Wastewater Discharge Permit

PRODUCTION INFORMATIONProduct 1 Product 2 Product 3Product NameActual ProductionActual Production in thePrevious YearType of Process Batch Batch BatchContinuous Continuous ContinuousNote: **Please use generic product name, not in brand names, in metric tons of product, carbonated drinks and beer (m 3 )except for the following substances: hog raising(heads) slaughtering/preservingWater Pollution InformationLocation & Distribution of the Name of the Receiving Estimated Ave. Estimated Ave. Estimated AverageOutlet body if not Discharging BOD/TSS conc. Rate of Discharge BOD/TSS LoadOutlet In the lake. (mg/l) (m 3 /day) (kg/day)Number123TotalName of Laboratory performing Analysis:Address of Laboratory:Date of Sampling :Method of Sampling :Date of AnalysisVicinity Map (The map should show relative location of the establishment with respect to existing structures, landmarks, rivers, lakes andOther water bodies, etc..Use scale to fit into the frame below.Fixed Fee Official Receipt Number:_____________________Date of issue__________________I hereby certify that the above information are true and correct to the best of my knowledge. Done this _________day of_________________of 20______________._________________________________________________Name and Signature of the Pollution Control Officer_______________________________________________Chief Executive OfficerSUBSCRIBE AND SWORN to before a Notary Public. This __________ day of ____________________.Affiant exhibiting to me his/herCommunity Tax Receipt NO._________________Issued at _______________________ on______________________.NOTARY PUBLIC

REQUIREMENTS FOR APPLICATION FOR A WASTEWATER DISCHARGE PERMITFOR NEW APPLICATIONa) Engineer’s Report containing such information as:i) Vicinity map identifying the street address, location or plant premises;ii) The nature of project or business;iii) Production capacity; quantity or volume and the generic name(s) of product(s)iv) The nature and character of the applicant’s wastewater and its physical and chemicalcomposition;v) Total daily volume of discharge of raw wastewater;vi) Treatment process and estimated treatment efficiency;vii) The total daily volume of water consumption and discharge of final treated wastewater oreffluentviii) The name of receiving body of water and its official water classification and in case ofland discharge, the nearest receiving body of water and its official water classification;ix) Information on flow measurement equipment and procedure;x) Pollution prevention/Environmental System plan of program;xi) DENR ID Number as hazardous waste generator (if applicable)xii) Statement of the cost incurred in the installation and maintenance of wastewatertreatment facility, if any;xiii) Quality and quantity of abstracted water; andxiv) Copy of Environmental Compliance Certificate (ECC) from the Department ofCertificate of Non-Coverage (CNC), as applicable.A registered chemical or sanitary engineer or Pollution Control Officer shall sign such engineerreport concurred by the Managing Head.FOR RENEWAL OF DISCHARGE PERMITSb) A copy of the quarterly self-monitoring report for the immediately preceding year.c) A copy of the Certificate of Accreditation of the Pollution Control Officer duly issued by the department, orappointment/designation as such by the Managing Head;d) Official receipt for the payment of the applicable Fixed fee; ande) Other documents that may be required related to land applicationFailure to submit the necessary requirements shall be sufficient ground for the disapproval of application.