DRR-CCA EIA Technical Guidelines - Environmental Management ...

EIA DRR/CCA TECHNICAL GUIDELINES2. Use of the IEE Checklist Report Forms 173. Coverage and Scope 174. The IEE Checklist Report Forms 20Executive Summary (Project Fact Sheet) 21Project Description 21Environmental Impact and Management Plan 21Abandonment/Decommissioning/Rehabilitation Policies and GenericGuidelines22Institutional Plan for EMP Implementation 225. Documentary Requirements 22ANNEXESAnnex 1: EIS Screening Forms1-A: Agricultural Plantation Projects1-B: Food & Food By-Product and Beverages Manufacturing Plants Projects1-C: Non-Food Manufacturing Plants Projects1-D: Forestry Projects1-E: Hydropower/Dam Projects1-F: New Mining Projects1-G: Sanitary Landfill Projects1-H: Thermal Power Plant ProjectsAnnex 2: IEE Checklist Reports Forms2–A: Batching and Crushing Plant Projects2–B: Fishery/Aquaculture Projects2–C: Food & Food By-Product and Beverages Manufacturing Plant Projects2–D: Non-Food (Textile, Rubber, Chemical) Manufacturing Plant Projects2–E: Subdivision and Housing Projects2–F: Building Projects2–G: Cemetery and Other Funeral Facilities Projects2–H: Livestock/Poultry Projects2–I: Resorts & Other Tourism/Leisure Projects2–J: Road/Bridge Projects2–K: Water Supply Projects2–L: Irrigation/Flood Control/Minor Dam Projects2–M: Waste Management Projects2–N: Genericii

EIA DRR/CCA TECHNICAL GUIDELINESAcronyms & AbbreviationsCARP Comprehensive Agrarian Reform ProgramCADC/CADT Certificate of Ancestral Domain Claim/Certificate of Ancestral Domain TitleCCAClimate Change AdaptationCNC Certificate of Non-CoverageCOC Coal Operating ContractDAO DENR Administrative OrderDENR Department of Environment and Natural ResourcesDRADisaster Risk AssessmentDODissolved OxygenDRR Disaster Risk ReductionECAEnvironmentally Critical AreaECCEnvironmental Compliance CertificateEIAEnvironmental Impact AssessmentEIARC Environmental Impact Assessment Review CommitteeEISEnvironmental Impact StatementEGFEnvironmental Guarantee FundEMFEnvironmental Monitoring FundEMB Environmental Management BureauEMB-RO Environmental Management Bureau-Regional OfficeEMoP Environmental Monitoring PlanEMP Environmental Management PlanEPRMP Environmental Performance Report and Management PlanEUEuropean UnionIFMA/CBFMA Integrated Forest Management Agreement/Community Based Forest ManagementAgreementGDP Gross Domestic ProductIECInformation, Education, and CommunicationIEEInitial Environmental ExaminationIPIndigenous PeoplesIPCC Inter-governmental Panel on Climate ChangeLGULocal Government UnitM & E Monitoring & EvaluationMCMemorandum CircularMDGF Millennium Development Goal Achievement FundMGB Mines and Geo-Sciences BureauMMT Multi-Partite Monitoring TeamMPSA Mineral Production Sharing AgreementMSDS Material Safety Data SheetMTMetric TonNAMRIA National Mapping and Resource Information AuthorityNDCC National Disaster Coordinating CouncilNDRRMC National Disaster Risk Reduction Management CouncilNEDA National Economic and Development AuthorityNGO Non-Government OrganizationNOxNitrogen OxidesOCTOriginal Certificate of TitlePAGASA Philippine Atmospheric, Geophysical and Astronomical Services AdministrationPDSProject Description for ScopingPEISS Philippine Environmental Impact Statement SystemPHIVOLCS Philippine Institute of Volcanology and SeismologyPCLPriority Chemical ListPEPRMP Programmatic Environmental Performance Report and Management PlanRPM Revised Procedural Manualiii

EIA DRR/CCA TECHNICAL GUIDELINESQRAROWSDPSOxTCTTSPTSSUNDPUSLEWFPWWTFQuantitative Risk AssessmentRight of WaySocial Development PlanSulfur OxidesTransfer Certificate of TitleTotal Suspended ParticulateTotal Suspended SolidsUnited Nations Development ProgrammeUniversal Soil Loss EquationWork and Financial PlanWaste Water Treatment Facilityiv

EIA DRR/CCA TECHNICAL GUIDELINESAcknowledgementThe development and printing of this manual was made possible with the support and assistance of theUnited Nations Development Programme (UNDP) and the National Economic and Development Authority(NEDA), through the Millennium Development Goals Fund (MDGF-1656) Joint Programme onStrengthening the Philippines’ Institutional Capacity to Adapt to Climate Change.The formulation of the guidelines was made possible under the leadership, support and encouragementof:Director Juan Miguel CunaAssistant Director Jonas LeonesAssistant Director Gilbert GonzalesEngr. Cesar SiadorThis is also to acknowledge the active participation of the various stakeholders especially during theseries of consultations. Recognition is also extended for the technical inputs provided by the following:Engr. Pura Vita G. PedrosaEngr. Esperanza A. SajulEngr. Elsie P. CezarEngr. Marivic YaoEngr. Regina EugenioFor. Verna VidalMr. Jess AdaweMr. Allan AlcantaraEngr. Jayr LilesDr. Jacob S. TioDr. Renato Lapitanv

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EIA DRR/CCA TECHNICAL GUIDELINESA. INTRODUCTIONIt is the policy of the State that optimum economic development shall be achieved without delay but shallbe pursued ensuring that the present generation meets its needs without compromising the needs of thefuture generations. This is consistent with the principles of sustainable development. The PhilippineEnvironmental Impact Statement System (PEISS) established under Presidential Decree 1586 in 1978provides a systems-oriented integrated approach in the analysis and management of environmentalconcerns vis-à-vis the national development program. It requires a proponent to conduct anEnvironmental Impact Assessment (EIA) and secure an Environmental Compliance Certificate (ECC)prior to implementation of development projects classified as environmentally critical or those that areproposed to be located in environmentally critical areas (ECAs).As a planning and decision-making tool, the essential purpose of the EIA process is “to improve decisionmaking and to ensure that project options under consideration are environmentally sound andsustainable” (World Bank, 1999). However, conventional EIA does not include natural hazards andclimate change projections as considerations either as factors in assessing the impact of the project onthe environment, or with respect to the impact of the environment on the project. Considering thedisastrous effects of natural hazards and the potential aggravating effects of climate change, it isessential that the EIA cover natural hazards and related risks as well as the anticipated rise in thefrequency and intensity of climatological hazards associated with climate change.1. Context/RationaleThe Philippines is one of the countries in the world that is prone to natural hazards. Deaths from naturaldisasters in the 1990 decade and in 2000-2006 have increased compared with the 1980 decade levels. Asignificant number of deaths are caused by typhoons. The National Disaster Coordinating Council(NDCC) has estimated that during the period 1970-2002, an average of 500 deaths was recorded eachyear due to typhoons and tropical cyclones. The high number of deaths in the 90s was mainly due to the1990 earthquake that struck Luzon and the 1991 Mt. Pinatubo eruption wherein lives lost numbered about2,000 and 6,200, respectively. The NDCC recorded a total number of 36,019 deaths caused by naturaldisasters from 1980 to 2006. 1In economic terms, the average cost of direct damage from natural disasters from 1970 to 2006 isestimated at PhP15 billion at 2000 prices. Direct damage covers damage to agricultural crops, publicinfrastructure and private homes. Damage was highest at about PhP70 billion in 1978 when 15 disastersstruck the country. Other major disasters with high direct damage were the Luzon earthquake in 1990(about PhP66 billion), the Mt. Pinatubo eruption in 1991 (about PhP33 billion) and the droughts in 1984and 1987. As a result, the declines in gross domestic product (GDP) were estimated at: a) 1.2 percentdue to the 1990 Luzon earthquake; b) 0.9 percent due to the Pinatubo eruption; and, c) 0.5 percentaverage due to typhoons every year. 2Compounding this vulnerability to natural hazards are the perceived effects of climate change. Accordingto the Fourth Assessment Report (Working Group 1) of the Inter-governmental Panel on Climate Change(IPCC), the warming of the climate system is deemed unequivocal, as it is now evident from observationsof increases in global average air and ocean temperatures, widespread melting of snow and ice, andrising global average sea level. 3As global climate change escalates, the risk of floods, droughts and severe storms increases. In its 4 thAssessment Report, the IPCC projects that rising global temperature will cause increasing_______________________________________________1 NEDA-UNDP-EU, Guidelines on Mainstreaming Risk Reduction in Sub-national Development and land use/physical planning in the Philippines2 NEDA-UNDP-EU, Guidelines on Mainstreaming Risk Reduction in Sub-national Development and land use/physical planning in the Philippines3 Inter-governmental Panel on Climate Change (IPCC). Fourth Assessment Report: Climate Change 2007 (The Physical Science Basis)1

EIA DRR/CCA TECHNICAL GUIDELINESdrought in mid-latitudes and semi-arid latitudes, increased water stress in many parts of the world,increased damage from storms, and coastal flooding affecting millions more people each year.The IPCC also concludes in the report of Working Group II that there are documented associationsbetween changes in temperature and observations of changes in physical and biological systems in theaquatic, terrestrial and marine environments. These are environmental receptors that are typicallycovered in EIAs. As such, it is imperative for the EIA to not only focus on possible environmentaldegradation but to also ensure that the disaster- and climate-related consequences of potential projectsare carefully spelled out as part of the assessment process and taken into account in project design. Forinstance, clearing mangroves to make way for prawn farming or tourism development may generatesubstantial livelihood opportunities, but it also increases exposure to storm surges and tsunamis.To ensure that natural hazard- and climate-related factors are incorporated in the EIA, the following needto be observed:Natural hazards, climate change and related risks should be considered as a fundamental firststep in broader project scoping and the findings should be used to determine if disaster and/orclimate change risks should be examined in further detail in other components of the projectappraisal process.Systematic analysis of the potential disaster/climate risk-related consequences of a project via itsimpact on the environment should be included as a central component of the assessmentprocess, especially in hazard-prone areas.Measures to address identified environmental issues, including disaster risk reduction/climatechange adaptation (DRR/CCA) concerns should be formulated for incorporation in the finaldesign and implementation of the project.1. Objectives of the GuidelinesThe EIA DRR/CCA Technical Guidelines is intended to promote climate change adaptation and disasterrisk reduction at the project level, as well as to streamline EIA requirements under the PEISS as providedfor in DENR Memorandum Circular (MC) 2010-14. Specifically, the Guidelines aim to:Provide enhanced standards for the preparation of EIA Reports that are customized forspecific industry types as required under the PEISS; andProvide guidance for project proponents in integrating DRR and CCA concerns in the projectplanning stage through the EIA Process to facilitate review and implementation of projects byincorporating international best practices.These Guidelines were formulated to provide EIA practitioners and stakeholders with:an understanding of the implications of disaster and climate change risks in relation to thepreparation of an EIA Report;direction on a project-specific basis on how disaster risks and climate change need to beconsidered in an EIA;sources of information for use in assessing disaster risks and climate change implications, andguidance in incorporating DRR and CCA considerations into the EIA process.2

EIA DRR/CCA TECHNICAL GUIDELINESNote for Users:The EIA Technical Guidelines on DRR/CCA is intended to guide proponents andpreparers in mainstreaming DRR/CCA at the project level. The DRR/CCA activitiesin the PEISS are not intended to replace the responsibilities of government agenciesin the conduct of natural hazard assessment, disaster risk assessment (DRA),sectoral impact assessment, vulnerability assessment and other similar studies at thenational and sub-national levels.2. Scope of the GuidelinesThese Guidelines, including the annexes, shall be collectively known as the “Environmental ImpactAssessment (EIA) Technical Guidelines for Incorporating Disaster Risk Reduction (DRR) andClimate Change Adaptation (CCA) concerns in the Philippine EIS System” (EIA DRR/CCA TechnicalGuidelines).”This shall serve as the guidance document for the conduct of EIA and preparation of EIA Reports (i.e.,EIS) required for ECC applications under the PEISS. The EIA is enhanced as a risk-based planning toolto integrate DRR and CCA concerns in the project design and implementation. The Guidelines cover theEIA requirement for both Environmentally Critical Projects (ECPs) and Non-ECPs located inEnvironmentally Critical Areas (ECAs) as defined under Presidential Proclamation 2146 and the existingimplementing rules and regulations. Following are the components of the Guidelines:General guidance document which provides the conceptual framework for MainstreamingDRR/CCA in EIAProcedures on the use of the DRR/CCA-enhanced EIS Screening FormsProcedures on the use of the DRR/CCA-enhanced Initial Environmental Examination (IEE)Checklist Report FormsB. GENERAL GUIDANCE FOR MAINSTREAMING DRR/CCA IN EIA1. Overview of the Philippine EIS System (PEISS)The EIA is a comprehensive and systematic process under the PEISS designed to identify, analyze andevaluate the environmental effects of proposed projects. As a process, it is intended to:involve the public in an open, transparent and participatory mannerallow for the effective integration of environmental considerations and public concerns into thedecision-making processprovide a powerful tool to help decision-makers achieve the goal of sustainable developmentProjects covered by the PEISS are defined in the Revised Procedural Manual for DENR AdministrativeOrder (DAO) 2003-30. Heavy industries, resource extractive industries, infrastructure projects and golfcourse projects are considered as ECPs that are covered under the PEISS. Also covered are projectslocated in ECAs such as: areas declared by law as national parks, watershed reserves, wildlife preserves,sanctuaries; areas set aside as aesthetic potential tourist spots; areas which are traditionally occupied bycultural communities or tribes; areas frequently visited and/or hard-hit by natural calamities (geologichazards, floods, typhoons, volcanic activity, etc.); and, areas with critical slopes, among others. Details oncoverage and thresholds are contained in the RPM.3

EIA DRR/CCA TECHNICAL GUIDELINESThe EIA process in the Philippines consists of seven (7) steps presented in brief below. Each step isequally important in determining the overall environmental performance of the project:1. Screening. This first step in the EIA process serves to determine whether a proposed project iscovered under the PEISS and, if covered, the level of assessment required.2) Scoping. This step identifies the key issues and corresponding impact that should be the focusof the EIA. This stage also defines the spatial boundary and time limit of the study.3) Impact analysis. This step includes gathering of baseline information as well as identificationand prediction of the likely environmental and social impact of the proposed project and theevaluation of its significance.4) Mitigation. This step involves the formulation of recommended actions to reduce and avoidthe potential adverse environmental consequences of development activities.5) Reporting. At this stage, the results of the EIA in the form of a report (i.e., EIA report) isprepared for submission to the EMB.6) Review of EIA/Project Appraisal. Here, the EMB examines the adequacy and appropriatenessof the EIA report. The EMB also ensures that information necessary for decision-making iscontained in the EIA report.7) Project Implementation and Monitoring. At this stage, the project is commissioned. TheProject Monitoring and Evaluation (M&E) system is designed to ensure that the actual impact ofthe project does not exceed the legal standards, and implementation of the mitigationmeasures are consistent with those in the EIA report.2. Mainstreaming DRR/CCA in the EIA ProcessThe DRR/CCA-enhanced EIA is a tool for ensuring that future developments (e.g., projects) are resilientand that their environmental impact does not exacerbate natural hazards or climate change’s effects onhuman or natural systems. It should also be noted that the integration of DRR and CCA considerationsinto the EIA process requires no change to the essential steps or sequence of the EIA process itself.Basic Project ConsiderationsIn the initial project definition and description, there is a need to determine if natural hazards and climatechange are likely to be potential considerations in the EIA process. Factors influencing this decisioninclude:the nature of the project and its settingthe life of the projectnatural hazard and climate-related parameters likely to influence the critical environmentalreceptors and the projectanticipated changes in these parameters over the life of the project, andapplicable regulatory requirements, guidelines and expectations.At this stage, the principles of precautionary approach should be applied in incorporating DRR/CCA intothe EIA process. The precautionary approach recognizes that the absence of full scientific certaintyshould not be used as a reason to postpone decisions where there is a risk of serious or irreversible4

EIA DRR/CCA TECHNICAL GUIDELINESharm, and that precautionary measures should be taken even if some cause and effect relationships arenot fully established scientifically.Project ScreeningScreening of projects for coverage and EIA Requirement under the PEISS involves the consideration ofthe project type (i.e., ECP) and thresholds, as well as its location in Environmentally Critical Areas(ECAs).Conceptually, projects would undergo additional screening by determining if their environmental impactare highly likely to contribute to increased vulnerability to natural hazards and climate change. Thisimpact would be site-specific, typically reversible and, in most cases, risk reduction/mitigation measurescould easily be incorporated in the EMP/EMoP.Under the EIA DRR/CCA Technical Guidelines, the screening process will be strengthened with the useof hazard maps generated by mandated agencies (e.g., PHIVOLCS, MGB) and funded projects (e.g.,READY Project). The screening process is further refined with the use of the climate change projectionsgenerated by PAGASA.Project ScopingThis stage of the process is critical as it defines the scope of the EIA to be required. EIA reports should, ingeneral, present detailed information concerning the nature, scope, setting (legal, financial, institutional)and timing for the proposed project or activity. The level of information that may be required shall bewithin what is relevant and available at the Feasibility Study Stage – specific detailed engineering designshall not be required. The project description to be submitted for purposes of scoping should containsufficient information to frame the scope of the EIA investigation so that time and resources are focusedon relevant issues.It is important to note that scoping simply indicates whether or not there are concerns that need to beaddressed. It does not determine the extent of an effect, or whether an effect will actually occur. Publicconcern raised at a meeting is sufficient at this stage to flag an issue as important enough to be includedin the scoping task. It is at this stage that scoping must also determine whether natural hazards and/orclimate change is/are relevant and should be included in the EIA – whether in relation to potentialchanges to the environment, or in consideration of the effects of the environment on the project.Scoping must consider both natural hazards and climate change in relation to:Project design criteria – current project design criteria and code-related issues (i.e., regulatoryrequirements such as safety, structural) must be reviewed and justified with respect to predictedclimatic changes and to the physical environment over the life span of the project. Ifnecessary, the project design criteria must be amended appropriately and/or modified designfactors must be applied to the project.Ecological, socio-economic and physical factors – possible changes and/or additions tocritical environmental receptors to be studied (e.g., health and safety, or pathways) due tonatural hazards and/or climate changes over the life- span of the project must be determinedand incorporated into the EIA process. This also includes possible physical environmentalfactors that might affect the project.Environmental impact – possible environmental impact (including cumulative effects, ifappropriate) must be identified based on effects associated with natural hazards and/or climatechanges being considered for the life-span of the project.Note that the integration of natural hazards and climate change into the EIA process should notnecessarily require modification of existing regulatory requirements, best practices or performancestandards, which would be outside of the scope of an EIA. In addition, it is important not to shift liability or5

EIA DRR/CCA TECHNICAL GUIDELINESintroduce unreasonable costs into the EIA process. However, it is important to consider, for example, theeffects of natural hazards and the implications of the frequency and intensity of climatic extremes, andtheir effects on both the project and its potentially modified impact on the environment.Under the EIA DRR/CCA Technical Guidelines, scoping would ensure that description of theproject/activity includes the identification of environmental or social issues of concern as well as anynatural hazards and climate change vulnerabilities at the project level. One potential mode of integrationis the assessment of issues, especially with regards to the historical and projected occurrence of tropicalcyclones and other extreme climate events in the proposed project location that may affect project design,construction, implementation or abandonment.Examples of integration schemes for disaster and climate change risk are as follows (especially forprojects located in hazard-prone areas):Energy – impact of hydropower projects on natural water flow and flooding patterns.Transport – impact of road construction and associated infrastructure on drainage systems andflooding patterns.Urban development – impact of development on the capacity of services and utilities toprevent increased risk of flooding as could occur if, say, drainage systems are inadequate orgarbage collection services are limited, resulting in dumping of garbage in drainage systems orwaterways.Mining – implications for droughts and floods from impact of mining operations on level ofgroundwater.Agriculture – impact on soil erosion and consequences in terms of levels of water retention,downstream siltation and flooding; resilience of proposed projects in the event of rainfallexcesses or deficits.Fisheries – consequences of clearance of mangroves and other vegetation.Forestry – risk reduction benefits of forestry projects (e.g., in providing protection againstwindstorms, landslides or tsunamis, and reducing the risk of flash flooding).For projects that require an EIS, DRR/CCA-enhanced EIS ScreeningForms are provided in Annex 1.Impact AnalysisIn general, the EIA process requires a detailed identification of significant impact. Determining whether animpact is significant is a critical step in an EIA, and it is necessary to identify the criteria on which thisdecision is based.Traditional EIA typically views the environment in its current state, usually based on a seasonal analysisof conditions (e.g., wet and dry seasons). The existing status of each environmental receptor ischaracterized, and project activities are then analyzed vis-à-vis the existing environment to determine theimpact.Incorporating natural hazards and climate change impact requires a paradigm shift from this perspective,as the existing environment can no longer be viewed as a constant and separate from project effects. Infact, a specific analysis of the potential changes associated with natural hazards and/or climate changewill be required before the impact of project activities can be isolated and assessed. The essence of theEIA process does not change. Effects on the environment with and without the project are still6

