slope



protection measures

  

Re+ular inspection of slope protection measures in erosion-prone areas

%esi+nate a .poils .tora+e Area1 ith topsoil set aside for later use and allo ma*imum re-use of spoils



Construction durin+ dry season



Re+ular inspection for ne



.lope2 Erosion Control Cost 99999999999

 &thers1 specify 999999999999

eroded areas near the site &thers1 specify 99999999999

.tabili!ation of embankment ith +rasses or other soil co#er

 Is the project site located in an area identified by $G82PAGA.A2PFI&,C. as ha!ard proneH

 .oil2,and contamination due to improper solid aste disposal



es



:o

E*istin+ soil type in the area



sandy



clay



sandy-loam



&thers1 specify 999999999999



&thers1 specify 999999999999 Compliance ith the %E:R Administrati#e &rder :o3 '(()-)( and %E:R Administrati#e &rder :o7 '(((-'<1 Implementin+ Guidelines on En+ineerin+ Geolo+ical and Geo-Fa!ard Assessment /EGGA07



Implementation of the Ecolo+ical .olid



;aste $ana+ement Plan /E.;$P0



.et-up temporary fence around the construction area



%aily inspection of aste2recyclin+ bins for se+re+ation



Implement re-use and recyclin+ of aste materials




%aily inspection for presence of mi*ed +arba+e in the facility


Possi$l" En
.as"lin" En



Implement proper se+re+ation1 collection and disposal of domestic astes in desi+nated areas



Pro#ide receptacles 2 bins for solid astes



Coordinate ith the municipal 2 city aste collectors






;eekly inspection of aste accumulated





Possi$l" En


Chan+e in surface landform2 topo+raphy2 terrain2slope



.oil Erosion

.as"lin" En


Grassland



$an+ro#e



;etland



&thers1 specify

99999999999999999999 .lope



flat /(-)D0



+ently slopin+ to rollin+ /)-B


steep /B

 



Pro#ide temporary fencin+ for #e+etation that ill be retained Promote restoration of dama+ed or destroyed #e+etation here possible /e7+71 tree plantin+0



Pro#ide erosion control and slope



protection measures

  

Re+ular inspection of slope protection measures in erosion-prone areas

%esi+nate a .poils .tora+e Area1 ith topsoil set aside for later use and allo ma*imum re-use of spoils



Construction durin+ dry season



Re+ular inspection for ne



.lope2 Erosion Control Cost 99999999999

 &thers1 specify 999999999999

eroded areas near the site &thers1 specify 99999999999

.tabili!ation of embankment ith +rasses or other soil co#er

 Is the project site located in an area identified by $G82PAGA.A2PFI&,C. as ha!ard proneH

 .oil2,and contamination due to improper solid aste disposal



es



:o

E*istin+ soil type in the area



sandy



clay



sandy-loam






&thers1 specify 999999999999 Compliance ith the %E:R Administrati#e &rder :o3 '(()-)( and %E:R Administrati#e &rder :o7 '(((-'<1 Implementin+ Guidelines on En+ineerin+ Geolo+ical and Geo-Fa!ard Assessment /EGGA07



Implementation of the Ecolo+ical .olid



;aste $ana+ement Plan /E.;$P0



.et-up temporary fence around the construction area



%aily inspection of



aste2recyclin+ bins for se+re+ation



Implement re-use and recyclin+ of aste materials


%aily inspection for presence of mi*ed +arba+e in the facility


Possi$l" En
.as"lin" En









Coordinate ith the municipal 2 city aste





;eekly inspection of aste accumulated




collectors



En+a+e third party company for aste collection



Impairment of #isual aesthetics



Presence of #isually si+nificant landforms2landscape2structuresH

%e#aluation of land #alues



es



:o



&thers1 specify 9999999999999999



Implement landscapin+ and other



beautification measures



Pro#ide adequate buffer



Compensate adjacent property oners



&thers1 specify 9999999999999999

Re+ular inspection of



landscapin+ and other beautification acti#ities



Cost inte+rated in the construction2 operation cost

Re+ular monitorin+ of buffer !ones



Re+ularly monitor presence2absence of complaints from adjacent property oners

;ATER



Increased siltation due to project acti#ities



;ater quality de+radation



&thers1 specify 9999999999999999999

.pecify nearest2recei#in+ ater body 9999999999999999999999999999 %istance to nearest2recei#in+ ater body



