Self-Monitoring Report (SMR)

8/17/2019 Self-Monitoring Report (SMR)

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REGULATORY GROUP

ECOLOGY CENTER Regulatory Building, Labitan St., cor. Rizal Highway, Subic Bay Freeport ZonePhilippines 2222 (63-47) 252-4435 Fax: (63-47) 252-4157

S E L F - M O N I T O R I N G R E P O R T

f o r _ _ _ Q u a r t e r , Y e a r _ _ _ _

MODULE 1: GENERAL INFORMATION

Name of the Enterprise

Address

Responsible Officer/s:

CEO/President. __________________________________________________

Tel #: _____________________ Fax #: __________________________

e-mail address: _______________________________________________

Plant Manager: ________________________________________________

Tel #: _____________________ Fax #: __________________________

e-mail address: _______________________________________________

Pollution Control Officer

Name. ___

Tel #: Fax #: ___

e-mail address: ___

Legal Classification

single proprietorship partnership

private domestic corporation Multi-national

Permits/Licenses/Clearances

EnvironmentalLaws

Permits Date of Issue Expiry Date

P.D. 984 PTO

PD 1586/SBMAEIS System

ECC

ECC Amendment1

ECC Amendment 2

RA 6969

DENR RegistryID

SBMA RegistryNo.

CCO Registry

ImporterClearance No

Permit toTransport

Operation

Operating hours/day Operating days/week # of shift/day

Average

Maximum

Operation/Production/Capacity:

Average Daily ProductionOutput

Total Output this Quarter



REGULATORY GROUP


Total Water Consumptionthis Quarter (cubicmeters)

Total ElectricConsumption this Quarter(KwH)

(Please use additional sheet/s if necessary)MODULE 2: RA 6969

A. Chemicals Used

Name Origin Volume/monthCommon Name CAS No.

Stock Inventory/Waste Chemical Generated:

Average Quantity of

Waste ChemicalGenerated per month

Total Quantity of Waste

Chemical Generated thisQuarter

Quantity of StockInventory (Start ofQuarter)

Quantity of StockInventory (End of Quarter)

Other Information:

Manner of handlinghazardous wastes

storage on-site Treatment on-site

storage off-site Treatment off-site

Changes in SafetyManagement System

Yes (please attach copy of revised plan)

No

Chemical SubstitutePlan

Yes (please attach copy if not submitted/included in previous report/s or had beenrevised)

No

B. Hazardous Wastes Generator

HW Generation:

Type Vol./month

Total for thisQuarter

Transporter Treater

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

Water Pollution Data

Domestic wastewater _________(cu. m./day)Process wastewater

_________(cu. m./day)

Cooling water _________(cu. m./day) Others: _________(cu. m./day)

Wash water, equipment _________(cu. m./day)Wash water, floor

_________(cu. m./day)



REGULATORY GROUP


Water Pollution Control facility/equipment

Sewage Treatment Plant __ yes ___ no

Septic Tank __ yes ___ noGrease Trap __ yes ___ noOil-water separator __ yes ___ no

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

Month 1 Month 2 Month 3

Person employed, (# ofemployees)

Person employed, (cost)

Cost of Chemicals usedby WTP

Utility Costs of WTP(electricity & water)

Administrative andOverhead CostsCost of operating in-house laboratory

New/AdditionalInvestments in WTP(Description)

Cost of New/AddInvestments

WTP Discharge Location

OutletNumber Location of the Outlet Name of Receiving Water Body

1

2

Detailed Report of Wastewater Characteristics for Conventional Pollutants

DATEEffluent Flow Rate

(m3/day)

BOD(mg/L)

TSS(mg/L)

Color pHOil & Grease

(mg/L)Temp rise

(ºC)

Standard

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



REGULATORY GROUP


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

Summary of APSE/APCF

Process Equipment # of hrs of operations

1. .

2.

3.

Fuel Burning Equipment Fuel UsedQuantity

Consumed# of hrs ofoperations

1.

2.

Pollution Control Facility/Device # of hrs of operations

1.

2.

3.

Cost of Treatment

Month 1 Month 2 Month 3

Cost of Person employed,(salary)

Total Consumption ofWater (cubic meters)

Total Cost of chemicalsused (e.g., activatedcarbon, KMnO4)

Total Consumption ofElectricity (KwH)

Administrative andOverhead Costs

Cost of operating in-house laboratory, if any

Improvement ormodification, if any.(Description)

Cost of improvement ofmodification

Detailed Report of Air Emission Characteristics

Description/Locationof PCF

DATEFlow Rate(Ncm/day)

CO(mg/Nc

m)

NOx (mg/Ncm)

Particulates(mg/Ncm)

_______(name)

(mg/Ncm)

_______(name)

(mg/Ncm)

_______(name)

(mg/Ncm)

_______(name)

(mg/Ncm)

Standard



REGULATORY GROUP


MODULE 5: P.D. 1586 (Philippine EIS)

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

Description/Locationof Monitoring Station

DATENoise

Level (dB)CO

(mg/Ncm)NOx

(mg/Ncm)Particulates(mg/Ncm)

_______(name)

(mg/Ncm)

_______(name)

(mg/Ncm)

_______(name)

(mg/Ncm)

_______(name)

(mg/Ncm)

Standard

(Please accomplish one table per monitoring station.)

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

Description/Locationof Sampling Station

DATE

_______

(name)

(unit)

_______

(name)

(unit)

_______

(name)

(unit)

_______

(name)

(unit)

_______

(name)

(unit)

_______

(name)

(unit)

_______

(name)

(unit)

_______

(name)

(unit)

Standard

(Please accomplish one table per sampling station.)

Other ECC Conditions

ECC Condition/sStatus of Compliance

Actions TakenYes No

1.2.

3.

(Please accomplish one table per sampling station.)

Environmental Management Plan/Program

Enhancement/Mitigation MeasuresStatus of Implementation

Actions TakenYes No

1.

2.

3.

(Please use additional sheet/s if necessary).

Solid Waste Characterization/Information:

Average Quantity of SolidWastes Generated permonth

Total Quantity of SolidWastes Generated thisQuarter

Average Quantity of SolidWastes Collected permonth

Total Quantity of SolidWastes Collected thisQuarter

Entity in charge ofcollecting solid wastes



REGULATORY GROUP


MODULE 6: OTHERS

Accidents & Emergency Records

Date Area/Location Findings andObservation

Actions Taken Remarks

Personnel/Staff Training

Date Conducted Course/Training Description # of Personnel Trained

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

Done this _________________________, in ________________________.

Name/Signature of PCO

Name/Signature of CEO

Self-Monitoring Report (SMR)

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