EIA DRR/CCA TECHNICAL GUIDELINESdetermined, and the existing definitions of significance should be used to evaluate the impact of theproject after climate change considerations have been integrated.The EIA, being ideally conducted at the project planning stage, has a lot of uncertainties, thus the need toconsider options and alternatives. The analysis of environmental impact shall consider range ofassumptions on production capacity, areas of development, process technologies, emissions, dischargesand other wastes. Under the DRR/CCA-enhanced guidelines, the PAGASA climate projections for 2020and 2050 in the province where the project is to be located should be integrated into the project impactanalysis. Examination of the consequences of climate variability and changes, as well as theeffectiveness, costs and feasibility of adaptations that can reduce vulnerability at the project level shallalso be included in the impact analysis.Ideally, the EIA shall consider the potential effects of the project (during construction, operation and, ifrelevant, decommissioning) on the frequency, intensity and consequences of significant natural hazardsand the impact of these hazards, in turn, on the project. The assessment should take into accountrelevant natural hazards and climate change concerns (e.g., how a rise in sea level might affect stormsurges, or how changes in precipitation might affect drought and flooding). In some cases, findings ofmathematical and computer-based hazard modeling exercises in the project area (for instance,modeling of earthquake, flood or windstorm) should be used. Such exercises, if not available, should beundertaken for large projects in high-risk areas.On the other hand, the EIA process provides an excellent means to ensure that environmental effects onthe project are considered and factored into project decision-making. Possible adverse effects of theenvironment (in terms of natural hazards and/or climate change) on the project may include:destruction of the project or components of the projectnegative impact to the operation and productivity of the projectincrease in cost of project developmentrevisions of project designincrease in maintenance frequency and costs, andrequirement for future project modificationsPotential effects of the environment on the design criteria shall be the primary concern of the project.Decisions on the project design criteria must be made in the context of the climate change projectionsover the lifespan of the project. Detailed analysis may not necessarily be done during this assessment,but the source of climate predictions and their specific magnitude must be described along with therationale for accepting the design criteria. Overall, any adverse impact of extreme climate events on theproject should be identified and the likelihood of their occurrence, specified.These assessments will help to determine if these effects are significant. If potential effects are deemedsignificant, appropriate management, mitigation and adaptation options must be identified. Furthermore,if it has been determined that a project is highly affected by climate change, a project-level climatechange adaptation program should also be developed to address significant impact and define projectadaptation measures.7

EIA DRR/CCA TECHNICAL GUIDELINESFor projects that require an EIS, t he DRR/CCA-enhanced EIS ScreeningForms provide a list of projected impact and corresponding baseline datarequirement as well as prescribed assessment methodology and approach inconsideration of the disaster and climate change vulnerability parametersrelevant for specific types of projects. These pre-identified requirements shallbe included as part of impact analysis of the EIA.For projects where the IEE Checklist Report Form would suffice, pre-identifiedbaseline data and impact analysis requirements as well as DRR/CCA optionsare provided for particular project types to be filled-up/accomplished.Detailed guidance on the use of the forms is provided in other sections of the EIADRR/CCA Technical Guidelines.Impact Mitigation PlanningThe impact mitigation section of the EIA report should consider the reduction or elimination of residualimpact remaining after standard measures (such as installation of pollution control devices and erosioncontrol techniques) have been applied. Note that standard mitigation through best management practicesis typically an integral part of the project design.Measures associated with disaster risk reduction and climate change will normally fall within this categoryand may include a range appropriate to the project and its setting. Mitigation, including any DRR/CCAmeasures, should remain focused on reduction or elimination of significant impact of the project on theenvironment, as well as the effects of the disaster and climate change risk projections on the project.Note for Users:The mainstreaming of DRR/CCA in the PEISS is focused at the project level. Assuch, the assessment process should be limited to the impact of a project onnatural hazards as well as effects of natural and climate hazards on the project.Likewise, risk reduction and adaptation measures should be appropriate for project levelimplementation.Preparation of the Environmental Impact Statement (EIS)As a process, the EIA is primarily used to identify potentially significant impact and formulate measures toreduce the impact to acceptable levels. The results of the process are documented in an environmentalimpact statement (EIS). The EIS is prepared to convey the results of the various analyses conductedduring the EIA, as well as to incorporate the management, mitigation and adaptation measures necessaryto address natural hazard/climate change vulnerabilities and risks identified. The EIS should also beused to ensure that the program for monitoring project implementation and impact includes theassessment of effectiveness of these measures.The nature, quality and quantity of data, impact assessment and management measures presented in theEIS shall include those that will be most useful and critical in the integration of environmental, social,climate and disaster risk reduction concerns during the preparation and finalization of the proponent’sfeasibility study and subsequent activities of the project, such as detailed engineering design,construction, operation and decommissioning/ abandonment.8

EIA DRR/CCA TECHNICAL GUIDELINESFor projects that require an EIS, t he DRR/CCA-enhanced EIS ScreeningForms will serve as the checklist f o r information and analysis requirementsidentified during the scoping stage.For projects where the IEE Checklist Report Form would suffice, the dulyaccomplished/completed form wi l l serve as the EIA Report for the proposedproject.Detailed guidance on the use of the forms is provided in other sections of thisEIA DRR/CCA Technical Guidelines.Review ProcessThe PEISS review process is premised on the following criteria:Clarity. The EIS document is intended to communicate the results of the EIA to a wide range ofstakeholders, including regulators, evaluators from various disciplines and professions, decisionmakers, affected communities, and the general public. It should therefore be written in a waythat is easily understood.Balance. There are many ways by which balance can be gauged. An EIS document isconsidered balanced if it is devoid of bias in the presentation and analysis of data. It is notsupposed to provide justifications for pre-conceived conclusions in favor of any interest group.Moreover, the EIS document should demonstrate a balanced treatment of descriptive andanalytical discussion. Facts or data and their meaning or interpretation should be presented intandem; one without the other will not withstand scientific scrutiny.Accuracy and Precision. These are universal criteria that need to be satisfied throughscientific inquiry or investigation. All analytical data presented in the EIS should satisfy theprescribed levels of accuracy and precision as derived from established statistical tools andmethods. Furthermore, all the baseline characterization methods (e.g., sampling, survey,testing procedures), as well as impact prediction tools and techniques (e.g., modelingtechniques, field tests, laboratory experiments) used in the EIA study will be scrutinized not onlyfor statistical, but also for scientific soundness.Under the EIA DRR/CCA Technical Guidelines, the integration of DRR/CCA into the review process willalso ensure that:All potentially significant environmental impact have been identified and analyzed, and both theclimate change projections and the hazard potential in the proposed project location wereconsidered. Furthermore, the review process shall ensure that appropriate impact mitigationmeasures, as well as climate change adaptation and disaster risk reduction have beenformulated and analyzed based on agreements during the screening and scoping stages.The project proponent has committed to implement and incorporate into the project design: a)the appropriate and sufficient impact management and mitigation measures, and b) theappropriate climate change adaptation and disaster risk reduction considerations.Project Monitoring and EvaluationIn the context of the PEISS, monitoring and evaluation (M&E) is undertaken after the issuance of theEnvironmental Compliance Certificate (ECC) to determine whether predictions made in the EIA reportwere accurate. Furthermore, if disaster and climate change risks have been identified as potentialconcerns, the M&E should take this into consideration. Monitoring should focus on areas wherepotentially significant impact could occur, or where mitigating measures have been proposed. The9

EIA DRR/CCA TECHNICAL GUIDELINESknowledge base for disaster risks and climate change in project-specific areas will normally improvesubstantially over the life of a project. It should also be noted that disaster and/or climate change risksare normally long-term risks, and hence may be difficult to assess in the short-term (i.e., project life).Therefore, if a project is particularly sensitive to disaster risks and/or climate change over its predictedlife, monitoring should include periodic assessment of these aspects by reviewing new information and/ormonitoring specific hazard/climate elements. At the minimum, the evaluation should focus ondetermining whether the mitigating and/or adaptation measures that were put in place were effective andwhether there were problems or excessive costs associated with them.The compliance monitoring by the project proponent, validation by the Multi-Partite Monitoring Team(MMT) (if required) and the evaluation by the EMB should focus on confirming whether mitigatingmeasures are performing as designed, or to identify changes needed to address the actual environmentalimpact of the project. This will show whether the project had achieved its objectives or had causedunintended adverse impact. In which case, it may be necessary to re-assess adaptation options, selectnew mitigation and/or adaptation measures or modify the current set of measures.C. PROCEDURES IN USING THE DRR/CCA-ENHANCED SCREENING FORMS1. Purpose of the EIS Screening FormsFor projects requiring an Environmental Impact Statement (EIS), DRR/CCA-enhanced EIS ScreeningForms have been developed as a guide for the scoping process. These screening forms are basicallychecklists of the required scope of the EIA. The forms also provide guidance on how to incorporatedisaster and climate change risks, including the formulation of appropriate mitigation and adaptationoptions at the project level.The EIS Screening Forms have been customized for specific industry types to allow for a more preciseidentification of the following:assessment needs in terms of specific impact of each industry typethe critical climate and disaster risk parameters that need to be incorporated in the EIAdisaster risk reduction measures and/or climate change adaptation options that should beconsidered/studied and incorporated in the project designThe purpose of this document is to guide users (e.g., project proponent, EIA Consultant, EMB and otherstakeholders) in implementing a risk-based planning and management system for the proposed project, inconsideration of environmental management concerns as well as the climate change and disaster risksconcerns. This shall also serve as a guide for the formulation of an enhanced environmental managementplan which has integrated climate change adaptation and disaster risk reduction plan as an input to theoverall project design.2. Use of the EIS Screening FormsThe EIS Screening Form was designed based on the prescribed outline contained in DENRMemorandum Circular 2010-14 dated 29 June 2010. The form also includes the pre-identification of thepotential environmental impact specific to the industry type. The baseline data and the assessmentmethodology requirement are likewise based on these considerations. The same form could be used forcompleteness checking of EIAs being submitted as a requirement for ECC application. Columns havebeen provided for such purpose.10

EIA DRR/CCA TECHNICAL GUIDELINESAvailable data on identified hazard areas and climate projections for specific provinces shall be includedin the assessment of project impact. Specifically, climate projections for rainfall, temperature, tropicalcyclones and extreme climate events for years 2020 and 2050 shall be used. Furthermore, a climatechange adaptation program shall be developed as part of the Environmental Management Plan (EMP).Likewise, available data on areas prone to hazards or have historical incidence of disasters shall be usedto develop the Disaster Risk Management Plan at the project level. This Plan shall likewise beincorporated in the EMP and considered in the project design.3. The EIS Screening FormsThe EIS Screening Form is composed of four (4) major parts:General InformationThis is where the basic information on the project to be screened are inputted. It also contains achecklist of documentary requirements for the ECC application.Checklist of EIS ContentsThis provides technical guidance on the specific content requirement for each of the major sectionsof the EIS for the specific project sector.Checklist of Key Environmental ImpactThis contains a listing of pre-identified key environmental impacts for the specific project sector andthe corresponding environmental baseline data that needs to be established before theimplementation of the project. It also specifies required environmental assessmentmethodology/approach for each identified key environmental impact. A corresponding managementand monitoring plan shall be formulated for each of the identified key environmental impact. Thechecklist provides columns for checking the presence of these in the EIS that will be subjected toscreening.Environmental Risk Assessment Requirement ChecklistThis is a guide for identifying the type of risks that is critical for the specific project type (safety orphysical), the scope of assessment and the output/report type required for the type of risk. Anemergency response and monitoring plan should be formulated for the identified risks. Thechecklist provides columns for checking the presence of these in the EIS that are subjected toscreening.The EIS Screening Form also has provisions for affixing signatures of Reviewers, Preparers, Proponentand EMB Representative who participated in the scoping activity.Each of the EIS Screening Form was customized for specific project sectors but the following provides ageneral guidance on what each of the sections of the EIS should contain.The Executive SummaryThe Screening Form starts with the Executive Summary. This section should be written clearly andconcisely as a stand-alone document summarizing the main findings of the study and how they werearrived at. The summary should cover all main issues discussed in the Report and contain at least a briefdescription of the project and the environment.The summary should include a brief description of anticipated significant climate change impact affectingthe development, an account of the main mitigation and adaptation measures to be undertaken by theproponent, and a description of any significant residual impact.11

EIA DRR/CCA TECHNICAL GUIDELINESA brief discussion of the method by which data were obtained should also be included.Section I. Project Description1. The proponent/EIA consultant should indicate the precise location and boundaries of the proposedproject shown on a detailed (preferably topographic) map, a statement of the objectives of theproposed project, its component and size, manpower and indicative project investment cost, includingall portions and phases of the project with corresponding timeframes needed for evaluation andreview of the environmental impact.2. Under Project Rationale, the proponent should be able to state clearly the purpose or justification (inreference to specific sustainable development agenda, e.g., regional development plan, provincialdevelopment plan, local development plan) of the proposed project to allow for an evaluation of theenvironmental effects vis-à-vis the proposed development.3. Under Project Alternatives, a brief discussion on feasible alternatives including the reasons for theselection of the preferred option should be provided. The discussion should include a comparison ofsignificant adverse environmental impact of the various options and the consideration of prevailingand projected environmental issues. The “no project” option should also form part of this discussion.A “no project” alternative is not equivalent to a status quo condition, as it must account for growth anddevelopment in the foreseeable future if the proposed project were not approved based on currentplans and available infrastructure and community service.4. The Project Component section should present a clear description of the project (text and maps, whenpossible) of the project’s basic lay-out, activities and support facilities likely to cause environmentaleffects. This information will serve as a benchmark against which to measure environmental changesand assess impact.5. The Method/Technology option should identify the types and quantities of wastes which might beproduced, and the proposed disposal scheme/s.An improvement under this section should include a description of the vulnerability to natural hazardsassociated with climate change. Wastes include all residual process materials, effluents andemissions. The types and quantities of waste matter or residual materials as well as the rate at whichthese will be generated should be estimated. Further, the ways by which the project proposes totreat these wastes and residuals should be indicated, along with the pathways by which they willeventually be disposed of to the environment. If waste is to be recycled, the process should beoutlined in the report.6. Project Size refers to a description of the magnitude of operation including any associated activitiesrequired by or for the project using parameters specified in Annex 2-1b of the Revised ProceduralManual for DAO 2003-30.7. Development Plan, Description of Project Phases and Corresponding Timeframes refer to a detaileddescription of the processes and activities, including timeframes associated with the different phases(i.e., pre-construction, construction, operation, abandonment) of the proposed project.8. In the Manpower section, the estimated number of people that will be employed in the various projectphases should be provided. The skill and qualification requirements should likewise be indicated.9. The Indicative Project Investment Cost is a natural outgrowth of the proposed project expenditurescovering the entire project operation tasks and staffing processes. The cost estimate should be tiedup with the overall performance and realization of the proposed project covering the period from preplanningto pre-construction, construction, operation, and all way to the abandonment phase of theentire engagement.12

EIA DRR/CCA TECHNICAL GUIDELINESSection II. Key Environmental Impact and Management / Monitoring PlanKey Environmental ImpactThe current policy directive under DENR MC 2010-14 is to focus the EIA Report requirement to the mostessential information and on the environmental aspects that have scientific basis and are verifiable forspecific project types. As such, integrated analysis by environmental receptors (i.e., land, water, air andpeople) shall be used in presenting the baseline information, impact assessment, impact managementand impact monitoring.The discussions shall be based on the pre-identified project-specific environmental impact as reflected inthe various screening forms developed. The required baseline information has likewise been focused onthe relevant parameters in relation to the pre-identified key environmental impact.The nature of the environmental impact shall be analyzed as to whether these are direct or indirect,synergistic or cumulative, short-, medium- or long-term, permanent or temporary, positive or negative.The impact should also be investigated and described with particular regard to identifying its effects onbiodiversity, soil, water, air, climate, coastal landscape, human health risk and the interactions amongthem.The expected relevance that the projected impact will have for people and the environment should beconsidered in this section. The sources of standards and criteria, along with the rationale, assumptionsand value judgments used in assessing significance should be fully described. The significance of animpact should be assessed, taking into consideration national and international quality standards, whereavailable.Local land use plans, guidelines and policies shall serve as the main reference point of discussions. Ifnecessary, additional data shall be collected to support the assessment, taking into account natural andhuman activities.The analysis of impact should consider not only the current baseline scenario but also climate changeprojections and disaster risks specifically for relevant parameters that have been pre-identified andreflected in the EIS Screening Forms. The section should also include sufficient background in terms ofclimate trends and climate change projections that may affect the project area. The level of detail in thisdescription should be sufficient to convey the general nature of the environmental and social resourcescondition of the affected areas.The proponent/preparer must be able to formulate an EMP that describes how the mitigation and otherenvironmental measures will be implemented. These measures should be set out to cover all phases ofthe project from pre-construction, construction, operation through decommissioning phase, and shouldoutline mitigation and other measures that will be undertaken to ensure compliance with environmentalregulations and reduce or eliminate adverse impact. The cost of mitigation should be assessed andincluded in the report.The proponent/preparer must also be able to formulate appropriate risk reduction and adaptationmeasures that would address significant disaster and climate change impact at the project level. Thesemeasures must address adverse impact of the project on the environment as well as the impact of theenvironment on the project.Environmental Monitoring Plan (EMoP)The proponent/EIA consultant must be able to formulate an EMoP that would monitor the followingconcerns: a) extent and severity of the actual environmental impact against the predicted impact; b)performance of the environmental protection measures or compliance with pertinent rules andregulations; c)trends in impact; and, d) overall effectiveness of the project’s EMP.13

EIA DRR/CCA TECHNICAL GUIDELINESThe EMoP should identify specific parameters to be monitored based on impact assessment as well asthe necessary sampling and measurement plan, responsible entity/ies and environmental qualityperformance management scheme.A specific monitoring scheme should be developed for each of the pre-identified environmental impact forspecific project types as identified in the various EIS screening forms. The submission of such monitoringplan/s shall be verified prior to official acceptance of the EIS for ECC applications.As a guide for completeness checking prior to official acceptance of the EIS for ECC applications, blankcolumns are provided on the right side of the list of key environmental impact, baseline data andassessment method requirement. Page numbers where the baseline data, impact assessment, impactmanagement and monitoring plan requirements can be found within the EIS shall be indicated in thescreening form by the proponent/preparer along with the EIS submitted for procedural screening.Section III. Environmental / Ecological Risks AssessmentThis component of the EIA Screening Form is required if the proposed project involves hazardous, toxic,flammable, or explosive materials or chemicals, or if it involves the construction of structures such asdams and bridges, which would endanger life, property, or the environment should they fail.Appropriate and sufficient data shall be provided in the Project Description forScoping (PDS) to allow for determination whether an ERA is requiredor not.The preparer/proponent shall undertake initial screening (for ERA coverage)which will be validated during the scoping process. The scoping processis deemed complete only when it includes the determination of ERArequirement.For these types of projects, the PDS should include the following:- Projected inventory of hazardous materials- Material Safety Data Sheet of the hazardous materials- Level of Coverage Computation based on Annex 2-7e of the Revised ProceduralManual for DAO 2003-30 (for projects involving hazardous, toxic, flammable, orexplosive materials or chemicals and other unclassified hazardous materials)- Maximum impounding/storage capacity (for projects involving the construction ofstructures such as dams and bridges, which would endanger life, property, or theenvironment should they fail.During scoping, the type of risk shall be identified by putting a check mark () in the boxes provided inthe first column of the last page of the screening forms. The requirement for a Quantitative RiskAssessment (QRA) shall be decided upon during the scoping based on the validation of the Level ofCoverage Computation done or based on technical discussions. A check mark () shall then be placedin the box provided if a QRA would be required.As a guide for completeness checking prior to official acceptance of the EIS for ECC applications,blank columns are provided on the right side of the ERA requirement listing. Page numbers wherethe specific risk assessment, emergency response plan and the monitoring plan requirements can befound within the EIS shall be provided by the proponent/preparer along with the EIS submitted forprocedural screening.Section IV. Impact Management Plan (IMP)In general, the proponent/EIA consultant assesses the impact on various environmental aspects as aresult of a proposed project. Once the impact have been examined, their significance should be14