( to less than (7J km



(7J to B km



$ore than B km

 

.et-up proper and adequate sanitary

Re+ular /ocular0 inspection of

facilities



%raina+e 2 canal systems

.trictly require the contractor and its



;ater treatment facility /i7e71

orkers to obser#e proper aste disposal and proper sanitation



.trictly obser#e proper aste handlin+ and disposal



Pro#ision of asteater treatment facility /e7+7 septic tank1 oil and ater separator1 etc70




+rease trap1 septic tank1 etc70 4uarterly monitorin+ of the folloin+



pF



T.. concentration


Possi$l" En
.as"lin" En


AA



A



8



C


 

.et up silt trap2stillin+ ponds to minimi!e



8&%

donstream siltation



Total Coliform



Color



&il and Grease

Pro#ision of three-chambered septic tank for domestic sea+e



Pro#ide rin+ canals around fuellin+ tanks2 motorpool2 maintenance areas





Possi$l" En
.as"lin" En









Coordinate ith the municipal 2 city aste


 


;eekly inspection of aste accumulated &thers1 specify 9999999999999

collectors





Impairment of #isual aesthetics



Presence of #isually si+nificant landforms2landscape2structuresH

%e#aluation of land #alues



es



:o

En+a+e third party company for aste collection



&thers1 specify 9999999999999999



Implement landscapin+ and other



beautification measures



Pro#ide adequate buffer



Compensate adjacent property oners



&thers1 specify 9999999999999999

Re+ular inspection of



landscapin+ and other beautification acti#ities







Re+ularly monitor presence2absence of complaints from adjacent property oners

;ATER



Increased siltation due to project acti#ities



;ater quality de+radation



&thers1 specify 9999999999999999999

.pecify nearest2recei#in+ ater body 9999999999999999999999999999 %istance to nearest2recei#in+ ater body






(7J to B km



$ore than B km

 

.et-up proper and adequate sanitary


facilities



%raina+e 2 canal systems

.trictly require the contractor and its



;ater treatment facility /i7e71

orkers to obser#e proper aste disposal and proper sanitation



.trictly obser#e proper aste handlin+ and disposal



Pro#ision of asteater treatment facility /e7+7 septic tank1 oil and ater separator1 etc70




+rease trap1 septic tank1 etc70 4uarterly monitorin+ of the folloin+



pF



T.. concentration


Possi$l" En
.as"lin" En


AA



A



8



C



%


 

.et up silt trap2stillin+ ponds to minimi!e



8&%

donstream siltation



Total Coliform



Color



&il and Grease

Pro#ision of three-chambered septic tank for domestic sea+e




Pro#ide rin+ canals around fuellin+ tanks2


motorpool2 maintenance areas




If nearest2recei#in+ ater body is coastal or marine ater1 specify classification



.A



.8



.C



.%

Current ;ater se



"ishery



Tourist Kone 2 Park



Recreational



Industrial



A+ricultural


Possi$l" En
.as"lin" En





(7J to B km



$ore than B km

se of the nearest ell




Possi$l" En
.as"lin" En


AA



A



8



C



%


 

.et up silt trap2stillin+ ponds to minimi!e donstream siltation Pro#ision of three-chambered septic tank for domestic sea+e



Pro#ide rin+ canals around fuellin+ tanks2




8&%



Total Coliform



Color



&il and Grease


motorpool2 maintenance areas




If nearest2recei#in+ ater body is coastal or marine ater1 specify classification



.A



.8



.C



.%

Current ;ater se



"ishery



Tourist Kone 2 Park



Recreational



Industrial



A+ricultural


Possi$l" En
.as"lin" En



%istance of project area to the nearest ell used






(7J to B km



$ore than B km




%rinkin+2%omestic



Industrial



 

Competition in ater use %epletion of ater resources

A+ricultural

.i!e of population usin+ recei#in+ surface ater



L B1((( persons



B1((( and L J1(((persons



J1(((person

A#ailable2nearest ater source7



%eepell



;ater district2,G



.urface ater



Implement rainater har#estin+ and similar measures as an alternati#e source of ater



&bser#e ater conser#ation measures



Careful selection of project site to a#oid disruption of traditional ater uses



&btain ;ater Permit from :;R8



Impro#e efficiency of ater supply and distribution system



&thers1 specify

 

Re+ularly monitor presence2absence of complaints




Re+ular coordination ith concerned a+encies



Re+ularly monitor occurrences of ater shorta+es



&thers1 specify

999999999999

999999999999999999999

 &thers1 specify 999999999999999999999999


Possi$l" En


Increased occurrence of floodin+

.as"lin" En


es



:o




se appropriate desi+n for project facilities



Implement appropriate draina+e system



Re+ularly remo#e debris and other materials that may obstruct ater flo



se appropriate technolo+y /e7+7 raised hand-pumps0 to protect drinkin+ ater from










Re+ularly monitor increased frequency of floodin+





Possi$l" En
.as"lin" En



%istance of project area to the nearest ell used






(7J to B km



$ore than B km




%rinkin+2%omestic



Industrial



 

Competition in ater use %epletion of ater resources

A+ricultural

.i!e of population usin+ recei#in+ surface ater



L B1((( persons






J1(((person

A#ailable2nearest ater source7



%eepell



;ater district2,G



.urface ater



Implement rainater har#estin+ and similar measures as an alternati#e source of ater



&bser#e ater conser#ation measures



Careful selection of project site to a#oid disruption of traditional ater uses



&btain ;ater Permit from :;R8



Impro#e efficiency of ater supply and distribution system



&thers1 specify

 








Re+ularly monitor occurrences of ater shorta+es



&thers1 specify

999999999999

999999999999999999999

 &thers1 specify 999999999999999999999999


Possi$l" En



.as"lin" En


es



:o


   







se appropriate technolo+y /e7+7 raised



&thers1 specify

999999999999999999999

Re+ularly monitor




presence2absence of complaints


hand-pumps0 to protect drinkin+ ater from flood contamination








Re+ularly monitor increased frequency of floodin+ &thers1 specify

99999999999999999

AIR 2 :&I.E


Possi$l" En


Air quality de+radation

.as"lin" En





(7J to B km



$ore than B km




Properly operate and maintain all emission sources /e7+7 #ehicles1 pumps1 +enerator1 etc0



Install hen applicable1 the appropriate air pollution control de#ice2s



.trictly enforce +ood housekeepin+ practices








Absence of hite or black smoke from #ehicles1





Possi$l" En



.as"lin" En


es



:o











 

se appropriate technolo+y /e7+7 raised hand-pumps0 to protect drinkin+ ater from flood contamination &thers1 specify

999999999999999999999


 







 

Re+ularly monitor increased frequency of floodin+ &thers1 specify

99999999999999999

AIR 2 :&I.E


Possi$l" En



.as"lin" En





(7J to B km



$ore than B km




Properly operate and maintain all emission




sources /e7+7 #ehicles1 pumps1 +enerator1 etc0



Install hen applicable1 the appropriate air pollution control de#ice2s

 









Absence of hite or black smoke from #ehicles1 hea#y equipment and +enerator

Control #ehicle speed to lessen suspension



of road dust



Re+ularly monitor


Conduct ater sprayin+ to suppress dust

Presence of truck co#er durin+ deli#eries

sources and minimi!e discomfort to nearby residents



se co#ered #ehicles to deli#er materials that may +enerate dust



&ther1 specify 9999999999999999999



:uisance due to noise +eneration

%istance to nearest community






(7J to B km



$ore than B km



Properly operate and maintain all noise



sources /e7+7 #ehicles1 pumps1 +enerator1 etc0



Install hen applicable1 the appropriate

Implement appropriate operatin+ hours



Pro#ide adequate buffer and2or plantin+ of






noise control de#ice2s /e7+71 mufflers1 silencer1 sound barriers1 etc70



Re+ularly monitor



trees



&thers1 specify 9999999999999999999999


Possi$l" En
.as"lin" En



PE&P,E



%isplacement of

.i!e of population of host baran+ay





Pro#ide relocation2disturbance



Re+ularly monitor



Cost inte+rated in the

Possi$l" En



.as"lin" En





(7J to B km



$ore than B km


 

Properly operate and maintain all emission sources /e7+7 #ehicles1 pumps1 +enerator1 etc0 Install hen applicable1 the appropriate air pollution control de#ice2s