EIA DRR/CCA TECHNICAL GUIDELINESdetermined, i.e., whether they are acceptable, require mitigation, or considered unacceptable.Corresponding measures will have to be provided to mitigate adverse impact or enhance positive impactat all stages of project implementation – from pre-construction/construction to operation all the way to theabandonment/decommissioning stage. The IMP should ensure that all residual environmental impact areappropriately and adequately managed. Methods that would be implemented may include technical,social, and institutional measures to be made integral elements of the project.The section should contain both a narrative summary of significant impact and a matrix (see Annex 2-17of the Revised Procedural Manual for the format).As regards to climate change, the assessment may consider the nature, extent and magnitude ofchanges likely to be contributed by a proposed project to climate change. More importantly, theassessment should examine the impact of climate change on the project. Also, the assessment shouldscrutinize the potential aggravating effects of climate change on the project’s environmental impact. Forexample, climate change may aggravate the effect of the project on the extent or magnitude of flooding inthe area.Assessment should be aided by various tools and techniques, the choice of which depends upon thenature of the impact, data availability or lack of it, and the appropriate specifics of models employedbased on certain criteria established. All of these will have to be written down in a manner that iscomprehensible to the non-specialist. Tables, graphs and other devices should be used as appropriate.Unnecessary technical or obscure language should be avoided. Technical terms, acronyms and initialsshould be defined, either when first introduced into the text or in a glossary.Section V. Social Development Plan (SDP) and IEC FrameworkThe SDP and IEC Framework shall be required for all ECPs. These may be required for EIS-Based ECCapplications for non ECPs at the discretion of the EMB-Regional Office (RO).Social Development Plan (SDP)The SDP of the project shall be derived from and aligned with the LGU's existing SDP. The project's SDPnormally aims to prevent/mitigate the project’s adverse impact and enhance the positive impact onpeople's livelihood, health and environment. The SDP shall contain the following: a) livelihood orcommunity development programs/activities, b) responsible party and/or beneficiaries, c) partnerinstitutions (government, NGO, others), d) timeframe of implementation, and e) source of funds andamount allocated per activity/component.Information, Education and Communication (IEC) FrameworkIEC is a critical component of the project to establish support, linkages, and participation of thestakeholders by raising awareness about the proposed project and its impact on the environment,including climate change, natural hazards and the associated risks and vulnerabilities. Publicconsultations are needed to generate awareness, enable informed opinions/views, and solicitsuggestions/approaches from the community. It is important that misconceptions are clarified andstakeholders are fully aware and well informed so as to eventually stimulate dynamic participation andsupport in the implementation of adequate responses in the locality.The IEC Framework shall include the following information: a) Target Sector Identified as needing ProjectIEC, b) Major topic/s or concerns in relation to the project, c) IEC Scheme/Strategy/Methods, d)Information medium, e) Indicative timelines and frequency, and f) Indicative cost.Section VI. Environmental Compliance MonitoringThis section describes the monitoring activities to be carried out to ensure that adverse environmentalimpact will be minimized and the EMP is implemented. It describes how, when, where the environmental15

EIA DRR/CCA TECHNICAL GUIDELINEScompliance monitoring activities will be undertaken; who will carry them out; and, who should receive themonitoring report. It should also clearly describe the commitment of the proponent and identify theimplementation scheme and source of funds for such activities.Section VII. Emergency Preparedness and Response Policy and Generic GuidelinesIn general, the Emergency Preparedness and Response Policy and Generic Guidelines aim to prevent,control and/or limit possible on-site and off-site negative impact arising from adverse events associatedwith a particular project in a given area. Also, in anticipation of adverse impact of climate change, anEmergency Response Plan should be designed to provide mitigation measures, if not prevent occurrenceof adverse impact, which could lead to accidents, and to reduce the magnitude of consequences in theevent that accidents may happen.An Emergency Response Plan should have the following components, which should considervulnerabilities to disaster risk and climate change:Safety Management PolicyEmergency Response OrganizationEvacuation and Rescue PlanFire/Toxic Gas Explosion Accident Prevention and ControlSection VIII. Abandonment / Decommissioning / Rehabilitation PolicyThe essence of abandonment/decommissioning and rehabilitation should be to restore the stability of theproject site, improve the aesthetic quality, and render the land suitable for some other productive uses.In addition, the Abandonment and Rehabilitation Policies and Procedures to be adopted by the proponentshould aim to achieve the following: a) reduce or eliminate adverse environmental effects once the projectceases to operate; b) re-establish physical and biological conditions which meet regulatory requirements;and, c) ensure that the decommissioned project does not pose an unacceptable risk to public health andsafety.Section IX. Institutional Plan for EMP ImplementationThe Plan should indicate the institutional set-up with specific responsibilities that will ensure effectiveimplementation of the EMP.The plan should specifically define an institutional structure that would: a) ensure the integration of allenvironmental concerns in overall planning through coordination with affected stakeholders; b) ensureobservance of proper safeguards in the execution of all activities, including those in existence that have,or are likely to have significant impact on the environment; and, c) enforce environmental standards,regulations and policies relating to environment safety, public health, ecology and biodiversity.D. PROCEDURES IN USING THE DRR/CCA-ENHANCED IEE CHECKLISTREPORT FORMS1. Purpose of the IEE Checklist Report FormsFor projects where an Initial Environmental Examination (IEE) Checklist Report Form is prescribed,DRR/CCA-enhanced IEE Checklist Report Forms have been developed to serve as the EIA Reportsubmission for ECC application. Concerns on disaster and climate change risks have been integratedinto the Checklist Forms.16

EIA DRR/CCA TECHNICAL GUIDELINESThe Checklist Forms have been customized for specific industry types where the following have beenpre-identified:specific impact expected of specific industry typesdisaster risk reduction measures and/or climate change adaptation options thatconsidered/studied and incorporated in the project designshould beThe purpose of the forms is to guide users (e.g., the project proponent, EMB and other stakeholders) inimplementing a risk-based planning and management system for the proposed project in consideration ofenvironmental management concerns, as well as climate change and disaster risks concerns. TheChecklist Forms also provide a pre-structured and enhanced environmental management plan which hasintegrated climate change adaptation and disaster risk reduction considerations as an input to the overallproject design.The IEE Checklist Report Form is a simplified form identifying all the activities of the proposed project andsources of impact, including those arising from disaster risk and climate change. The assessment coversall activities from construction to operation or decommissioning of the project, and considers thesealongside the characteristics of the project environment that could be affected, and determines wherethere could be interactions among them.2. Use of the IEE Checklist Report FormsThe IEE Checklist Report Forms were designed based on the prescribed outline in DENR MemorandumCircular 2010-14 dated 29 June 2010. The idea was to simplify and standardize EIA Reports such thatminimal technical expertise would be required in filling up the forms.The IEE Checklist Report Forms contain a series of questions dealing with issues and concerns about theproposed project and its environment. The checklist will also provide information on the proposedproject’s environmental impact, both positive and negative. The information contained in the checklist willserve as basis for the review and assessment of the EMB Regional Office to either approve or deny anECC application.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators to accomplish/fill-up the IEE Checklist Report Form.The Report Forms have been designed to be user-friendly.Furthermore, EMB Regional Offices are required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of completed/duly-accomplished forms.3. Coverage and ScopeThe IEE Checklist Report Forms shall suffice as EIA Report submission for the following projects locatedin ECAs covered under the PEISS:17

EIA DRR/CCA TECHNICAL GUIDELINESType of ProjectBatching and CrushingPlantFishery/AquacultureFood & Food By-productand BeveragesManufacturing PlantsNon-Food (Textile,Rubber, Chemical)Manufacturing PlantsProject/Industry----For projects using fresh or brackishwaterFor projects located in coastal ormarine area (off-shore)Animal products processing(fish/meat processing, canning,slaughterhouses, etc.)Coconut processing plants(including production of coconutbasedproducts)Distillation and Fermentation Plants( e.g. bio-ethanol project)Fruit and vegetable processingOther types of food (and other food byproducts,additives, etc.) processingindustriesProcessing of dairy productsSugar MillsGlass-based productsMetal-based products (includingsemi-conductor / electronicindustries)Paper and plastic-based productsManufacturing, processing and/or useof substances included in the PriorityChemical List (PCL)Manufacture of agri-chemicals andother industrial chemicals not in thePCLPharmaceutical industries andmanufacture of soap anddetergents, health and beautyproducts, and other consumerproducts.Surface coating industries (paints,pigments, varnishes, lacquers, anticapacityfouling coating, printinginks)Textile, Wood, Rubber IndustriesLeather and related industriesMetallic Mineral or Ore Processing(e.g., copper, lead, nickel, cobalt, zinc,silver, magnesium, and manganese,gold, placer with metal content) withPhysical or Mechanical ProcessingCriteria/Limit(Threshold)Regardless of size and capacity(those that are mobile or to beoperated for less than 1 year may beissued CNC)≥ 1 hectare but < 25 hectares≥ 1 hectare but < 100 hectares≥ 125 MT but < 2,500 MT(Annual production/rated capacity)< 25,000 MT(Monthly rated/production rate)< 50,000 MT(Annual production/rated capacity)< 125 MT(Annual production/rated capacity)< 50,000 MT(Annual rated/production rate offinished product)< 10,000 L (liquid)or< 100 MT (solid)(Monthly production rate)< 50,000 MT(Annual rated/production rate)≥ 30,000 MT(Annual rated/production rate)≥ 15,000 MT(Annual rated/production rate)≥ 15,000 MT(Annual rated/production rate)>0.001 MT but < 1.0 MT(quantity of toxic chemicals to beused per month)> 200 MT but < 30,000 MT(Annual rated/production rate)> 200 MT but < 50,000 MT(Annual rated/production rate)> 200 MT but < 30,000 MT(Annual rated/production rate)200 MT but

EIA DRR/CCA TECHNICAL GUIDELINESType of ProjectSubdivision and HousingBuildingProject/IndustrySubdivision and housingprojects, resettlement projects,economic and socialized housingproject, open market housing andother similar (horizontal) landdevelopment projectsLow-cost subdivision/housingand resettlement area projects(including amenities)Commercial, [business centers withresidential units (mixed use), malls,supermarkets, public markets]Fast food/Restaurant ProjectsCommercial Establishments(i.e., Showrooms)Commercial [office spaces only],Institutional and other related facilities:religious, government, and educationalInstitutional and other relatedfacilities: medical facilitiesInstitutional and other structureswith laboratory facilitiesMotels, Hotels, Condominiums /Apartelles (residential) withcommercial space 10% or less ofthe total floor areaStorage facilities, non-toxic/nonhazardousmaterials, substances orproductsStorage facilities, toxic/hazardousmaterials, substances or productsLand transport terminal (for buses,jeepneys and other modes oftransportation) with service facilitiesCemetery, memorial park andsimilar projectsCriteria/Limit(Threshold)> 10 hectares(total land area, including all common,open and other areas)(Per Memorandum dated 31 May 2012, implementation ofthis was deferred. Hence, threshold is >1 hectares)≥ 1 hectare but 5 hectares(total land area)≥ 1 hectareColumbarium and similar projects(total/gross floor area includingparking and other areas)Livestock /Poultry Pigs / Goats ≥ 100 heads but < 5,000 heads(Stock Population)Poultry / Birds≥ 10,000 heads but < 100,000heads (Stock Population)Resorts and other>0.1 hectare but

EIA DRR/CCA TECHNICAL GUIDELINESType of ProjectWater SupplyIrrigation/FloodControl/Minor DamWaste ManagementSanitary LandfillProject/IndustryTunnels and sub-grade roads andrailways----Water Supply Systems (CompleteSystem)Water Supply System (DistributionOnly)Impounding System or FloodControl ProjectIrrigation System (DistributionSystem Only)Compost/Fertilizer makingDomestic waste water treatmentfacilityMaterials recovery facilityReceiving facilities, paper, plasticand other material recyclingSanitary landfill for domestic wasteonlyCriteria/Limit(Threshold)< 1.0 km ( length)All underpass projects(Pedestrian passages)6 wells and other systems (e.g.,infiltration gallery, etc.)Level III – with householdconnection and water treatment< 25 hectaresORimpounded water ≤ 20 million m 3(reservoir flooded area or waterstorage capacity)≥300 hectares but < 1,000 hectares(service area)3,750 MT(Annual rated/ production rate)< 5,000 cubic meter (Quantity ofwaste to be treated annually)With composting facilities of 3,750MT or more annualrated/production rate< 300,000 MTORinvolving the use of chemicals(Quantity of waste to be treatedannually)Category 1: Net Residual WasteGenerated or Net ResidualDisposable Waste < 3,750 MTannual rated capacityCategory 2: Net Residual WasteGenerated or Net ResidualDisposable Waste > 3,750 but

EIA DRR/CCA TECHNICAL GUIDELINESAbandonment/Decommissioning/Rehabilitation Policies and Generic GuidelinesInstitutional Plan for EMP ImplementationExecutive Summary (Project Fact Sheet)The Project Fact Sheet serves as the Executive Summary of the IEE Checklist Report Form. It providesan overview of the project.Project DescriptionThe project proponent should furnish details that would give a brief but clear picture of the following:Project Location and Area. Use maps showing general location, specific location, projectboundary and project site layout accompanied by specific geographical coordinates.Project Component. Present, in tabular form, a clear description of the project components,such as number of units or size, types of equipment/support facility/ies accompanied by specificdetails, which are likely to cause environmental effects. The table should also include supportfacilities and pollution control device/s.Utilities Requirement. Provide an estimate and source of the power and water requirement.Manpower Requirement. Provide an estimated labor requirement for both the construction andoperation phases.Indicative Project Cost. Provide an estimated project cost in Philippine Pesos equivalent.Environmental Impact and Management PlanThis Plan, prepared in matrix form, provides the checklist of environmental parameters for differentprojects.Possible Environmental/Social Impact. This section will serve to screen out “no significant impact” fromthose with significant adverse impact by reviewing each relevant parameter according to the variousfactors or operational stages.Baseline Data Parameter. The proponent should enumerate significant data which describes the existingenvironmental status of the identified study area. The project proponent must select an answer bychecking the appropriate box(es), as necessary.In addition, the project proponent must also select/check appropriate measures designed to address thepotential disaster risks and climate change impact of the proposed project, as necessary. Note that thesedisaster and climate change considerations have been integrated into the matrix. Mitigation measures,where appropriate, were pre-identified as recommended measures to address environmental issues.Potential environmental enhancement and adaptation measures are also included.Monitoring Parameters/Implementation. This column describes the parameters that should bemonitored to ensure that adverse environmental impact are addressed. Also, as appropriate, climatechange monitoring parameters have been included.Cost of Mitigation. Mitigation is the stage when measures are identified to avoid, minimize or remedyimpact. These measures are implemented as part of the process of impact management along with anynecessary adjustments to respond to unforeseen impact. This would therefore require financial support torealize such undertakings. Under this column, the Project Proponent must commit to allocate someamount to cover expenditures in implementing these measures.21

EIA DRR/CCA TECHNICAL GUIDELINESAbandonment/Decommissioning/Rehabilitation Policies and Generic GuidelinesThe essence of abandonment/decommissioning and rehabilitation is to restore the stability of the projectsite, improve the aesthetic quality and render the land suitable for productive uses.Based on the estimated project life/service, the Project Proponent shall provide a brief description of theabandonment/decommissioning activities to be undertaken at the end of the project life/service.Institutional Plan for EMP ImplementationThis Plan should indicate an institutional set-up with specific responsibilities that will ensure effectiveimplementation of the EMP.It should define an institutional structure that would: a) ensure the integration of all environmentalconcerns in overall planning through coordination with affected stakeholders; b) ensure observance ofproper safeguards in the execution of all activities, including those in existence that have or are likely tohave significant impact on the environment; and, c)enforce environmental standards, regulations andpolicies relating to environment safety, public health, ecology and biodiversity. A flowchart or diagrammay be used to show the interrelationship of the various elements or components of the Plan.For the IEE Checklist Report Form, the organization chart with a brief description of the jobfunctions/responsibilities of key officer/s shall suffice as compliance. The appropriate space is providedfor this purpose.5. Documentary RequirementsThe IEE Checklist Report Form shall be submitted along with the following supporting documents:Proof of compatibility with existing land use plan as contained in the zoning ordinance of theLGU/s concernedProof of ownership or authority over the project site (e.g., OCT/TCT, lease agreement)Vicinity/location map and photographs of the project siteSite development/layout planOrganizational/Institutional Chart showing functions and responsibilities as well as the lines ofcommand and reporting of the Pollution Control Officer, andDrawings/Plans of pollution control facilities/devices (e.g., wastewater treatment facility, airpollution control devices) as may be applicable and appropriate.Additional documentary requirements for specific industry types are listed/indicated in the respectiveIEE Checklist Report Forms.22

Annex 1 - AECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningDate Submitted for Screening: _______________________________________________________________Form of Submission: ___ Hard ___ DigitalProject Title: _____________________________________________________________________________Project Location: _________________________________________________________________________Project Proponent: ________________________________________________________________________Address: ________________________________________________________________________________Contact No:Fax No:______________Contact Person:___________________________EIS Consultant: ___________________________________________________________________________Address: ________________________________________________________________________________Contact No: Fax No: Contact Person:__________________________Project Classification & Type: _______________________________________________________________Project Classification Code (Refer to RPM for DAO 2003-30): ______________________________________Project Size based on Classification: __________________________________________________________Date of Technical Scoping:______________________________________________________________Venue of Technical Scoping:_____________________________________________________________Checklist of Documentary RequirementsTo be filled-up upon submission of EISAcceptable?Yes NoScreening Officer’s RemarksEnvironmental Impact Statement (EIS) 1Proof of Compatibility with the existing LandUse PlanProof of Authority over the Project SiteAccountability Statements of Preparers &Proponents (see Annexes 2-21 & 2-22 ofRevised Procedural Manual for DAO 2003-30)Photographs or plates of the project site,impact areas and affected areas andcommunitiesDuly Accomplished Project EnvironmentalMonitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d ofRevised Procedural Manual for DAO 2003-30)ACTION TAKEN: (Please check to indicate corresponding action taken)Document accepted; please submit __ copiesEIARC Needed? ( ) Yes ( ) No Expertise Needed:Processing Fee: PhP _______ (Pay at EMB Cashier) Review Fund: Based on WFP (Pay to the dulyauthorized 3 rd Party Review Fund Manager)Document not acceptedO.R. #DateNOTED BY:____________________________________________________Screening OfficerSection/Division ChiefEMB Regional OfficeScreening OfficeDate:1

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Checklist of EIS ContentsI. Executive Summary (maximum of 5 pages)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningContents Page # Acceptable?REMARKSProject Fact Sheet PD Summary (1 page)Process Documentation of the conduct of EIA (1 page) (EIA Team, EIAStudy Schedule & Area, EIA Methodology, Public Participation)Summary of Baseline Characterization, Key Environmental Impacts andManagement & Monitoring Plan, and EMF Commitments (if applicable)Items to be Described Specific Data Requirement Page # Acceptable?REMARKSII. I. Project Description1) Project Location andAreaa) Map showing sitio, barangay, municipality,province, region boundaries, vicinity, proposedbuffers surrounding the area and primary &secondary impact areasb) Geographic coordinates (shape file data) ofproject area (use PRS 92 datum - GPS setting)c) Rationale for selection of primary & secondaryimpact areasd) Discussion on the accessibility of the projectsite/area2) Project Rationale Cite and focus on the need for the projectbased on national and regional/localeconomic development in terms ofcontribution to sustainable developmentagenda or current development thrusts.Describe the justification for the project withparticular reference to the economic andsocial benefits, including employment andassociate economic development which theproject may provide. The status of the projectshould be discussed in a regional andnational context.3) Project Alternatives a) Cite criteria used in determining preliminaryoptions for facility siting, development design,process/technology selection, resourceutilization including discussion of theconsequences of not proceeding with theproject:Contextualize site selection in terms ofvulnerability/susceptibility to liquefaction,ground shaking, ground rupture,earthquake-induced landslides, volcaniceruptions, rain-induced landslide, stormsurge, tsunami, and flooding as well asextreme climatologic conditions (data canbe obtained from NDRRMC and NAMRIAas well as other mandated agencies).2