 











Absence of hite or black smoke from #ehicles1 hea#y equipment and +enerator

Control #ehicle speed to lessen suspension



of road dust





Conduct ater sprayin+ to suppress dust

Presence of truck co#er durin+ deli#eries

sources and minimi!e discomfort to nearby residents



se co#ered #ehicles to deli#er materials that may +enerate dust



&ther1 specify 9999999999999999999



:uisance due to noise +eneration

%istance to nearest community






(7J to B km



$ore than B km

 

Properly operate and maintain all noise sources /e7+7 #ehicles1 pumps1 +enerator1 etc0 Install hen applicable1 the appropriate

 

noise control de#ice2s /e7+71 mufflers1 silencer1 sound barriers1 etc70



Implement appropriate operatin+ hours



Pro#ide adequate buffer and2or plantin+ of






trees



&thers1 specify 9999999999999999999999


Possi$l" En
.as"lin" En



PE&P,E



%isplacement of residents in the project site and ithin its #icinity

    





%isplacement of Indi+enous People Enhanced employment and2or li#elihood opportunities Reduced employment and2or li#elihood opportunities Increased re#enues for ,G %isruption2Competition in deli#ery of public ser#ices /e7+71 education1 peace and order1 etc70 Enhanced deli#ery of public ser#ices /e7+71 education1 peace and order1 etc70




Pro#ide relocation2disturbance



L B1((( persons






Prioriti!e local residents for employment

J1(((person



Promptly pay local ta*es and other



financial obli+ations Classification of host baran+ay



rban



Rural

A#ailable ser#ices ithin2near the host baran+ay



.chools /e7+7 elementary1 hi+h school1 colle+e0

 

Fealth facilities /e7+71 clinics1 hospitals1 etc70 Peace and order /e7+71 police



compensation packa+es

 

  

Re+ular coordination ith ,G

Re+ularly monitor










&thers1 specify 99999999999999999

Prior consultation 3 coordination to minimi!e disruption on daily domestic acti#ities 3 respect for IP ri+hts and cultural practices Ensure participation of IPs in consultations and dialo+ues Pro#ide appropriate traffic2arnin+ si+ns1 li+htin+1 etc &thers1 specify 9999999999999999

outpost1 br+y7 Tanod1 etc70

 

Recreation and sports facilities &thers1 specify 999999999999999999999

Increase in traffic #olume and orsenin+


Possi$l" En


Impacts on community health and safety



&thers1 specify

.as"lin" En

 

Re+ular coordination ith ,G Pro#ide appropriate arnin+ si+ns1 li+htin+




Presence2Absence of complaints



Re+ular coordination ith





Possi$l" En
.as"lin" En



PE&P,E



    





%isplacement of residents in the project site and ithin its #icinity %isplacement of Indi+enous People Enhanced employment and2or li#elihood opportunities Reduced employment and2or li#elihood opportunities Increased re#enues for ,G %isruption2Competition in deli#ery of public ser#ices /e7+71 education1 peace and order1 etc70 Enhanced deli#ery of public ser#ices /e7+71 education1 peace and order1 etc70




Pro#ide relocation2disturbance compensation packa+es



L B1((( persons






Prioriti!e local residents for employment

J1(((person



Promptly pay local ta*es and other



financial obli+ations Classification of host baran+ay



rban



Rural

A#ailable ser#ices ithin2near the host baran+ay



.chools /e7+7 elementary1 hi+h school1 colle+e0

 

Fealth facilities /e7+71 clinics1 hospitals1 etc70 Peace and order /e7+71 police

 

 


 








&thers1 specify 99999999999999999

Prior consultation 3 coordination to minimi!e disruption on daily domestic acti#ities 3 respect for IP ri+hts and cultural practices Ensure participation of IPs in consultations and dialo+ues Pro#ide appropriate traffic2arnin+ si+ns1 li+htin+1 etc



&thers1 specify 9999999999999999

outpost1 br+y7 Tanod1 etc70

 

Recreation and sports facilities &thers1 specify 999999999999999999999

Increase in traffic #olume and orsenin+


Possi$l" En
 

Impacts on community health and safety &thers1 specify 999999999999999

.as"lin" En






Pro#ide appropriate arnin+ si+ns1 li+htin+ and barricades1 hene#er practicable

  