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to be Described Specific Data Requirement Page # Acceptable?REMARKSDiscuss the alternatives (type and location)considered and nominated during thecourse of selecting the best option forwhich the EIS is prepared.Describe the bases upon which thealternatives were rejected in favor of thepreferred option.Describe the significant differences inenvironmental impacts among thealternatives considered.Siting: Cite alternative project locationsincluding factors significant to the selection,such as perception of affected communitieswith regards to project, ancestral domainissues, land classification, etc. Discuss otheroptions on the siting of major components ofthe project within the project area.Technology Selection/Operation Processes:Discuss the project’s advantage overalternative technologies, operation processesand engineering design.Discuss alternative measures for theprevention of the occurrence of major impacts(e.g., air and water pollution, possiblegroundwater and land contamination.Resources: Discuss the alternativesconsidered in the course of selecting thepower/water requirements as well as rawmaterials, and how the decisions were made infavor of the preferred resource. Discuss thesustainability of the raw materials/inputs (e.g.,fertilizers, planting stocks, pesticides, etc.) tobe tapped and transportation plan of rawmaterials.b) Cite reasons for selecting the preferred optionsdelineated in terms of technical, commercial,social and natural environmental aspects.c) After determining the preliminary options,please provide a summary of the comparativeenvironmental impacts of each alternative.4) Project Components Identification of major components (includingtechnical details, such as areaplanted/cultivated, specifications, capacity,number, etc.)Specify the operations and processIdentification of other Support Facilities (e.g.energy/power source, water supply system,etc.)Identification of materials/product handlingfacilities, infrastructure requirements (transport— road/rail/ship, energy, water supply andstorage, storm water drainage, sewerage,telecommunications, accommodation andother infrastructure)3

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to be Described Specific Data Requirement Page # Acceptable?REMARKSIdentification of pollution control devicesincluding other waste management andcorresponding facility being served orconnectedGeneral layout of facilitiesFootprint of proposed layout of project facilities(if any)Maps should be provided showing the preciselocation of the project area, and in particular,the location and boundaries of project area,location and footprint of project components,and location of all proposed buffers.When applicable, contextualize using the PAG-ASA 2020 and 2050 projectedrainfall/temperature data.5) Process/ Technology Method / Technology for:Planting / Harvesting - fertilizers and pesticidesto be used and corresponding amount forapplications. Discuss the handling/storageprocedures for fertilizers and pesticidesProcessing/Post harvest technology -Indicative process flow-sheets showingmaterial balances for the processing plant (ifany), and the anticipated rates of inputs, alongwith similar data on products, wastes andrecycle streamsPower & water supply systemWaste Management Systems (wastewatertreatment facility, dust collector, etc.)When applicable, consider the PAG-ASA 2020and 2050 projected rainfall data.6) Project Size Estimated yield per hectare and, If withprocessing, indicate annual production rateTotal Project Area in square meters or hectares7) Development Plan,Description of ProjectPhases andCorrespondingTimeframesPhases to be described in terms of identifyingspecific activities (with special attention on thosewith significant environmental impacts as well asclimate change adaptation options relevant to theproject and project activities) and correspondingprojected implementation timeframes:Pre-construction (e.g., planning, securingpermits/ clearances, etc.)Construction (e.g., land/site clearing, fencing,transport of materials, etc.)Operation (projected period of startup/commissioning/fulloperation of variousproject components) include discussion on theoperation of various components (as identifiedabove) in terms of material/product handling,infrastructure requirements (transport—road/rail/ship, energy, water supply and4

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to be Described Specific Data Requirement Page # Acceptable?REMARKSstorage, storm water drainage, sewerage,telecommunications, accommodation andother infrastructure), waste management(characteristics and quantities of wastematerials: wastewater, air emissions, solidwastes - toxic and hazardous, non toxic andnon hazardous)AbandonmentDecommissioning plan to include landrestoration, procedures, and proposedschedule.8) Manpower Tabulate the following per project phase:manpower requirements;expertise/skills needed;nature and estimated number of jobsavailable for men, women, and indigenouspeoples (if sited in IP ancestral land);preferred scheme for sourcing locally fromhost and neighboring LGUs9) Indicative Project Investment Cost (Philippine Peso)General Contents Specific Content Requirement Page # Acceptable? REMARKSII. Key EnvironmentalImpacts andManagement/Monitoring PlanIII. Environmental RiskAssessmentIV. ImpactManagement PlanV. Social DevelopmentPlan (SDP) and IECFrameworkVI. EnvironmentalCompliance MonitoringSee attached checklist of contentsWhen applicable, include appropriate climatechange adaptation measures/options (embeddedin each sector).See attached checklist of contentsLimit to most significant impacts per projectphase and per environmental component arisingfrom key environmental aspects (See Annex 2-17 of RPM for DAO 2003-30)SDPCommunity development or livelihoodprograms/activities, projected beneficiaries,partner institutions, timeframe of implementationas well as source and amount allotted peractivity/component (See Annex 2-18 of RPM forDAO 2003-30)IECTarget sector, key messages,scheme/strategy/methods, Information medium,timelines and frequency, cost (See Annex 2-19of RPM for DAO 2003-30)Environmental Monitoring Plan ( Self Monitoring)Use Annex 2-20 of RPM for DAO 2003-30 as5

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral Contents Specific Content Requirement Page # Acceptable? REMARKStemplateMulti-Sectoral Monitoring Framework / (ifapplicable)Tabulate the list of stakeholder-members of theMMT, basis for selection, proposed role, andscope of MMT responsibilities and activities, etc.(See Annex 3-4 of the RPM for DAO 2003-30).Environmental Monitoring Fund Commitments (ifapplicable)VII. EmergencyPreparedness andResponse Policy andGeneric GuidelinesVIII. Abandonment/Decommissioning/Rehabilitation PolicyIX. Institutional Plan forEMP ImplementationPresent a proposed amount of EMF (based on adraft AWFP in Annex 3-4 and consistent withguidelines in Annex 3-5 of RPM for DAO 2003-30)The safety policy and generic guidelines shouldbe consistent with the regulatory requirements.Emergency Preparedness should also considernatural hazards to the infrastructures andfacilities.Statement on proponent’s policies and genericprocedures for Decommissioning/Abandonment.Discuss the organizational scheme of theproponent including line of command andreporting procedures as well as manpowercomplement and relationships with otheroperating departments.6

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningChecklist of EIS ContentsKey Environmental Impacts and Management/Monitoring PlanList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1. THE LAND1.1 Land Use and Classification1.1.1 Change/Inconsistency in land Description & Map showing theuseproject area in relation to existing land1.1.2 Encroachment inEnvironmentally CriticalAreas (ECAs)use.Identify ECA where the project islocated or near the project area.Identify areas vulnerable/susceptibleto natural hazards where the projectis located or near the project area(include map/s).1.1.3 Possible tenurial / land issue Identify areas under CARP or withCADC / CADT where the project islocated or near the project area.Assessment of thecompatibility of theproposed project inrelation to land useand/or the coastalresource managementplan of the LGU, if any for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditions Analysis Plan PlanPage Page Page Page Remarks1.2 Geology/Geomorphology1.2.1 Change in surface landform/topography/ terrain/slope1.2.2 Change in sub-surface/underground geomorphology1.2.3 Inducement of subsidence,liquefaction, landslides, mud /debris flow, etc.1.3 Pedology1.3.1 Soil erosion / Loss of topsoil/overburdenSpecify other conflicting tenurial / landissues (e.g., IFMA/CBFMA withinCOC and within MPSA, etc.)Slope and Elevation/TopographicMapRegional/General Geological MapGeological Maps as needed; HazardMaps (NAMRIA, NDRRMC, MGB,PHIVOLCS, PAG-ASA)Summary of Soil Investigation Reporton soil type and quality; Erodibilitypotential; Bank stabilityInclude discussions onimpacts/effects of naturalhazard on the project.USLE / similar modelingwhen applicable.If applicable, providediscussions on possiblesoil contaminations dueto project operation7

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1.3.2 Change in soil quality/fertility Laboratory results on soil sampleanalysis for N, P, K, pH, organicmatter, micronutrients1.4 Terrestrial Ecology1.4.1 Vegetation removal and lossof habitat1.4.2 Threat to existence and/orloss of important local species1.4.3Threat to abundance,frequency and distribution ofimportant speciesFlora and fauna species inventoryor survey reportHistorical occurrences of pestinfestation, forest/grass fire and/orsimilar incidencesSummary of endemicity/ conservationstatusSummary of abundance, frequencyand distributionEconomic importance and uses ofsignificant flora and fauna1.4.4 Hindrance to wildlife access Sampling / survey map in relation tothe project site2. THE WATER2.1. Hydrology/Hydrogeology2.1.1 Change in drainagemorphology/Inducement offlooding/ Reduction in streamvolumetric flowDrainage map; historicalflooding/drought occurrences, streamflow measurements/estimates;Delineation of watershed /subwatersheds/floodplain; andidentification of aquifers, if anyPhysical analysis (waterholding capacity;secondary data:chemical analysisQuadrat sampling forfloraUse of mist nets, traps,transect walk for faunaInclude discussions onoverall impact to floraand faunaInclude impactassessment onvegetation (e.g.,likelihood of destruction)and specificmanagement measures(e.g., protection, balling,transplanting,replacement, etc.)Discuss possibleimpacts of the project onthe occurrence offlooding and vice versa.Consider extremeweather conditions andthe PAG-ASA 2020 and2050 climate projections.Assessment shouldinclude potentialoccurrence or8 for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditions Analysis Plan PlanPage Page Page Page Remarks

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.aggravation of floodingin nearby areas.2.1.2 Change in stream, lake water Regional hydrogeological mapdepth2.1.3 Depletion of water resources /competition in water use2.2 Oceanography2.2.1 Change/disruption incirculation patternIdentification of current / projectedwater use in the area and adjacentareasSpring and well inventory and locationmap; depth of water tableAnalysis/estimation of wateravailability taking into considerationthe PAG-ASA 2020 and 2050 climateprojectionsPredicted tides; 24-hour tidal cycles;Surface current systemFor project withsignificant waterrequirement, conductwater balance / budgetanalysis.If applicable, provideAquifer (Groundwater)vulnerability Assessment(ie. discussions ongroundwatercontamination due toproject operation) orgroundwatercontamination modeling2.2.2 Change in bathymetry Bathymetric map USLE / similar modelingwhen applicable2.3 Water Quality2.3.1 Degradation of groundwaterquality2.3.2 Degradation of surface waterqualityPhysico-Chemical characterization ofwater : pH BOD5 DO Oil and grease TSSUse DENR standardmethods and proceduresfor sampling andanalysis. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditions Analysis Plan PlanPage Page Page Page Remarks9

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.2.3.3 Degradation of coastal/ pesticide analysismarine water quality others:__________________________ for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditions Analysis Plan PlanPage Page Page Page Remarks2.4 Freshwater Ecology2.4.1 Threat to existence and/orloss of important local speciesand habitat2.4.2 Threat to abundance,frequency and distribution ofspecies2.5 Marine Ecology2.5.1 Threat to existence and/orloss of important local species andhabitat2.5.2 Threat to abundance,frequency and distributionsampling site mapSummary of endemicity/conservation statusAbundance of ecologically andeconomically important species(fishes, benthos, planktons);Presence of pollution indicatorspeciessampling site mapAbundance/densities/distribution ofecologically and economicallyimportant species (mangroves,fishes, benthos, planktons, coralreefs, algae, seaweeds, seagrasses);Presence of pollution indicatorspecies;Historical occurrences of red tide,fish kill or any related eventMarine resource mapsampling site mapInclude discussions onoverall impact tofreshwater ecologyQuadrat, transect, lineintercept, spot dive,manta tow, marineresourcecharacterization(e.g., municipal andcommercial fisheriesdata)Include discussions onoverall impact to marineecology10

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.3. THE AIR3.1 Meteorology/Climatology3.1.1 Change in the local climate,e.g., local temperatureMonthly average rainfall andtemperature of the area;Climatological normals/extremes;Wind rose diagrams; Frequency ofTropical cyclonesIn the assessment,consider the PAG-ASAclimate changeprojections for 2020 and2050. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditions Analysis Plan PlanPage Page Page Page Remarks3.1.2 Contribution in terms ofgreenhouse gas emissions/sequestrationData on Greenhouse gasses (i.e.,carbon dioxide, methane, nitrousoxide); Calculation of projected GHGemission/sequestrationDiscuss the project’scontribution in terms ofgreenhouse gasemissions/sequestration3.2 Air Quality (and Noise)3.2.1 Degradation of air quality Characterization of ambient airquality: TSPPM10SOxNOxothers:__________________________Use DENR standardmethods and proceduresfor sampling andanalysis.3.2.2 Increase in ambient noiselevel(for sampling methods refer to CleanAir Act)sampling site mapCharacterization of ambient noiselevelsampling site mapUse DENR standardmethods and proceduresfor sampling andmeasurement.Noise attenuationmodeling (applicable ifthere is a sourcecapable of generating11

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.200 dB or more) or withpresence of residentialarea in the projectvicinity4. THE PEOPLE4.1 Displacement of settler/sDisplacement / disturbance ofpropertiesChange/conflict in landownershipChange/conflict in right of way4.2 In-migrationProliferation of informalsettlersDemographic data of impact area:- Number of households andhousehold size- Land area,- Population,- Population density /growth- Gender and age profile,- Literacy rate, profile of educationalattainment,Settlements mapCensus of population / property thatwill be displaced / disturbedDiscuss how the projectwould affect existingproperties in the area interms of relocation anddevaluationDiscuss the in-migrationpatterns as a result ofproject implementation for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditions Analysis Plan PlanPage Page Page Page Remarks4.3 Cultural/Lifestyle change(especially on Indigenous Peoples,if any)4.4 Threat to delivery of basicservices /resource competition4.5 Threat to public health andsafetyHousing ownership profile /availability of housing/ number ofinformal settlersDemographic data on IndigenousPeoples (if any) and existingCulture/Lifestyle that may besignificantly affectedAvailability of public services in termsof:Water supplyPower supplyCommunications/transportationHealth resources (Governmentand Private)Peace and order / crimeEducation facilitiesDiscuss the impacts onIPs and Culture/LifestyleDiscuss how the projectwould affect the deliveryof basic services andmay result in resourcecompetition in the areaDiscuss the projectimplementation’s threatto public health vis-à-vis12

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Recreational facilities / sports the baseline healthfacilitiesconditions in the area for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditions Analysis Plan PlanPage Page Page Page Remarks4.6 Generation of Local Benefitsfrom the projectEnhancement ofemployment and livelihoodopportunitiesIncreased businessopportunities and associatedeconomic activitiesStatistical data / information related topublic services:Literacy rate, profile ofeducational attainmentMorbidity and mortality rates(infants and adults - 5-yeartrend)Common diseases in thearea including endemicdiseasesEnvironmental Health andSanitation ProfileCrime rateFood securitySocioeconomic data:Main sources of IncomeEmployment rate/ profileSources of livelihoodPoverty IncidenceCommercial establishmentsand activitiesBanking and financialinstitutionsAnalysis of diseases thatmay be affected byclimate change.Increased revenue of LGUs4.7 Traffic congestion Road network/ systemsExisting transportation/traffic situationTraffic impactassessment if applicable(including capacity ofroad system in terms ofload/count)13

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningIII.Environmental Risk AssessmentType of Risks Scope of Assessment Report/Output RequiredDuring scoping: Check () required/applicable items; items with are automatically required; write specific instructions ( ifany) on the blanks/spaces provided.Safety RisksRelease of toxicsubstances- Identification of conditions, events andcircumstances which could be significant inbringing about identified safety risks- Description & assessment of the possibleaccident scenarios- Assessment of whether the project location isprojected to have extreme climate events for2020 and/or 2050 that could contribute to thetriggering identified scenarios- Description of the hazards, both immediate(acute effects) and delayed (chronic effects)for man and the environment posed by therelease of toxic substance, as applicableERA REQUIREMENT Quantitative RiskAssessment(QRA)Specific Instructions:_________________________ Descriptive/Qualitative RiskAssessment for completeness during procedural screening; page numbers shouldbe provided upon submission of the EISERA ERP MonitoringPlanRemarksPage Page Page Specific Instructions:_________________________ EMERGENCY PLAN :Specific Instructions:_________________________Refer to Annex 2-7e for the decisioncriteria outline14

ECC APPLICATION SCREENING FORM FOR AGRICULTURAL AND PLANTATION PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningNoted By: Signature SignatureReview Committee MembersEMB Representatives1. 1.2. 2.3. 3.4. Project Proponent:5.6. Project Preparer/Consultant:Resource Person1.15

OKAY FOR PRINTING: _____________________________________________ ________________________________Signature over Printed Name DateAnnex 1 - BECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGESMANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningDate Submitted for Screening: _______________________________________________________________Form of Submission: ___ Hard ___ DigitalProject Title: _____________________________________________________________________________Project Location: _________________________________________________________________________Project Proponent: ________________________________________________________________________Address: ________________________________________________________________________________Contact No:Fax No:______________Contact Person:__________________________EIS Consultant: ___________________________________________________________________________Address: ________________________________________________________________________________Contact No: Fax No: Contact Person:__________________________Project Classification & Type: _______________________________________________________________Project Classification Code (Refer to RPM for DAO 2003-30): ______________________________________Project Size based on Classification: __________________________________________________________Date of Technical Scoping:______________________________________________________________Venue of Technical Scoping:_____________________________________________________________Checklist of Documentary RequirementsTo be filled-up upon submission of EISEnvironmental Impact Statement (EIS) 1Proof of Compatibility with the existing LandUse PlanProof of Authority over the Project SiteAccountability Statements of Preparers &Proponents (see Annexes 2-21 & 2-22 ofRevised Procedural Manual for DAO 2003-30)Photographs or plates of the project site,impact areas and affected areas andcommunitiesDuly Accomplished Project EnvironmentalMonitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d ofRevised Procedural Manual for DAO 2003-30)Acceptable?Yes NoScreening Officer’s RemarksACTION TAKEN: (Please check to indicate corresponding action taken)Document accepted; please submit __ copiesEIARC Needed? ( ) Yes ( ) No Expertise Needed:Processing Fee: PhP _______ (Pay at EMB Cashier) Review Fund: Based on WFP (Pay to the dulyauthorized 3 rd Party Review Fund Manager)Document not acceptedO.R. #DateNOTED BY:___________________________Screening Officer_________________________Section/Division ChiefEMB Regional OfficeScreening OfficeDate:_____________________________1 Please refer to attached checklist of EIS Contents1

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGESMANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Checklist of EIS ContentsI. Executive Summary (maximum of 5 pages)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningContents Page # Acceptable? REMARKSProject Fact Sheet PD Summary (1 page)Process Documentation of the conduct of EIA (1 page) (EIA Team, EIAStudy Schedule & Area, EIA Methodology, Public Participation)Summary of Baseline Characterization, Key Environmental Impacts andManagement & Monitoring Plan; and EMF Commitments (if applicable)Items to beDescribedI. Project DescriptionSpecific Data Requirement Page # Acceptable? REMARKS1) Project Locationand Areaa) Map showing sitio, barangay, municipality,province, region boundaries, vicinity,proposed buffers surrounding the area andprimary & secondary impact areasb) Geographic coordinates (shape file data) ofproject area (use PRS 92 datum - GPSsetting)c) Rationale for selection of primary &secondary impact areasd) Discussion on the accessibility of the projectsite/area2) Project Rationale Cite and focus on the need for the projectbased on national and regional/localeconomic development in terms ofcontribution to sustainable developmentagenda or current development thrusts.Discuss the justification for the Project withparticular reference to the economic andsocial benefits, including employment andassociate economic development, whichthe project may provide. The status of theproject should be discussed in a regionaland national context.3) ProjectAlternativesa) Cite criteria used in determining preliminaryoptions for facility siting, developmentdesign, process/technology selection,resource utilization including discussion ofthe consequences of not proceeding with theproject:Contextualize site selection in terms ofvulnerability/susceptibility to liquefaction,ground shaking, ground rupture,earthquake-induced landslides, volcaniceruptions, rain-induced landslide, stormsurge, tsunami, and flooding as well asextreme climatologic conditions (data canbe obtained from NDRRMC and NAMRIAas well as mandated agencies)2

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGESMANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data Requirement Page # Acceptable? REMARKSDiscuss the alternatives (type andlocation) considered and nominatedduring the course of selecting the bestoption for which the EIS is prepared;Describe the bases upon which thealternatives were rejected in favor of thepreferred option;Describe the significant differences inenvironmental impacts among thealternatives considered.Siting: Cite alternative project locationsincluding factors significant to the selectionsuch as perception of affected communitieswith regards to project, ancestral domainissues, land classification, etc. Discuss otheroptions on the siting of major components ofthe project within the project area.Technology Selection/Operation Processes:Discuss the project’s advantage overalternative technologies, operationprocesses and engineering designDiscuss alternative measures to preventoccurrence of major impactsResources: Discuss the alternativesconsidered in the course of selecting thepower/water requirements as well as rawmaterials, and how the decisions were madein favor of the preferred resource. Discussthe sustainability of the raw materials/inputs(e.g., fertilizers, planting stocks, pesticides,meat, crops, packaging materials etc.) to betapped and transportation plan of rawmaterials.b) Reasons for selecting the preferred optionsdelineated in terms of technical, commercial,social and natural environmental aspectsc) After determining the preliminary options,please provide a summary of the comparativeenvironmental impacts of each alternative4) ProjectComponentsIdentification of major components (includingtechnical details, such as areaplanted/cultivated and types of crops,processing/manufacturing facilities, capacity,number, etc.)Specify the operations and processIdentification of other Support Facilities (e.g.energy/power source, water supply system,etc.)3

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGESMANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribed5) Process/TechnologySpecific Data Requirement Page # Acceptable? REMARKSIdentification of materials/product handlingfacilities, infrastructure requirements(transport — road/rail/ship, energy, watersupply and storage, storm water drainage,sewerage,telecommunications,accommodation and other infrastructure)Identification of Pollution Control devicesand corresponding facility being served orconnected.Identification of waste management facilitiesand devices to address solid wastematerials (domestic and hazardous andchemicals) air emissions, solid wastedisposal, and wastewaterGeneral layout of facilitiesFootprint of proposed layout of projectfacilities (if any)Maps should be provided showing theprecise location of the project area, and inparticular, the location and boundaries ofproject area, location and footprint of projectcomponents, and location of all proposedbuffers.When applicable contextualize using thePAG-ASA 2020 and 2050 projectedrainfall/temperature data.Processing/ManufacturingIndicative process flow-sheets showingmaterial balances for the processing plant, andthe anticipated rates of inputs, along withsimilar data on products, wastes and recyclestreamsPower & water supply systemWaste Management System (wastewatertreatment facility, solid waste managementsystem, dust collector etc.)When applicable, consider the PAG-ASA 2020and 2050 projected rainfall data.6) Project Size Daily/Monthly/Annual Production rateTotal Project Area in square meters orhectares7) DevelopmentPlan, Descriptionof Project PhasesandCorrespondingTimeframesPhases to be described in terms of identifyingspecific activities (with special attention onthose with significant environmental impactsas well as climate change adaptation optionsrelevant to the project and project activities)and corresponding projected implementationtimeframes:Pre-construction (e.g., planning, acquisitionof rights to use land, etc.)Construction (e.g. land/site clearing,4

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGESMANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data Requirement Page # Acceptable? REMARKStemporary housing, transport of materials,health and other services for the workforce)Operation (projected period of startup/commissioning/fulloperation of variousproject components) include discussion onthe operation of various components (asidentified above) in terms of material/producthandling, infrastructure requirements(transport—road/rail/ship, energy, watersupply and storage, storm water drainage,sewerage, telecommunications,accommodation and other infrastructure),waste management (character andquantities of waste materials, air emissions,Solid waste disposal, wastewater)AbandonmentFinal Rehabilitation/ Decommissioning Plan, toinclude Land/soil restoration-The land usesuitability of the various land disturbance typesshould also be described.The proposed decommissioning plan shouldbe in terms of the following:Procedures for the decommissioning of theproject components;Transport/disposal of equipment and othermaterials used in the plant’s operation;Alternatives for the future use ofabandoned area;Consistency with long-term zoning and landuse development plan of the municipality;Rehabilitation plans, if any8) Manpower Tabulate the following per project phase:manpower requirements;expertise/skills needed;nature & estimated number of jobsavailable for men, women, and indigenouspeoples (if sited in IP ancestral land);preferred scheme for sourcing locally fromhost and neighboring LGUs9) Indicative Project Investment Cost (Philippine Peso)General ContentsSpecific Content RequirementPage #Acceptable?REMARKSII. KeyEnvironmentalImpacts andManagement/Monitoring PlanSee attached checklist of contentsWhen applicable, include appropriate climatechange adaptation measures/options(embedded in each sector).5

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGESMANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral ContentsSpecific Content RequirementPage #Acceptable?REMARKSIII. EnvironmentalRisk AssessmentSee attached checklist of contentsIV. ImpactManagement PlanLimit to most significant impacts per projectphase and per environmental componentarising from key environmental aspects (SeeAnnex 2-17 of RPM for DAO 2003-30)V. SocialDevelopment Plan(SDP) and IECFrameworkSDP (if applicable)Community development or livelihoodprograms/activities, projected beneficiaries,partner institutions, timeframe ofimplementation as well as source and amountallotted per activity/component (See Annex 2-18 of RPM for DAO 2003-30)IEC (if applicable)Target sector, key messages,scheme/strategy/methods, Informationmedium, timelines and frequency, cost (SeeAnnex 2-19 of RPM for DAO 2003-30)VI. EnvironmentalComplianceMonitoringSelf-Monitoring PlanUse Annex 2-20 of RPM for DAO 2003-30 astemplateMulti-Sectoral Monitoring Framework / (ifapplicable)Tabulate the list of stakeholder-members ofthe MMT, basis of selection, proposed role,and scope of MMT responsibilities andactivities, etc. (See Annex 3-4 of the RPM forDAO 2003-30).Environmental Guarantee and MonitoringFund Commitments (if applicable)Present a proposed amount of EMF(based on a draft AWFP in Annex 3-4 andconsistent with guidelines in Annex 3-5 ofRPM for DAO 2003-30); andPresent a proposed amount of EGF andthe basis for the estimate following theguidelines in Annex 3-6 of RPM for DAO2003-306

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGESMANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral ContentsSpecific Content RequirementPage #Acceptable?REMARKSVII. EmergencyPreparedness andResponse Policyand GenericGuidelinesThe safety policy and generic guidelinesshould be consistent with the regulatoryrequirements. Emergency Preparednessshould also consider natural hazards to theinfrastructures and facilities.VIII. Abandonment/Decommissioning/Rehabilitation PolicyStatement on proponent’s policies and genericproceduresforDecommissioning/Abandonment.IX. Institutional Planfor EMPImplementationDiscuss the organizational scheme of theproponent including line of command andreporting procedures as well as manpowercomplement and relationships with otheroperating departments.7

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningChecklist of EIS ContentsKey Environmental Impacts and Management/Monitoring PlanList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1. 1. THE LAND1.1 Land Use and Classification1.1.1 Change/Inconsistency in Description & Map showing theland useproject area in relation to existing1.1.2 Encroachment inEnvironmentally CriticalAreas (ECAs)1.1.3 Possible tenurial / landissue1.2 Geology/Geomorphology1.2.1 Change in surfacelandform/ topography/terrain/slope1.2.2Change in sub-surface/undergroundgeomorphology1.2.3 Inducement ofsubsidence, liquefaction,landslides, mud / debrisflow, etc.1.3 Pedology1.3.1 Soil erosion / Loss oftopsoil/overburdenland use.Identify ECA where the project islocated or near the project area.Identify areas vulnerable/susceptibleto natural hazards where the projectis located or near the project area(include map/s).Identify areas under CARP or withCADC / CADT where the project islocated or near the project area.Specify other conflicting tenurial /land issues (e.g., IFMA/CBFMAwithin COC and within MPSA, etc.)Slope and Elevation/TopographicMapRegional/General Geological MapGeological Maps as needed; Hazardmaps (NAMRIA, NDRRMC, MGB,PHIVOLCS, PAG-ASA)Summary of Soil InvestigationReport on soil type and quality;Erodibility potential; Bank stabilityAssessment of thecompatibility of theproposed project in relationto land use and/or thecoastal resourcemanagement plan of theLGU, if anyInclude discussions onimpacts/effects of naturalhazard on the project.USLE / similar modelingwhen applicable8 for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditions AnalysisPlanPage Page Page Page Remarks

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1.3.2 Change in soil quality/fertility1.4 Terrestrial Ecology1.4.1 Vegetation removal andloss of habitat1.4.2 Threat to existence and/orloss of important localspecies1.4.3 Threat to abundance,frequency and distributionof important species1.4.4 Hindrance to wildlifeaccess2. THE WATER2.1 Hydrology/Hydrogeology2.1.1 Change in drainagemorphology / Inducement offlooding/ Reduction in streamvolumetric flow2.1.2 Change in stream, lakewater depth2.1.3 Depletion of waterresources / competition in wateruseLaboratory results on soil sampleanalysis for N, P, K, pH, organicmatter, micronutrientsFlora and fauna species inventoryor survey report;Historical occurrences of pestinfestation, forest/grass fire and/orsimilar incidencesSummary of endemicity /conservation statusSummary of abundance,frequency and distributionEconomic importance and uses ofsignificant flora and faunaSampling / survey map in relation tothe project siteDrainage map; historicalflooding/drought occurrences,stream flowmeasurements/estimates;Delineation of watershed /subwatersheds/floodplain; andidentification of aquifers, if anyRegional hydrogeological mapIdentification of current / projectedwater use in the area and adjacentareasPhysical analysis (waterholding capacity;secondary data: chemicalanalysisQuadrat sampling for flora;Use of mist nets, traps,transect walk for faunaDiscuss possible impactsof the project on theoccurrence of flooding andvice versa. Considerextreme weather conditionsand the PAG-ASA 2020and 2050 climateprojectionsFor project with significantwater requirement, conductwater balance / budgetanalysis9 for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditions AnalysisPlanPage Page Page Page Remarks

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Spring and well inventory andlocation map; depth of water table for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditions AnalysisPlanPage Page Page Page Remarks2.2 Oceanography2.2.1 Change/disruption incirculation patternAnalysis/estimation of wateravailability taking into considerationthe PAG-ASA 2020 and 2050climate projectionsPredicted tides; 24-hour tidal cycles;Surface current system2.2.2 Change in bathymetry Bathymetric map USLE / similar modelingwhen applicable2.3 Water Quality2.3.1 Degradation ofgroundwater quality2.3.2 Degradation of surfacewater quality2.3.3 Degradation of coastal/marine water qualityPhysico-Chemical characterizationof water : pH BOD5 DO Oil and grease TSS fecal / total coliform pesticide analysis others:_________________________sampling site mapUse DENR standardmethods and proceduresfor sampling and analysis.For project withcoastal/marine structuresand /or significant marine /coastal discharges,conduct circulation / plumemodeling (include worstcase scenario of failure ofWWTF)2.4 Freshwater Ecology2.4.1 Threat to existenceand/or loss of importantlocal species and habitat2.4.2 Threat to abundance,Summary of endemicity/conservation statusAbundance of ecologically andeconomically important species10

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.frequency and distribution of (fishes, benthos, planktons);speciesPresence of pollution indicatorspecies; for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditions AnalysisPlanPage Page Page Page Remarks2.5 Marine Ecology3.5.1 Threat to existenceand/or loss of important localspecies and habitat2.5.2 Threat to abundance,frequency and distribution3. THE AIR3.1 Meteorology/Climatology3.1.1 Change in the localclimate, e.g., local temperaturesampling site mapAbundance/densities/distributionof ecologically and economicallyimportant species (mangroves,fishes, benthos, planktons, coralreefs, algae, seaweeds, seagrasses);Presence of pollution indicatorspecies;Historical occurrences of red-tide,fish kill or any related eventMarine resource mapsampling site mapMonthly average rainfall andtemperature of the area;Climatological normals/extremes;Wind rose diagrams; Frequency ofTropical cyclonesQuadrat, transect, lineintercept, spot dive,manta tow, marineresource characterization(e.g., municipal andcommercial fisheriesdata)In the assessment,consider the PAG-ASAclimate change projectionsfor 2020 and 2050.3.2 Air Quality (and Noise)3.2.1 Degradation of air quality characterization of ambient airquality: TSP PM10 SOxUse DENR standardmethods and proceduresfor sampling and analysis.11

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided. NOx others:_________________________ for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditions AnalysisPlanPage Page Page Page Remarks3.2.2 Increase in ambient noiselevel4. THE PEOPLE4.1 Displacement of settler/sDisplacement /disturbance of propertiesChange/conflict in landownershipChange/conflict in right ofway4.2 In-migrationProliferation of informalsettlers(for sampling methods refer to CleanAir Act)sampling site mapCharacterization of ambient noiselevelsampling site mapDemographic data of impact area:- Number of households andhousehold size- Land area,- Population,- Population density /growth- Gender and age profile,- Literacy rate, profile of educationalattainment,settlements mapCensus of population / property thatwill be displaced / disturbedUse DENR standardmethods and proceduresfor sampling andmeasurement.If applicable, noiseattenuation modeling(applicable if there issource capable ofgenerating 200 dB ormore)Discuss how the projectwould affect existingproperties in the area interms of relocation anddevaluationDiscuss the in-migrationpatterns as a result ofproject implementation12

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditions AnalysisPlanPage Page Page Page Remarks4.3 Cultural/Lifestyle change(especially on IndigenousPeoples, if any)4.4 Threat to delivery of basicservices /resource competition4.5 Threat to public health andsafetyHousing ownership profile /availability of housing/ number ofinformal settlersDemographic data on IndigenousPeoples (if any) and existingCulture/Lifestyle that may besignificantly affectedAvailability of public services interms of:Water supplyPower supplyCommunications/transportationHealthresources(Government and Private)Peace and order / crimeEducation facilitiesRecreational facilities /sports facilitiesStatistical data / information relatedto public services:Literacy rate, profile ofeducational attainmentMorbidity and mortalityrates (infants and adults -5-year trend)Common diseases in thearea including endemicdiseases;Environmental Health andSanitation Profile;Crime rateFood securityDiscuss the impacts on IPsand Culture/LifestyleDiscuss how the projectwould affect the delivery ofbasic services and mayresult in resourcecompetition in the areaDiscuss the projectimplementation’s threat topublic health vis-à-vis thebaseline health conditionsin the areaAnalysis of diseases thatmay be affected by climatechange.13

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.4.6 Generation of LocalBenefits from the projectEnhancement ofemployment andlivelihood opportunitiesIncreased businessopportunities andassociated economicactivitiesSocioeconomic data:Main sources of IncomeEmployment rate/ profileSources of livelihoodCommercial establishmentsand activitiesBanking and financialinstitutions for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditions AnalysisPlanPage Page Page Page RemarksIncreased revenue ofLGUs4.7 Traffic congestion Road network/ systemsExisting transportation/trafficsituationTraffic impact assessmentif applicable (includingcapacity of road system interms of load/count)14

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningIII.Environmental Risk AssessmentType of Risks Scope of Assessment Report/Output RequiredDuring scoping: Check () required/applicable items; items with are automatically required; write specific instructions ( if any)on the blanks/spaces provided.Safety Risks- Identification of conditions, events and ERA REQUIREMENTcircumstances which could be Release of toxic significant in bringing about identified Quantitative Risk Assessment(QRA)substances (e.g. safety risksammonia from cold - Description & assessment of theSpecific Instructions :storage facility) possible accident scenarios_____________________________- Assessment of whether the projectlocation is projected to have extreme Descriptive/Qualitative Riskclimate events for 2020 and/or 2050Assessmentthat could contribute to the triggeringidentified scenariosSpecific Instructions :- Description of the hazards, both____________________________immediate (acute effects) and delayed(chronic effects) for man and theEMERGENCY PLAN :environment posed by the release oftoxic substance, as applicableSpecific Instructions :__________________________ for completeness during procedural screening; page numbersshould be provided upon submission of the EISERA ERP MonitoringPlanRemarksPage Page Page Refer to Annex 2-7e for the decisioncriteria outline15

ECC APPLICATION SCREENING FORM FOR FOOD AND FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningNoted By: Signature SignatureReview Committee MembersEMB Representatives1. 1.2. 2.3. 3.4. Project Proponent:5.6. Project Preparer/Consultant:Resource Person1.16

OKAY FOR PRINTING: _____________________________________________ ________________________________Signature over Printed Name DateAnnex 1 - CECC APPLICATION FORM FOR NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningDate Submitted for Screening: _______________________________________________________________Form of Submission: ___ Hard ___ DigitalProject Title: _____________________________________________________________________________Project Location: _________________________________________________________________________Project Proponent: ________________________________________________________________________Address: ________________________________________________________________________________Contact No:Fax No:______________Contact Person:__________________________EIS Consultant: ___________________________________________________________________________Address: ________________________________________________________________________________Contact No: Fax No: Contact Person:__________________________Project Classification & Type: _______________________________________________________________Project Classification Code (Refer to RPM for DAO 2003-30): _____________________________________Project Size based on Classification: _________________________________________________________Date of Technical Scoping:______________________________________________________________Venue of Technical Scoping:_____________________________________________________________Checklist of Documentary RequirementsTo be filled-up upon submission of EISEnvironmental Impact Statement (EIS) 1Proof of Compatibility with the existing LandUse PlanProof of Authority over the Project SiteAccountability Statements of Preparers &Proponents (see Annexes 2-21 & 2-22 ofRevised Procedural Manual for DAO 2003-30)Photographs or plates of the project site,impact areas and affected areas andcommunitiesDuly Accomplished Project EnvironmentalMonitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d ofRevised Procedural Manual for DAO 2003-30)Acceptable?Yes NoScreening Officer’s RemarksACTION TAKEN: (Please check to indicate corresponding action taken)Document accepted; please submit __ copiesEIARC Needed? ( ) Yes ( ) No Expertise Needed:Processing Fee: PhP _______ (Pay at EMB Cashier) Review Fund: Based on WFP (Pay to the dulyauthorized 3 rd Party Review Fund Manager)Document not acceptedO.R. #DateNOTED BY:___________________________Screening Officer_________________________Section/Division ChiefEMB Regional OfficeScreening OfficeDate:_____________________________1 Please refer to attached checklist of EIS Contents1

Checklist of EIS ContentsI. Executive Summary (maximum of 5 pages)ECC APPLICATION FORM FOR NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningContentsPage #Acceptable?REMARKSProject Fact Sheet PD Summary (1 page)Process Documentation of the conduct of EIA (1 page) (EIA Team, EIAStudy Schedule & Area, EIA Methodology, Public Participation)Summary of Baseline Characterization, Key Environmental Impactsand Management & Monitoring Plan; and EMF Commitments (ifapplicable)Items to beDescribedSpecific Data RequirementPage #Acceptable?REMARKSII. I. Project Description1) Project Locationand Areaa) Map showing sitio, barangay, municipality,province, region boundaries, vicinity,proposed buffers surrounding the area andprimary & secondary impact areasb) Geographic coordinates (shape file data) ofproject area (use PRS 92 datum - GPSsetting)c) Rationale for selection of primary &secondary impact areasd) Discussion on the accessibility of the projectsite/area2) Project Rationale Cite and focus on the need for the projectbased on national and regional/localeconomic development in terms ofcontribution to sustainable developmentagenda or current development thrusts.Describe the justification for the Project withparticular reference to the economic andsocial benefits, including employment andassociated economic development, whichthe project may provide. The status of theproject should be discussed in a regionaland national context.3) ProjectAlternativesa) Cite criteria used in determining preliminaryoptions for facility siting, development design,process/technology selection, resourceutilization including discussion of theconsequences of not proceeding with theproject:Contextualize site selection in terms ofvulnerability/susceptibility to liquefaction,ground shaking, ground rupture,earthquake-induced landslides, volcaniceruptions, rain-induced landslide, stormsurge, tsunami, and flooding as well asextreme climatologic conditions (data canbe obtained from NDRRMC and NAMRIA2

ECC APPLICATION FORM FOR NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data RequirementPage #Acceptable?REMARKSas well as mandated agencies)Discuss the alternatives (type andlocation) considered and nominatedduring the course of selecting the bestoption for which the EIS is prepared;Describe the bases upon which thealternatives were rejected in favor of thepreferred option;Describe the significant differences inenvironmental impacts among thealternatives considered.Siting: Cite alternative project locationsincluding factors significant to the selectionsuch as perception of affected communitieswith regards to project, ancestral domainissues, land classification, etc. Discuss otheroptions on the siting of major components ofthe project within the project area.Technology Selection/Operation Processes:Discuss the project’s advantage overalternative technologies, operation processesand engineering designDiscuss alternative measures to preventoccurrence of major impactsResources: Discuss the alternativesconsidered in the course of selecting thepower/water requirements as well as rawmaterials, and how the decisions were madein favor of the preferred resource. Discussthe sustainability of the raw materials/inputsto be tapped and transportation plan of rawmaterials.b) Reasons for selecting the preferred optionsdelineated in terms of technical, commercial,social and natural environmental aspectsc) After determining the preliminary options,please provide a summary of the comparativeenvironmental impacts of each alternative4) ProjectComponentsIdentification of major components (includingtechnical details, such as areaplanted/cultivated, specifications, capacity,number, etc.)Specify the operations and processIdentification of other Support Facilities (e.g.,energy/power source, water supply system,etc.)Identification of materials/product handlingfacilities, infrastructure requirements(transport — road/rail/ship, energy, watersupply and storage, storm water drainage,sewerage,telecommunications,3