&bser#e proper housekeepin+ Pro#ide on-site medical ser#ices for any emer+ency7 Participate in public aareness pro+rams on health and safety




 

Presence2Absence of complaints








Re+ular submission of reports to concerned a+ency



&thers1 specify 99999999999999999

Implement appropriate safety pro+rams for both community and orkers

 

.trictly comply ith fire1 safety and similar re+ulatory requirements .trictly comply ith requirements of RA MNMN



&thers1 specify 9999999999999999999999


III3 A.AN0ONMENT -0ECOMMISSIONING-REHA.ILITATION POLICIES AN0 GENERIC G7I0ELINES /if Applicable0

Possi$l" En


.as"lin" En
Impacts on community health and safety



&thers1 specify 999999999999999


    

Re+ular coordination ith ,G Pro#ide appropriate arnin+ si+ns1 li+htin+ and barricades1 hene#er practicable &bser#e proper housekeepin+ Pro#ide on-site medical ser#ices for any emer+ency7 Participate in public aareness pro+rams




complaints









Re+ular submission of reports to concerned a+ency



on health and safety



Presence2Absence of


&thers1 specify 99999999999999999

Implement appropriate safety pro+rams for both community and orkers

  

.trictly comply ith fire1 safety and similar re+ulatory requirements .trictly comply ith requirements of RA MNMN &thers1 specify 9999999999999999999999



Project ,ife or .er#ice 99999999999 years Pro#ide description of the Abandonment acti#ities1 such as1 dismantlin+ and aste disposal7 9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999

IV3 INSTIT7TIONAL PLAN FOR EMP IMPLEMENTATION

&r+ani!ation Chart


Project ,ife or .er#ice 99999999999 years Pro#ide description of the Abandonment acti#ities1 such as1 dismantlin+ and aste disposal7 9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999999999999999999999999999999

IV3 INSTIT7TIONAL PLAN FOR EMP IMPLEMENTATION

&r+ani!ation Chart


Attac! 'rain*-plan o/ ast" at"r tr"at&"nt /acilit5 (it! 'i&"nsions an' '"scriptions)


Attac! 'rain*-plan o/ air poll%tion so%rc" an' control installations (it! 'i&"nsions an' '"scriptions)


S;ORN STATEMENT OF ACCO7NTA.ILIT? OF THE PROPONENT

This is to certify that all the information and commitments in this Initial En#ironmental E*amination /IEE0 Checklist Report are accurate and complete to the best of my knoled+e7 8y the authority #ested in me by the 9 99 (Compan" Name) as 999 (osition#Desi$nation) I hereby commit to ensure implementation of all commitments1 miti+atin+ measures and monitorin+ requirements indicated in this IEE Checklist Report as ell as the folloin+ Conform ith pertinent pro#isions of applicable en#ironmental las e7+71 R7A7 :o7 MNMN / ,oic 'ubstances and .a/ardous and Nuclear astes Control ct o! 10 0 1 R7A7 :o7 N(() / Ecolo$ical 'olid aste Mana$ement ct o! 2000 01 R7A7 :o7 N'5J / hilippine Clean ater ct o! 2004 01 and R7A7 :o7 <5=N / hilippine Clean ir ct o! 107 Abide and conform to ,G de#elopment plans and +uidelines7 Promptly pay local ta*es and other financial obli+ations7 Re+ularly submit reports to concerned a+encies7 •

• • •

I hereby bind myself to anser any penalty that may be imposed arisin+ from any misrepresentation or failure to state material information in this IEE Checklist7 In itness hereof1 I hereby set my hand this 9999 day of 9999999999 99999999999999999999997

at

99999999999999999999999999 :A$E &" PR&P&:E:T FEA% /Position0 /Company :ame0

.8.CRI8E% A:% .;&R: T& before me this 99999 day of 999999999999 '(B991 affiant e*hibitin+ his2her Community Ta* Certificate :o7 9999999999999999999 issued at 9999999999999999999999 on 999999999999999999999999997

%oc7 :o7 Pa+e :o7 8ook :o7 .eries of

99999999999999999999 99999999999999999999 99999999999999999999 99999999999999999999


GENERIC IEE Checklist Form

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