ECC APPLICATION FORM FOR NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribed5) Process/TechnologySpecific Data Requirementaccommodation and other infrastructure)Identification of Pollution Control devices andcorresponding facility being served orconnected.Identification of waste management facilitiesand devices to address solid waste materials(domestic and hazardous and chemicals) airemissions, solid waste disposal, andwastewaterGeneral layout of facilitiesFootprint of proposed layout of projectfacilities (if any)Maps should be provided showing theprecise location of the project area, and inparticular, the location and boundaries ofproject area, location and footprint of projectcomponents, and location of all proposedbuffers.When applicable, contextualize using thePAG-ASA 2020 and 2050 projectedrainfall/temperature data.Indicative process flow-sheets showingmaterial balances for the processing plant, andthe anticipated rates of inputs, along withsimilar data on products, wastes and recyclestreamsPower & water supply systemPage #Acceptable?REMARKSWaste Management Systems (e.g., wastewatertreatment facility, baghouse filter, desulfurizer,other pollution control devices6) Project Size Daily/Monthly/Annual production rate (refer toAnnex 2-1b)Total Project Area in square meters or hectares7) DevelopmentPlan, Descriptionof Project PhasesandCorrespondingTimeframesPhases to be described in terms of identifyingspecific activities (with special attention onthose with significant environmental impacts aswell as climate change adaptation optionsrelevant to the project and project activities)and corresponding projected implementationtimeframes:Pre-construction (e.g., planning, acquisitionof rights to use land, etc.)Construction (e.g., land/site clearing,temporary housing, transport of materials,health and other services for the workforce)Operation (projected period of startup/commissioning/fulloperation of variousproject components) include discussion onthe operation of various components (asidentified above) in terms of material/producthandling, infrastructure requirements(transport—road/rail/ship, energy, watersupply and storage, storm water drainage,sewerage,telecommunications,4

ECC APPLICATION FORM FOR NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data Requirementaccommodation and other infrastructure),waste management (character and quantitiesof waste materials, air emissions, Solidwaste disposal, wastewater)Abandonment Final Rehabilitation/Decommissioning Plan, to include land/soilrestoration, procedures, and projectedschedule. The land use suitability of thevarious land disturbance types should alsobe described.Page #Acceptable?REMARKSThe proposed decommissioning plan should bein terms of the following:Procedures for the decommissioning of theproject components;Transport/disposal of equipment and othermaterials used in the plant’s operation;Alternatives for the future use of abandonedarea;Consistency with long-term zoning and landuse development plan of the municipality;Rehabilitation plans, if any8) Manpower Tabulate the following per project phase:manpower requirements;expertise/skills needed;nature & estimated number of jobs availablefor men, women, and indigenous peoples (ifsited in IP ancestral land);preferred scheme for sourcing locally fromhost and neighboring LGUs9) Indicative Project Investment Cost (Philippine Peso)General Contents Specific Content Requirement Page # Acceptable? REMARKSII. KeyEnvironmentalImpacts andManagement/Monitoring PlanIII. EnvironmentalRisk AssessmentIV. ImpactManagement PlanV. SocialDevelopment Plan(SDP) and IECSee attached checklist of contentsWhen applicable, include appropriate climatechange adaptation measures/options(embedded in each sector).See attached checklist of contentsLimit to most significant impacts per projectphase and per environmental componentarising from key environmental aspects (SeeAnnex 2-17 of RPM for DAO 2003-30)SDP (if applicable)Community development or livelihood5

ECC APPLICATION FORM FOR NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral Contents Specific Content Requirement Page # Acceptable? REMARKSFramework programs/activities, projected beneficiaries,partner institutions, timeframe ofimplementation as well as source and amountallotted per activity/component (See Annex 2-18 of RPM for DAO 2003-30)IEC (if applicable)Target sector, key messages,scheme/strategy/methods, Informationmedium, timelines and frequency, cost (SeeAnnex 2-19 of RPM for DAO 2003-30)VI. EnvironmentalComplianceMonitoringEnvironmental Monitoring Plan ( SelfMonitoring)Use Annex 2-20 of RPM for DAO 2003-30 astemplateMulti-Sectoral Monitoring Framework / (ifapplicable)Tabulate the list of stakeholder-members of theMMT, basis of selection, proposed role, andscope of MMT responsibilities and activities,etc. (See Annex 3-4 of the RPM for DAO 2003-30).Environmental Guarantee and Monitoring FundCommitments (if applicable)VII. EmergencyPreparedness andResponse Policyand GenericGuidelinesVIII. Abandonment/Decommissioning/Rehabilitation PolicyIX. Institutional Planfor EMPImplementationPresent a proposed amount of EMF(based on a draft AWFP in Annex 3-4 andconsistent with guidelines in Annex 3-5 ofRPM for DAO 2003-30); andPresent a proposed amount of EGF andthe basis for the estimate following theguidelines in Annex 3-6 of RPM for DAO2003-30The safety policy and generic guidelines shouldbe consistent with the regulatory requirements.Emergency Preparedness should also considernatural hazards to the infrastructures andfacilities.Statement on proponent’s policies and genericprocedures for Decommissioning/Abandonment.Discuss the organizational scheme of theproponent including line of command andreporting procedures as well as manpowercomplement and relationships with otheroperating departments.6

ECC APPLICATION FORM FOR PROPOSED NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Checklist of EIS ContentsKey Environmental Impacts and Management/Monitoring PlanList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1. THE LAND1.1 Land Use and Classification1.1.1 Change/Inconsistency in Description & Map showing the projectland usearea in relation to existing land use.1.1.2 Encroachment inEnvironmentally Critical Areas(ECAs)1.1.3 Possible tenurial / landissueIdentify ECA where the project islocated or near the project area.Identify areas vulnerable/susceptible tonatural hazards where the project islocated or near the project area(include map/s).Identify areas under CARP or withCADC/ CADT where the project islocated or near the project area.Assessment of thecompatibility of theproposed project inrelation to land use and/orthe coastal resourcemanagement plan of theLGU, if any.Control No: __________ 1 st 2 nd 3 rd ___ th Screening for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditions AnalysisPlanPage Page Page Page 1.2 Geology/Geomorphology1.2.1 Change in surfacelandform/ topography/terrain/slope1.2.2Change in sub-surface/undergroundgeomorphology1.2.3 Inducement of subsidence,liquefaction, landslides,mud / debris flow, etc.1.3 Pedology1.3.1 Soil erosion / Loss oftopsoil/overburdenSpecify other conflicting tenurial / landissues (e.g., IFMA/CBFMA within COCand within MPSA, etc.)Slope and Elevation/Topographic MapRegional/General Geological MapGeological Maps as needed; Hazardmaps (NAMRIA, NDRRMC, MGB,PHIVOLCS, PAG-ASA)Summary of Soil Investigation Reporton soil type and quality; Erodibilitypotential; Bank stabilityInclude discussions onimpacts/effects of naturalhazard on the project.USLE / similar modelingwhen applicable1.4 Terrestrial Ecology7

ECC APPLICATION FORM FOR PROPOSED NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1.4.1 Vegetation removal and Flora and fauna species inventory or Quadrat sampling forloss of habitatsurvey report;floraHistorical occurrences of pestinfestation, forest/grass fire and/orsimilar incidences1.4.2 Threat to existence and/or Summary of endemicity / conservation Use of mist nets, traps,loss of important local statustransect walk for faunaspecies1.4.3Threat to abundance,frequency and distributionof important species1.4.4 Hindrance to wildlifeaccess2. THE WATER2.1 Hydrology/Hydrogeology2.1.1 Change in drainagemorphology / Inducement offlooding/ Reduction in streamvolumetric flow2.1.2 Change in stream, lakewater depth2.1.3 Depletion of waterresources / competition in wateruseSummary of abundance, frequencyand distributionEconomic importance and uses ofsignificant flora and faunaSampling / survey map in relation tothe project siteDrainage map; historicalflooding/drought occurrences, streamflow measurements/estimates;Delineation of watershed /subwatersheds/floodplain; andidentification of aquifers, if anyRegional hydrogeological mapIdentification of current / projectedwater use in the area and adjacentareasSpring and well inventory and locationmap; depth of water tableAnalysis/estimation of water availabilitytaking into consideration the PAG-ASA2020 and 2050 climate projectionsDiscuss possible impactsof the project on theoccurrence of floodingand vice versa. Considerextreme weatherconditions and the PAG-ASA 2020 and 2050climate projectionsFor project with significantwater requirement,conduct water balance /budget analysis for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditions AnalysisPlanPage Page Page Page 2.2 Oceanography2.2.1 Change/disruption in Predicted tides; 24-hour tidal cycles;8

ECC APPLICATION FORM FOR PROPOSED NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.circulation patternSurface current system2.2.2 Change in bathymetry Bathymetric map USLE / similar modelingwhen applicable2.3 Water Quality2.3.1 Degradation ofgroundwater quality2.3.2 Degradation of surfacewater quality2.3.3 Degradation ofcoastal/marine water qualityPhysico-Chemical characterization ofwater : pH BOD5 COD DO Oil and grease TSS Heavy Metals :_______________fecal / total coliform others:__________________________sampling site mapUse DENR standardmethods and proceduresfor sampling and analysis.For project withcoastal/marine structuresand /or significant marine/coastal discharges,conduct circulation /plume modeling (includeworst case scenario offailure of WWTF)For project with significantheavy metals discharges,conduct sedimenttransport modeling for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditions AnalysisPlanPage Page Page Page 2.4 Freshwater Ecology2.4.1 Threat to existence and/orloss of important local speciesand habitat2.4.2 Threat to abundance,frequency and distribution ofspecies2.5 Marine Ecology2.5.1 Threat to existence and/orloss of important local speciesand habitatSummary of endemicity /conservation statusAbundance of ecologically andeconomically important species(fishes, benthos, planktons)Presence of pollution indicatorspeciessampling site mapAbundance/densities/distribution ofecologically and economicallyimportant species (mangroves,fishes, benthos, planktons, coralreefs, algae, seaweeds, seagrasses);Presence of pollution indicatorQuadrat, transect, lineintercept, spot dive,manta tow, marineresource 9characterization (e.g.,municipal andcommercial fisheries

ECC APPLICATION FORM FOR PROPOSED NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.2.5.1 Threat to existence and/orloss of important local speciesand habitat3. THE AIR3.1 Meteorology/Climatology3.1.1 Change in the local climate,e.g., local temperatureMonthly average rainfall andtemperature of the area; Climatologicalnormals/extremes; Wind rosediagrams; Frequency of TropicalcyclonesIn the assessment,consider the PAG-ASAclimate changeprojections for 2020 and2050. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditions AnalysisPlanPage Page Page Page 3.1.2 Contribution in terms ofgreenhouse gas emissionsData on Greenhouse gasses (i.e.carbon dioxide, methane, nitrousoxide); Calculation of projected GHGemission3.2 Air Quality (and Noise)3.2.1 Degradation of air quality Characterization of ambient air quality: TSP PM10 SOx NOx Trace Metals:____________________ others:__________________________(for sampling methods refer to CleanAir Act)3.2.2 Increase in ambient noiselevelsampling site mapCharacterization of ambient noise levelsampling site mapDiscuss the project’scontribution in terms ofgreenhouse gasemissions (applicable forpower and landfill andpossible for mining anddam)Use DENR standardmethods and proceduresfor sampling and analysis.If applicable airdispersion modeling(include worst casescenario of failure ofAPCD)Heavy metals (baselineand modeling) apply toselected chemicalindustriesUse DENR standardmethods and proceduresfor sampling and10

ECC APPLICATION FORM FOR PROPOSED NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.measurement. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditions AnalysisPlanPage Page Page Page If applicable, noiseattenuation modeling(applicable if there is asource capable ofgenerating 200 dB ormore)4. THE PEOPLE4.1 Displacement of settler/sDisplacement / disturbanceof propertiesChange/conflict in landownershipChange/conflict in right ofway4.2 In-migrationProliferation of informalsettlers4.3 Cultural/Lifestyle change(especially on IndigenousPeoples, if any)4.4 Threat to delivery of basicservices /resource competitionDemographic data of impact area:- Number of households andhousehold size- Land area,- Population,- Population density /growth- Gender and age profile,- Literacy rate, profile of educationalattainment,Settlements mapCensus of population / property thatwill be displaced / disturbedHousing ownership profile / availabilityof housing/ number of informal settlersDemographic data on IndigenousPeoples (if any) and existingCulture/Lifestyle that may besignificantly affectedAvailability of public services in termsof:Water supplyDiscuss how the projectwould affect existingproperties in the area interms of relocation anddevaluationDiscuss the in-migrationpatterns as a result ofproject implementationDiscuss the impacts onIPs and Culture/LifestyleDiscuss how the projectwould affect the deliveryof basic services and may11

ECC APPLICATION FORM FOR PROPOSED NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Power supplyresult in resourceCommunicationscompetition in the area/transportationHealth resources4.5 Threat to public health and(Government and Private) Discuss the projectsafetyPeace and order / crime implementation’s threat toEducation facilitiespublic health vis-à-vis theRecreational facilities / sports baseline health conditionsfacilitiesin the area for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditions AnalysisPlanPage Page Page Page Statistical data / information related topublic services:Literacy rate, profile ofeducational attainmentMorbidity and mortality rates(infants and adults - 5-yeartrend)Common diseases in the areaincluding endemic diseases;Environmental Health andSanitation Profile;Crime rateFood securityAnalysis of diseases thatmay be affected byclimate change.4.6 Generation of Local Benefitsfrom the projectEnhancement ofemployment and livelihoodopportunitiesIncreased businessopportunities andassociated economicactivitiesSocioeconomic data:Main sources of IncomeEmployment rate/ profileSources of livelihoodCommercial establishmentsand activitiesBanking and financialinstitutions12

ECC APPLICATION FORM FOR PROPOSED NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Increased revenue ofLGUs for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditions AnalysisPlanPage Page Page Page 4.7 Traffic congestion Road network/ systemsExisting transportation/traffic situationTraffic impactassessment if applicable(including capacity ofroad system in terms ofload/count)13

ECC APPLICATION FORM FOR PROPOSED NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningIII. Environmental Risk AssessmentType of Risks Scope of Assessment Report/Output RequiredDuring scoping: Check () required/applicable items; items with are automatically required; write specific instructions ( ifany) on the blanks/spaces provided.Safety Risks- Identification of conditions, events and ERA REQUIREMENTcircumstances which could be significant in Firebringing about identified safety risks Quantitative Risk Explosion- Description & assessment of the possible Assessment(QRA) Release of toxic accident scenariossubstances- Assessment of whether the project location Specific Instructions :is projected to have extreme climateevents for 2020 and/or 2050 that could __________________________contribute to the triggering identifiedscenariosDescriptive/Qualitative Risk- Description of the hazards, both immediate Assessment(acute effects) and delayed (chroniceffects) for man and the environmentSpecific Instructions :posed by the release of toxic substance,as applicable____________________________ Physical Risks(Failure of Structure whichcould endanger life, propertyand/or the environment)- Identification of conditions, events and“trigger” which could be significant inbringing about identified physical risks- Description & assessment of the possibleaccident scenarios- Assessment of whether the project locationis projected to have extreme climateevents for 2020 and/or 2050 that couldcontribute to the triggering identifiedscenarios- Description of the hazards both immediate(acute effects) and delayed (chroniceffects) for man and the environmentposed by the failure of structure, asapplicable EMERGENCY PLAN :Specific Instructions :____________________________Refer to Annex 2-7e for thedecision criteria outline for completeness during procedural screening; page numbersshould be provided upon submission of the EISERA ERP MonitoringRemarksPlanPage Page Page 14

ECC APPLICATION FORM FOR PROPOSED NON-FOOD MANUFACTURING PLANTS PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningNoted By: Signature SignatureReview Committee MembersEMB Representatives1. 1.2. 2.3. 3.4. Project Proponent:5.6. Project Preparer/Consultant:Resource Person1.15

OKAY FOR PRINTING: _____________________________________________ ________________________________Signature over Printed Name DateAnnex 1 - DECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningDate Submitted for Screening: _______________________________________________________________Form of Submission: ___ Hard ___ DigitalProject Title: _____________________________________________________________________________Project Location: _________________________________________________________________________Project Proponent: ________________________________________________________________________Address: ________________________________________________________________________________Contact No:Fax No:______________Contact Person:__________________________EIS Consultant: ___________________________________________________________________________Address: ________________________________________________________________________________Contact No: Fax No: Contact Person:__________________________Project Classification & Type: _______________________________________________________________Project Classification Code (Refer to RPM for DAO 2003-30): _____________________________________Project Size based on Classification: _________________________________________________________Date of Technical Scoping:______________________________________________________________Venue of Technical Scoping:_____________________________________________________________Checklist of Documentary RequirementsTo be filled-up upon submission of EISAcceptable?Yes NoScreening Officer’s RemarksEnvironmental Impact Statement (EIS) 1Proof of Compatibility with the existing LandUse PlanProof of Authority over the Project SiteAccountability Statements of Preparers &Proponents (see Annexes 2-21 & 2-22 ofRevised Procedural Manual for DAO 2003-30)Photographs or plates of the project site,impact areas and affected areas andcommunitiesDuly Accomplished Project EnvironmentalMonitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d ofRevised Procedural Manual for DAO 2003-30)ACTION TAKEN: (Please check to indicate corresponding action taken)Document accepted; please submit __ copiesEIARC Needed? ( ) Yes ( ) No Expertise Needed:Processing Fee: PhP _______ (Pay at EMB Cashier) Review Fund: Based on WFP (Pay to the dulyauthorized 3 rd Party Review Fund Manager)Document not acceptedO.R. #DateNOTED BY:____________________________________________________Screening OfficerSection/Division ChiefEMB Regional OfficeScreening OfficeDate:1

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Checklist of EIS ContentsI. Executive Summary (maximum of 5 pages)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningContents Page # Acceptable?REMARKSProject Fact Sheet PD Summary (1 page)Process Documentation of the conduct of EIA (1 page) (EIA Team, EIAStudy Schedule & Area, EIA Methodology, Public Participation)Summary of Baseline Characterization, Key Environmental Impacts andManagement & Monitoring Plan, and EMF Commitments (if applicable)Items to beDescribedII. I. Project DescriptionSpecific Data Requirement Page # Acceptable?REMARKS1) Project Locationand Areaa) Map showing sitio, barangay, municipality,province, region boundaries, vicinity,proposed buffers surrounding the area andprimary & secondary impact areasb) Geographic coordinates (shape file data) ofproject area (use PRS 92 datum - GPSsetting)c) Rationale for selection of primary &secondary impact areasd) Discussion on the accessibility of the projectsite/area2) Project Rationale Cite and focus on the need for the projectbased on national and regional/localeconomic development in terms ofcontribution to sustainable developmentagenda or current development thrusts.Describe the justification for the project withparticular reference to the economic andsocial benefits, including employment andassociate economic development which theproject may provide. The status of theproject should be discussed in a regionaland national context.2

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribed3) ProjectAlternativesSpecific Data Requirement Page # Acceptable?a) Cite criteria used in determining preliminaryoptions for facility siting, development design,process/technology selection, resourceutilization including discussion of theconsequences of not proceeding with theproject:Contextualize site selection in terms ofvulnerability/susceptibility to liquefaction,ground shaking, ground rupture,earthquake-induced landslides, volcaniceruptions, rain-induced landslide, stormsurge, tsunami, and flooding as well asextreme climatologic conditions (data canbe obtained from NDRRMC and NAMRIAas well as other mandated agencies).Discuss the alternatives (type andlocation) considered and nominatedduring the course of selecting the bestoption for which the EIS is prepared.Describe the bases upon which thealternatives were rejected in favor of thepreferred option.Describe the significant differences inenvironmental impacts among thealternatives considered.Siting: Cite alternative project locationsincluding factors significant to the selection,such as perception of affected communitieswith regards to project, ancestral domainissues, land classification, etc. Discuss otheroptions on the siting of major components ofthe project within the project area. Discussalternative location of access roads in casethe preferred locations of the variouscomponents are found environmentally notfeasible.Technology Selection/Operation Processes:Discuss the project’s advantage overalternative technologies, operation processesand engineering design.Discuss alternative measures to preventoccurrence of major impactsResources: Discuss the alternativesconsidered in the course of selecting thepower/water requirements as well as rawmaterials, and how the decisions were madein favor of the preferred resource. Discuss thesustainability of the raw materials/inputs to betapped and transportation plan of rawmaterials.b) Cite reasons for selecting the preferredoptions delineated in terms of technical,commercial, social and natural environmentalaspects.REMARKS3

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribed4) ProjectComponents5) Process/TechnologySpecific Data Requirement Page # Acceptable?c) After determining the preliminary options,please provide a summary of the comparativeenvironmental impacts of each alternative.Identification of major components includingtechnical details specifications, capacity,number (e.g., area planted/cultivated,nursery, etc.) as well as processing facility, ifany (e.g., sawmill, veneer, plywood, etc.)Identification of other Support Facilities (e.g.energy/power source, water supply system,etc.)Identification of materials/product handlingfacilities, infrastructure requirements(transport — road/rail/ship, energy, watersupply and storage, storm water drainage,sewerage,telecommunications,accommodation and other infrastructure)Identification of Pollution Control devices andcorresponding facility being served orconnected.Identification of waste management facilitiesand devices to address solid waste materials(domestic and hazardous and chemicals) airemissions, solid waste disposal, andwastewaterGeneral layout of facilitiesFootprint of proposed layout of projectfacilities (if any)Maps should be provided showing the preciselocation of the project area, and in particular,the location and boundaries of project area,location and footprint of project components,and location of all proposed buffers.When applicable, contextualize using thePAG-ASA 2020 and 2050 projectedrainfall/temperature data.Indicative process flow-sheets showing materialbalances for the processing plant, and theanticipated rates of inputs, along with similardata on products, wastes and recycle streamsPower & water supply systemREMARKSWaste Management Systems (wastewatertreatment facility, dust collector, etc.)When applicable, consider the PAG-ASA2020 and 2050 projected rainfall data.6) Project Size Volume of trees to be cut and, if withprocessing, indicate annual production rate.Total Project Area in square meters or hectares7) DevelopmentPlan, Descriptionof Project PhasesandCorrespondingTimeframesPhases to be described in terms of identifyingspecific activities (with special attention onthose with significant environmental impacts aswell as climate change adaptation optionsrelevant to the project and project activities) and4

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data Requirement Page # Acceptable?corresponding projected implementationtimeframes:Pre-construction (e.g., planning, acquisitionof rights to use land, etc.)Construction (e.g., land/site clearing,temporary housing, transport of materials,health and other services for the workforce)Operation (projected period of startup/commissioning/fulloperation of variousproject components) include discussion onthe operation of various components (asidentified above) in terms of material/producthandling, infrastructure requirements(transport—road/rail/ship, energy, watersupply and storage, storm water drainage,sewerage,telecommunications,accommodation and other infrastructure),waste management (character and quantitiesof waste materials, air emissions, solid wastedisposal, wastewater)Abandonment Final Rehabilitation/Decommissioning Plan, to include land/soilrestoration and procedures and projectedschedule. The land use suitability of thevarious land disturbance types should also bedescribed.REMARKSInclude also the proposed decommissioningplan in terms of the following:Procedures for the decommissioning of theproject components;Transport/disposal of equipment and othermaterials used in the plant’s operation;Alternatives for the future use of abandonedarea;Consistency with long-term zoning and landuse development plan of the municipality;Rehabilitation plans, if any8) Manpower Tabulate the following per project phase:manpower requirements;expertise/skills needed;nature and estimated number of jobsavailable for men, women, and indigenouspeoples (if sited in IP ancestral land);preferred scheme for sourcing locally fromhost and neighboring LGUs9) Indicative Project Investment Cost (Philippine Peso)5

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral ContentsSpecific Content RequirementPage #Acceptable?REMARKSII. KeyEnvironmentalImpacts andManagement/Monitoring PlanSee attached checklist of contentsWhen applicable, include appropriate climatechange adaptation measures/options(embedded in each sector).III. EnvironmentalRisk AssessmentSee attached checklist of contentsIV. ImpactManagement PlanLimit to most significant impacts per projectphase and per environmental componentarising from key environmental aspects (SeeAnnex 2-17 of RPM for DAO 2003-30)V. SocialDevelopment Plan(SDP) and IECFrameworkSDPCommunity development or livelihoodprograms/activities, projected beneficiaries,partner institutions, timeframe ofimplementation as well as source and amountallotted per activity/component (See Annex 2-18 of RPM for DAO 2003-30)IECTarget sector, key messages,scheme/strategy/methods, Information medium,timelines and frequency, cost (See Annex 2-19of RPM for DAO 2003-30)VI. EnvironmentalComplianceMonitoringSelf-Monitoring PlanUse Annex 2-20 of RPM for DAO 2003-30 astemplateMulti-Sectoral Monitoring Framework / (ifapplicable)Tabulate the list of stakeholder-members of theMMT, basis for selection, proposed role, andscope of MMT responsibilities and activities,etc. (See Annex 3-4 of the RPM for DAO 2003-30).Environmental Guarantee and Monitoring FundCommitments (if applicable)Present a proposed amount of EMF (basedon a draft AWFP in Annex 3-4 andconsistent with guidelines in Annex 3-5 ofRPM for DAO 2003-30); andPresent a proposed amount of EGF andthe basis for the estimate following the6

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral ContentsSpecific Content RequirementPage #Acceptable?REMARKSVII. EmergencyPreparedness andResponse Policyand GenericGuidelinesguidelines in Annex 3-6 of RPM for DAO2003-30The safety policy and generic guidelines shouldbe consistent with the regulatory requirements.Emergency Preparedness should also considernatural hazards to the infrastructures andfacilities.VIII. Abandonment/Decommissioning/Rehabilitation PolicyStatement on proponent’s policies and genericprocedures for Rehabilitation/Decommissioning/Abandonment to besubmitted as post-ECC, within a timeframespecified in the ECC.IX. Institutional Planfor EMPImplementationDiscuss the organizational scheme of theproponent including line of command andreporting procedures as well as manpowercomplement and relationships with otheroperating departments.7

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningChecklist of EIS ContentsKey Environmental Impacts and Management/Monitoring PlanList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1. THE LAND1.1 Land Use and Classification1.1.1 Change/Inconsistency in land Description & Map showing theuseproject area in relation to existing land1.1.2 Encroachment inEnvironmentally CriticalAreas (ECAs)use.Identify ECA where the project islocated or near the project area.Identify areas vulnerable/susceptibleto natural hazards where the projectis located or near the project area(include map/s).1.1.3 Possible tenurial / land issue Identify areas under CARP or withCADC / CADT where the project islocated or near the project area.Specify other conflicting tenurial / landissues (e.g., IFMA/CBFMA withinCOC and within MPSA, etc.)1.2 Geology/Geomorphology1.2.1 Change in surface landform/topography/ terrain/slope1.2.2 Change in sub-surface/underground geomorphology1.2.3 Inducement of subsidence,liquefaction, landslides, mud /debris flow, etc.1.3 Pedology1.3.1 Soil erosion / Loss oftopsoil/overburdenSlope and Elevation/TopographicMapRegional/General Geological MapGeological Maps as needed; HazardMaps (NAMRIA, NDRRMC, MGB,PHIVOLCS, PAG-ASA)Summary of Soil Investigation Reporton soil type and quality; Erodibilitypotential; Bank stability;1.3.2 Change in soil quality/fertility Laboratory results on soil sampleanalysis for N, P, K, pH, organicmatter, micronutrientsAssessment of thecompatibility of theproposed project inrelation to land useand/or the coastalresource managementplan of the LGU, if anyInclude discussions onimpacts/effects of naturalhazard on the project.USLE / similar modelingwhen applicablePhysical analysis (waterholding capacity for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditions Analysis Plan PlanPage Page Page Page Remarks8

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1.4 Terrestrial Ecology1.4.1 Vegetation removal and loss Flora and fauna species inventory Quadrat sampling forof habitator survey reportflora1.4.2 Threat to existence and/orloss of important local species1.4.3Threat to abundance,frequency and distribution ofimportant speciesHistorical occurrences of pestinfestation, forest/grass fire and/orsimilar incidencesSummary of endemicity /conservation statusSummary of abundance, frequencyand distributionEconomic importance and uses ofsignificant flora and fauna1.4.4 Hindrance to wildlife access Sampling / survey map in relation tothe project site2. THE WATER2.1. Hydrology/Hydrogeology2.1.1 Change in drainagemorphology/Inducement offlooding/ Reduction in streamvolumetric flow2.1.2 Change in stream, lake waterdepth2.1.3 Depletion of water resources /competition in water useDrainage map; historicalflooding/drought occurrences, streamflow measurements/estimates;Delineation of watershed /subwatersheds/floodplain; andidentification of aquifers, if anyRegional hydrogeological mapIdentification of current / projectedwater use in the area and adjacentareasUse of mist nets, traps,transect walk for faunaInclude discussions onoverall impact to floraand faunaInclude impactassessment onvegetation (e.g.,likelihood of destruction)and specificmanagement measures(e.g., protection, balling,transplanting,replacement, etc.)Discuss possible impactsof the project on theoccurrence of floodingand vice versa. Considerextreme weatherconditions and the PAG-ASA 2020 and 2050climate projections for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks9

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Spring and well inventory and locationmap; depth of water table for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks2.2 Oceanography2.2.1 Change/disruption incirculation patternAnalysis/estimation of wateravailability taking into considerationthe PAG-ASA 2020 and 2050 climateprojectionsPredicted tides; 24-hour tidal cycles;Surface current system2.2.2 Change in bathymetry Bathymetric map USLE / similar modelingwhen applicable2.3 Water Quality2.3.1 Degradation of groundwaterquality2.3.2 Degradation of surface waterquality2.3.3Degradation of coastal/marinewater quality2.4 Freshwater Ecology2.4.1 Threat to existence and/orloss of important local speciesand habitatPhysico-Chemical characterization ofwater : pH DO Oil and grease TSS others:__________________________sampling site mapSummary of endemicity /conservation statusAbundance of ecologically andeconomically important species(fishes, benthos, planktons);Presence of pollution indicatorspeciesUse DENR standardmethods and proceduresfor sampling andanalysis.For projects withcoastal/marine structuresand /or significantmarine / coastaldischarges, conductcirculation / plumemodeling (include worstcase scenario of failureof WWTF)Include discussions onoverall impact tofreshwater ecology10

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks2.5 Marine Ecology (if applicable)2.5.1 Threat to existence and/orloss of important local species andhabitat2.5.2 Threat to abundance,frequency and distribution3. THE AIR3.1 Meteorology/Climatology3.1.1 Change in the local climate,e.g., local temperature3.1.2 Contribution in terms ofgreenhouse gas emissions/sequestration3.2 Air Quality (and Noise)3.2.1 Degradation of air quality, ifwith processingsampling site mapAbundance/densities/distribution ofecologically and economicallyimportant species (mangroves,fishes, benthos, planktons, coralreefs, algae, seaweeds, seagrasses);Presence of pollution indicatorspecies;Historical occurrences of red tide,fish kill or any related eventMarine resource mapsampling site mapMonthly average rainfall andtemperature of the area;Climatological normals/extremes;Wind rose diagrams; Frequency ofTropical cyclonesData on Greenhouse gasses (i.e.,carbon dioxide, methane, nitrousoxide); Calculation of projected GHGemission/sequestrationCharacterization of ambient airquality: TSP SOx NOxQuadrat, transect, lineintercept, spot dive,manta tow, marineresourcecharacterization(e.g., municipal andcommercial fisheriesdata)Include discussions onoverall impact to marineecologyIn the assessment,consider the PAG-ASAclimate changeprojections for 2020 and2050.Discuss the project’scontribution in terms ofgreenhouse gasemissions/sequestrationUse DENR standardmethods and proceduresfor sampling andanalysis.11

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.(for sampling methods, refer to CleanAir Act) for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks3.2.2 Increase in ambient noiselevel4. THE PEOPLE4.1 Displacement of settler/sDisplacement / disturbance ofpropertiesChange/conflict in landownershipChange/conflict in right of waysampling site mapCharacterization of ambient noiselevelsampling site mapDemographic data of impact area:- Number of households andhousehold size- Land area,- Population,- Population density /growth- Gender and age profile,- Literacy rate, profile of educationalattainment,Settlements mapCensus of population / property thatwill be displaced / disturbedHousing ownership profile /availability of housing/ number ofinformal settlersUse DENR standardmethods and proceduresfor sampling andmeasurement.If applicable, noiseattenuation modeling(applicable if there issource capable ofgenerating 200 dB ormore)Discuss how the projectwould affect existingproperties in the area interms of relocation anddevaluation12

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.4.2 In-migrationDiscuss the in-migrationpatterns as a result ofProliferation of informalproject implementationSettlers4.3 Cultural/Lifestyle change(especially on Indigenous Peoples,if any)4.4 Threat to delivery of basicservices /resource competition4.5 Threat to public health andsafetyDemographic data on IndigenousPeoples (if any) and existingCulture/Lifestyle that may besignificantly affectedAvailability of public services in termsof:Water supplyPower supplyCommunications/transportationHealth resources (Governmentand Private)Peace and order / crimeEducation facilitiesRecreational facilities / sportsfacilitiesStatistical data / information related topublic services:Literacy rate, profile ofeducational attainmentMorbidity and mortality rates(infants and adults - 5-yeartrend)Common diseases in thearea including endemicdiseasesEnvironmental Health andSanitation ProfileCrime rateFood securityDiscuss the impacts onIPs and Culture/LifestyleDiscuss how the projectwould affect the deliveryof basic services andmay result in resourcecompetition in the areaDiscuss the projectimplementation’s threatto public health vis-à-visthe baseline healthconditions in the areaAnalysis of diseases thatmay be affected byclimate change. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks13

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.4.6 Generation of Local Benefitsfrom the projectEnhancementofemployment and livelihoodopportunitiesIncreased businessopportunities and associatedeconomic activitiesSocioeconomic data:Main sources of IncomeEmployment rate/ profileSources of livelihoodCommercial establishmentsand activitiesBanking and financialinstitutions for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page RemarksIncreased revenue of LGUs4.7 Traffic congestion Road network/ systemsExisting transportation/traffic situationTraffic impactassessment if applicable(including capacity ofroad system in terms ofload/count)14

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningIII.Environmental Risk AssessmentType of Risks Scope of Assessment Report/Output RequiredDuring scoping: Check () required/applicable items; items with are automatically required; write specific instructions ( ifany) on the blanks/spaces provided.Safety Risks Fire Release of toxicsubstances Physical Risks(Failure of Structure whichcould endanger life, propertyand/or the environment)- Identification of conditions, events andcircumstances which could be significant inbringing about identified safety risks- Description & assessment of the possibleaccident scenarios- Assessment of whether the project location isprojected to have extreme climate events for2020 and/or 2050 that could contribute to thetriggering identified scenarios- Description of the hazards, both immediate(acute effects) and delayed (chronic effects)for man and the environment posed by therelease of toxic substance, as applicable- Identification of conditions, events and “trigger”which could be significant in bringing aboutidentified physical risks- Description & assessment of the possibleaccident scenarios- Assessment of whether the project location isprojected to have extreme climate events for2020 and/or 2050 that could contribute to thetriggering identified scenarios- Description of the hazards both immediate(acute effects) and delayed (chronic effects)for man and the environment posed by thefailure of structure, as applicableERA REQUIREMENT Quantitative RiskAssessment(QRA)Specific Instructions:_________________________ Descriptive/Qualitative RiskAssessmentSpecific Instructions:_________________________ EMERGENCY PLAN :Specific Instructions:_________________________Refer to Annex 2-7e for the decisioncriteria outline for completeness during procedural screening; page numbers shouldbe provided upon submission of the EISERA ERP MonitoringPlanPage Page Page Remarks15

ECC APPLICATION SCREENING FORM FOR FORESTRY PROJECTS(For Forestry Projects requiring EIS for ECC Application except Pulp and Paper Industry Projects)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningNoted By: Signature SignatureReview Committee MembersEMB Representatives1. 1.2. 2.3. 3.4. Project Proponent:5.6. Project Preparer/Consultant:Resource Person1.16

OKAY FOR PRINTING: _____________________________________________ ________________________________Signature over Printed Name DateAnnex 1 - EECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningDate Submitted for Screening: _______________________________________________________________Form of Submission: ___ Hard ___ DigitalProject Title: _____________________________________________________________________________Project Location: _________________________________________________________________________Project Proponent: ________________________________________________________________________Address: ________________________________________________________________________________Contact No:Fax No:______________Contact Person:__________________________EIS Consultant: ___________________________________________________________________________Address: ________________________________________________________________________________Contact No: Fax No: Contact Person:__________________________Project Classification & Type: _______________________________________________________________Project Classification Code (Refer to RPM for DAO 2003-30): _____________________________________Project Size based on Classification: _________________________________________________________Date of Technical Scoping:______________________________________________________________Venue of Technical Scoping:_____________________________________________________________Checklist of Documentary RequirementsTo be filled-up upon submission of EISEnvironmental Impact Statement (EIS) 1Proof of Compatibility with the existing LandUse PlanProof of Authority over the Project SiteAccountability Statements of Preparers &Proponents (see Annexes 2-21 & 2-22 ofRevised Procedural Manual for DAO 2003-30)Photographs or plates of the project site,impact areas and affected areas andcommunitiesDuly Accomplished Project EnvironmentalMonitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d ofRevised Procedural Manual for DAO 2003-30)Acceptable?Yes NoScreening Officer’s RemarksACTION TAKEN: (Please check to indicate corresponding action taken)Document accepted; please submit __ copiesEIARC Needed? ( ) Yes ( ) No Expertise Needed:Processing Fee: PhP _______ (Pay at EMB Cashier) Review Fund: Based on WFP (Pay to the dulyauthorized 3 rd Party Review Fund Manager)Document not acceptedO.R. #DateNOTED BY:___________________________Screening Officer_________________________Section/Division ChiefEMB Regional OfficeScreening OfficeDate:1 Please refer to attached checklist of EIS Contents1

Checklist of EIS ContentsI. Executive Summary (maximum of 5 pages)ECC APPLICATION SCREENING FORM FOR HYDROPWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningProject Fact Sheet PD Summary (1 page)Contents Page # Acceptable? REMARKSProcess Documentation of the conduct of EIA (1 page) (EIA Team, EIAStudy Schedule & Area, EIA Methodology, Public Participation)Summary of Baseline Characterization, Key Environmental Impactsand Management & Monitoring Plan; EGF and EMF CommitmentsItems to beDescribedSpecific Data RequirementPage # Acceptable?REMARKSII. I. Project DescriptionIII.1) Project Locationand Areaa) Map showing sitio, barangay, municipality,province, region boundaries, vicinity,proposed buffers surrounding the area andprimary & secondary impact areasb) Geographic coordinates (shape file data) ofproject area (use PRS 92 datum - GPSsetting)c) Rationale for selection of primary &secondary impact areasd) Discussion on the accessibility of the projectsite/area2) Project Rationale Cite and focus on the need for the projectbased on national and regional/localeconomic development in terms ofcontribution to sustainable developmentagenda or current development thrusts.Describe the justification for the Project withparticular reference to the economic andsocial benefits, including employment andassociate economic development, which theproject may provide. The status of theproject should be discussed in a regionaland national context.3) ProjectAlternativesa) Cite criteria used in determining preliminaryoptions for facility siting, development design,process/technology selection, resourceutilization including discussion of theconsequences of not proceeding with theproject:Contextualize site selection in terms ofvulnerability/susceptibility to liquefaction,ground shaking, ground rupture,earthquake-induced landslides, volcaniceruptions, rain-induced landslide, stormsurge, tsunami, and flooding as well asextreme climatologic conditions (data can2

ECC APPLICATION SCREENING FORM FOR HYDROPWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data RequirementPage # Acceptable?REMARKSbe obtained from NDRRMC and NAMRIAas well as other mandated agencies)Discuss the alternatives (type andlocation) considered and nominatedduring the course of selecting the bestoption for which the EIS is prepared;Describe the bases upon which thealternatives were rejected in favor of thepreferred option;Describe the significant differences inenvironmental impacts among thealternatives considered.Siting: Cite alternative project locationsincluding factors significant to the selection,such as perception of affected communitieswith regards to project, ancestral domainissues, land classification, etc. Discuss otheroptions on the siting of major components ofthe project within the project area. Discussalternative location of access roads in casethe preferred locations of the variouscomponents are found environmentally notfeasible.Technology Selection/Operation Processes:Discuss the project’s advantage overalternative technologies, operation processesand engineering design.Discuss alternative measures to preventoccurrence of major impacts.Resources: Discuss the alternativesconsidered for power generation and how thedecisions were made. Discussion should alsobe in the context of climate change (e.g. useof renewable energy).b) Reasons for selecting the preferred optionsdelineated in terms of technical, commercial,social and natural environmental aspectsc) After determining the preliminary options,please provide a summary of the comparativeenvironmental impacts of each alternative.4) ProjectComponentsIdentification of major components includingtechnical details such as specifications,capacity, number, etc. (e.g. penstock,spillway, freeboard, etc.)Specify the operations and processesIdentification of other Support Facilities (i.e.emergency power, process control, early3

ECC APPLICATION SCREENING FORM FOR HYDROPWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribed5) Process/TechnologySpecific Data RequirementPage # Acceptable?REMARKSwarning/alarm system, etc.)Identification of infrastructure requirements(transport—road/rail/ship, energy, stormwater drainage, sewerage,telecommunications, accommodation andother infrastructure),Identification ofmaterials/product handling facilities,infrastructure requirements (transport —road/rail/ship, energy, water supply andstorage, storm water drainage, sewerage,telecommunications, accommodation andother infrastructure)Identification of Pollution Control devices andcorresponding facility being served orconnected.Identification of waste management facilitiesand devices to address solid waste materials(domestic and hazardous and chemicals) airemissions, solid waste disposal, andwastewaterGeneral layout of facilitiesFootprint of proposed layout of projectfacilities (if any)Maps should be provided showing theprecise location of the project area, and inparticular, the location and boundaries ofproject area, location and footprint of projectcomponents, and location of all proposedbuffers.When applicable, contextualize using thePAG-ASA 2020 and 2050 projectedrainfall/temperature data.Technology Description and PerformanceSpecificationsIndicative process flow-sheets includingefficiency of power generationDiscuss the impacts of the PAG-ASA 2020 and2050 projected rainfall pattern on the projectand performance/efficiency of the facility.Power & water supply systemWaste Management Systems (wastewatertreatment facility, dust collector, etc.)When applicable, consider the PAG-ASA2020 and 2050 projected rainfall data.6) Project Size Total volume of water to be impounded &power rated capacity to be generated (ifhydropower)Capacity and type of Dam structureTotal Project Area in square meters or hectaresincluding area to be inundated and/or service4

ECC APPLICATION SCREENING FORM FOR HYDROPWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data RequirementPage # Acceptable?REMARKSarea7) Manpower Tabulate the following per project phase:manpower requirements;expertise/skills needed;nature & estimated number of jobs availablefor men, women, and indigenous peoples (ifsited in IP ancestral land);preferred scheme for sourcing locally fromhost and neighboring LGUs8) Indicative Project Investment Cost (Philippine Peso)General Contents Specific Content Requirement Page # Acceptable? REMARKSII. KeyEnvironmentalImpacts andManagement/Monitoring PlanIII.EnvironmentalRisk AssessmentSee attached checklist of contentsWhen applicable, include appropriate climatechange adaptation measures/options(embedded in each sector).See attached checklist of contentsIV. ImpactManagementPlanV. SocialDevelopmentPlan (SDP) andIEC FrameworkLimit to most significant impacts per projectphase and per environmental componentarising from key environmental aspects (SeeAnnex 2-17 of RPM for DAO 2003-30)SDPCommunity development or livelihoodprograms/activities, projected beneficiaries,partner institutions, timeframe ofimplementation as well as source and amountallotted per activity/component (See Annex 2-18 of RPM for DAO 2003-30)IECTarget sector, key messages,scheme/strategy/methods, Informationmedium, timelines and frequency, cost (SeeAnnex 2-19 of RPM for DAO 2003-30)VI. EnvironmentalComplianceSelf-Monitoring PlanUse Annex 2-20 of RPM for DAO 2003-30as template5

ECC APPLICATION SCREENING FORM FOR HYDROPWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral Contents Specific Content Requirement Page # Acceptable? REMARKSMonitoringMulti-Sectoral Monitoring FrameworkTabulate the list of stakeholder-members of theMMT, basis of selection, proposed role, andscope of MMT responsibilities and activities,etc. (See Annex 3-4 of the RPM for DAO 2003-30).Environmental Guarantee and Monitoring FundCommitments (if applicable)VII. EmergencyPreparedness andResponse Policyand GenericGuidelinesVIII. Abandonment/Decommissioning/Rehabilitation PolicyIX. Institutional Planfor EMPImplementationPresent a proposed amount of EMF(based on a draft AWFP in Annex 3-4 andconsistent with guidelines in Annex 3-5 ofRPM for DAO 2003-30); andPresent a proposed amount of EGF andthe basis for the estimate following theguidelines in Annex 3-6 of RPM for DAO2003-30The safety policy and generic guidelines shouldbe consistent with the regulatory requirements.Emergency Preparedness should also considernatural hazards to the infrastructures andfacilities.Statement on proponent’s policies and genericprocedures for Rehabilitation/Decommissioning/Abandonment to besubmitted as post-ECC, within a timeframespecified in the ECC.Discuss the organizational scheme of theproponent including line of command andreporting procedures as well as manpowercomplement and relationships with otheroperating departments.6

ECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningChecklist of EIS ContentsKey Environmental Impacts and Management/Monitoring PlanList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1. THE LAND1.1 Land Use and Classification1.1.1 Change/Inconsistency in Description & Map showing theland useproject area in relation to existing land1.1.2 Encroachment inEnvironmentally CriticalAreas (ECAs)use.Identify ECA where the project islocated or near the project area.Identify areas vulnerable/susceptibleto natural hazards where the projectis located or near the project area(include map/s).1.1.3 Possible tenurial / land issue Identify areas under CARP or withCADC / CADT/ CALC/ CALT wherethe project is located or near theproject area.Assessment of thecompatibility of theproposed project inrelation to land useand/or the coastalresource managementplan of the LGU, if any for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditions Analysis Plan PlanPage Page Page Page Remarks1.2 Geology/Geomorphology1.2.1 Change in surfacelandform/ topography/terrain/slope1.2.2Change in sub-surface/underground geomorphology1.2.3 Inducement of subsidence,liquefaction, landslides, mud/debris flow, etc.Specify other conflicting tenurial / landissues (e.g., IFMA/CBFMA withinCOC and within MPSA, etc.)Slope and Elevation/TopographicMapRegional/General Geological MapGeological Cross-Sections; SequenceStratigraphic Column of Rock Units;Geomorphological Map: G FactorContour Maps; Seismicity Map;Differential Settling Map; Results ofGeochemical Analyses of RockSamples (applicable areas); Hazardmaps (NAMRIA, NDRRMC, MGB,PHIVOLCS, PAG-ASA)Include discussions onimpacts/effects of naturalhazard on the project.7

ECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1.3 Pedology1.3.1 Soil erosion / Loss of Summary of Soil Investigation Report USLE / similar modelingtopsoil/overburdenon soil type and quality; Erodibility when applicablepotential; Bank stability1.3.2 Change in soil quality/fertility Laboratory results on soil sampleanalysis for N, P, K, pH, organicmatter, micronutrientsPhysical analysis (waterholding capacity, textureaggregate stability ofdam); secondary data:chemical analysis for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks1.4 Terrestrial Ecology1.4.1 Vegetation removal andloss of habitat1.4.2 Threat to existence and/orloss of important localspecies1.4.3Threat to abundance,frequency and distribution ofimportant speciesFlora and fauna species inventoryor survey report;Historical occurrences of pestinfestation, forest/grass fire and/orsimilar incidencesSummary of endemicity /conservation statusSummary of abundance, frequencyand distributionEconomic importance and uses ofsignificant flora and fauna1.4.4 Hindrance to wildlife access Sampling / survey map in relation tothe project siteQuadrat sampling forfloraUse of mist nets, traps,transect walk for faunaImpact inundation onterrestrial ecologyInclude discussions onoverall impact to floraand faunaInclude impactassessment onvegetation (e.g.,likelihood of destruction)and specificmanagement measures(e.g., protection, balling,transplanting,replacement etc.)2. THE WATER2.1 Hydrology/Hydrogeology2.1.1 Change in drainagemorphology / Inducement ofDrainage map; historicalflooding/drought occurrences, streamFlood simulation/modeling should8

ECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.flooding/ Reduction in streamvolumetric flowflow measurements/estimates;Delineation of watershed /subwatersheds/floodplain; andidentification of aquifers, if anyconsider extremeweather conditions andthe PAG-ASA 2020 and2050 climate projections for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks2.1.2 Change in stream, lakewater depth2.1.3 Depletion of waterresources/competition in water useRegional hydrogeological mapIdentification of current / projectedwater use in the area and adjacentareasSpring and well inventory and locationmap; depth of water tableAssessment shouldinclude potentialoccurrence oraggravation of flooding innearby areas.2.2 Oceanography2.2.1 Change/disruption incirculation patternAnalysis/estimation of wateravailability taking into considerationthe PAG-ASA 2020 and 2050 climateprojectionsPredicted tides; 24-hour tidal cycles;Surface current system2.2.2 Change in bathymetry Bathymetric map USLE / similar modelingwhen applicable2.3 Water Quality2.3.1 Degradation of groundwaterquality2.3.2 Degradation of surface waterquality2.3.3 Degradation of coastal/marine water qualityPhysico-Chemical characterization ofwater : pH BOD5 Oil and grease TSSUse DENR standardmethods and proceduresfor sampling andanalysis.9

ECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.sampling site map for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks2.4 Freshwater Ecology2.4.1 Threat to existence and/orloss of important localspecies and habitatSummary of endemicity/conservation statusAbundance of ecologically andeconomically important species(fishes, benthos, planktons);Presence of pollution indicatorspeciesInclude discussions onoverall impact tofreshwater ecology2.5 Marine Ecology (if applicable)2.5.1 Threat to existence and/orloss of important local species andhabitat2.5.2 Threat to abundance,frequency and distributionsampling site mapAbundance/densities/distribution ofecologically and economicallyimportant species (mangroves,fishes, benthos, planktons, coralreefs, algae, seaweeds, seagrasses);Presence of pollution indicatorspecies;Historical occurrences of red-tide,fish kill or any related eventMarine resource mapQuadrat, transect, lineintercept, spot dive,manta tow, marineresourcecharacterization (e.g.,municipal andcommercial fisheriesdata)Impact on inundationon marine ecology.3. THE AIR3.1 Meteorology/Climatology3.1.1 Change in the local climate,e.g., local temperature3.1.2 Contribution in terms ofgreenhouse gas emissions/sampling site mapMonthly average rainfall andtemperature of the area;Climatological normals/extremes;Wind rose diagrams; Frequency ofTropical cyclonesData on Greenhouse gasses (i.e.,carbon dioxide, methane); CalculationInclude discussions onoverall impact tomarine ecologyIn the assessment,consider the PAG-ASAclimate changeprojections for 2020 and2050.Discuss the project’scontribution in terms of10

ECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.sequestration of projected GHG emission greenhouse gasemissions3.2 Air Quality (and Noise)3.2.1 Degradation of air quality, ifwith processing3.2.2 Increase in ambient noiselevelcharacterization of ambient air quality: TSP(for sampling methods, refer to CleanAir Act)sampling site mapCharacterization of ambient noiselevelsampling site mapUse DENR standardmethods and proceduresfor sampling andanalysis.For construction phaseonlyUse DENR standardmethods and proceduresfor sampling andmeasurement. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks4. THE PEOPLE4.1 Displacement of settler/sDisplacement / disturbanceof propertiesChange/conflict in landownershipChange/conflict in right ofway4.2 In-migrationProliferation of informalsettlersDemographic data of impact area:- Number of households andhousehold size- Land area,- Population,- Population density /growth- Gender and age profile,- Literacy rate, profile of educationalattainment,settlements mapCensus of population / property thatwill be displaced / disturbedHousing ownership profile /availability of housing/ number ofinformal settlersDiscuss how the projectwould affect existingproperties in the area interms of relocation anddevaluationDiscuss the in-migrationpatterns as a result ofproject implementation11

ECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.4.3 Cultural/Lifestyle change Demographic data on Indigenous Discuss the impacts on(especially on Indigenous Peoples, Peoples (if any) and existing IPs and Culture/Lifestyleif any)Culture/Lifestyle that may be4.4 Threat to delivery of basicservices /resource competition4.5 Threat to public health andsafety4.6 Generation of Local Benefitsfrom the projectEnhancement ofemployment and livelihoodopportunitiessignificantly affectedAvailability of public services in termsof:Water supplyPower supplyCommunications/transportationHealthresources(Government and Private)Peace and order / crimeEducation facilitiesRecreational facilities /sports facilitiesStatistical data / information related topublic services:Literacy rate, profile ofeducational attainmentMorbidity and mortality rates(infants and adults - 5-yeartrend)Common diseases in thearea including endemicdiseasesEnvironmental Health andSanitation ProfileCrime rateFood securitySocioeconomic data:Main sources of IncomeEmployment rate/ profileSources of livelihoodPoverty incidenceDiscuss how the projectwould affect the deliveryof basic services andmay result in resourcecompetition in the areaDiscuss the projectimplementation’s threatto public health vis-à-visthe baseline healthconditions in the areaAnalysis of diseases thatmay be affected byclimate change.12 for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page Remarks

ECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Increased businessCommercial establishmentsopportunities andand activitiesassociated economicBanking and financialactivitiesinstitutions for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. MonitoringConditionsAnalysis Plan PlanPage Page Page Page RemarksIncreased revenue of LGUs4.7 Traffic congestion Road network/ systemsExisting transportation/traffic situationTraffic impactassessment, if applicable(including capacity ofroad system in terms ofload/count)13

ECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningIII.Environmental Risk AssessmentType of Risks Scope of Assessment Report/Output RequiredDuring scoping: Check () required/applicable items; items with are automatically required; write specific instructions ( ifany) on the blanks/spaces provided. for completeness during procedural screening; page numbersshould be provided upon submission of the EISERA ERP MonitoringPlanPage Page Page RemarksSafety Risks Fire Release of toxicsubstances Physical Risks(Failure of Structure whichcould endanger life, propertyand/or the environment)- Identification of conditions, events andcircumstances which could be significant in bringingabout identified safety risks- Description & assessment of the possible accidentscenarios- Assessment of whether the project location isprojected to have extreme climate events for 2020and/or 2050 that could contribute to the triggeringidentified scenarios- Description of the hazards, both immediate (acuteeffects) and delayed (chronic effects) for man andthe environment posed by the release of toxicsubstance, as applicable- Identification of conditions, events and “trigger”which could be significant in bringing aboutidentified physical risks- Description & assessment of the possible accidentscenarios- Assessment of whether the project location isprojected to have extreme climate events for 2020and/or 2050 that could contribute to the triggeringidentified scenarios- Description of the hazards both immediate (acuteeffects) and delayed (chronic effects) for man andthe environment posed by the failure of structure, asapplicableERA REQUIREMENT Quantitative RiskAssessment(QRA)Specific Instructions :__________________________ Descriptive/Qualitative RiskAssessmentSpecific Instructions :____________________________ EMERGENCY PLAN :Specific Instructions :_____________________________Refer to annex 2-7e for thedecision criteria outline14

ECC APPLICATION SCREENING FORM FOR HYDROPOWER/DAM PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningNoted By: Signature SignatureReview Committee MembersEMB Representatives1. 1.2. 2.3. 3.4. Project Proponent:5.6. Project Preparer/Consultant:Resource Person1.15

OKAY FOR PRINTING: _____________________________________________ ________________________________Signature over Printed Name DateAnnex 1 - FECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningDate Submitted for Screening: _______________________________________________________________Form of Submission: ___ Hard ___ DigitalProject Title: _____________________________________________________________________________Project Location: _________________________________________________________________________Project Proponent: ________________________________________________________________________Address: ________________________________________________________________________________Contact No:Fax No:______________Contact Person:__________________________EIS Consultant: ___________________________________________________________________________Address: ________________________________________________________________________________Contact No: Fax No: Contact Person:__________________________Project Classification & Type: _______________________________________________________________Project Classification Code (Refer to RPM for DAO 2003-30): _____________________________________Project Size based on Classification: _________________________________________________________Date of Technical Scoping:______________________________________________________________Venue of Technical Scoping:_____________________________________________________________Checklist of Documentary RequirementsTo be filled-up upon submission of EISEnvironmental Impact Statement (EIS) 1Proof of Compatibility with the existing LandUse PlanProof of Authority over the Project SiteAccountability Statements of Preparers &Proponents (see Annexes 2-21 & 2-22 ofRevised Procedural Manual for DAO 2003-30)Photographs or plates of the project site,impact areas and affected areas andcommunitiesDuly Accomplished Project EnvironmentalMonitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d ofRevised Procedural Manual for DAO 2003-30)Acceptable?Yes NoScreening Officer’s RemarksACTION TAKEN: (Please check to indicate corresponding action taken)Document accepted; please submit __ copiesEIARC Needed? ( ) Yes ( ) No Expertise Needed:Processing Fee: PhP _______ (Pay at EMB Cashier) Review Fund: Based on WFP (Pay to the dulyauthorized 3 rd Party Review Fund Manager)Document not acceptedO.R. #DateNOTED BY:___________________________Screening Officer_________________________Section/Division ChiefEMB Regional OfficeScreening OfficeDate:_____________________________1 Please refer to attached checklist of EIS Contents1

Checklist of EIS ContentsI. Executive Summary (maximum of 5 pages)ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningContentsPage # Acceptable? REMARKSProject Fact Sheet PD Summary (1 page)Process Documentation of the conduct of EIA (1 page) (EIA Team,EIA Study Schedule & Area, EIA Methodology, Public Participation)Summary of Baseline Characterization, Key Environmental Impactsand Management & Monitoring Plan, Contingent Liability andRehabilitation Fund (CLRF), Mine Rehabilitation Fund andEnvironmental Trust Fund (ETF) commitmentsItems to beDescribedII. I. Project DescriptionSpecific Data Requirement Page # Acceptable?REMARKS1) Project Locationand Areaa) Map showing sitio, barangay, municipality,province, region boundaries, vicinity,proposed buffers surrounding the area andprimary & secondary impact areasb) Geographic coordinates (shape file data) ofproject area (use PRS 92 datum - GPSsetting)c) Rationale for selection of primary &secondary impact areasd) Discussion on the accessibility of the projectsite/area2) Project Rationale Cite and focus on the need for the projectbased on national and regional/localeconomic development in terms ofcontribution to sustainable developmentagenda or current development thrusts.Describe the justification for the Project withparticular reference to the economic andsocial benefits, including employment andassociate economic development, whichthe project may provide. The status of theproject should be discussed in a regionaland national context.3) ProjectAlternativesa) Cite criteria used in determining preliminaryoptions for facility siting, developmentdesign, process/technology selection,resource utilization, including discussion ofthe consequences of not proceeding with theproject:Contextualize site selection in terms ofvulnerability/susceptibility to liquefaction,ground shaking, ground rupture,earthquake-induced landslides, volcaniceruptions, rain-induced landslide, stormsurge, tsunami, and flooding as well asextreme climatologic conditions (data canbe obtained from NDRRMC and NAMRIA2

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data Requirement Page # Acceptable?as well as other mandated agencies)Discuss the alternatives (type andlocation) considered and nominatedduring the course of selecting the bestoption for which the EIS is prepared;Describe the bases upon which thealternatives were rejected in favor of thepreferred optionDescribe the significant differences inenvironmental impacts among thealternatives considered.Siting: Cite alternative project locationsincluding factors significant to the selection,such as perception of affected communitieswith regards to project, ancestral domainissues, land classification, etc. Discuss otheroptions on the siting of major components ofthe project within the project area. Discussalternative location of access roads in casethe preferred locations of the variouscomponents are found environmentally notfeasible.Technology Selection/Operation Processes:Discuss the project’s advantage overalternative technologies, operationprocesses and engineering design.Discuss alternative measures to preventoccurrence of major impacts.REMARKS4) ProjectComponentsResources: Discuss the alternativesconsidered in the course of selecting theresource to be tapped for power generationand how the decisions were made in favor ofthe preferred resource. Discuss thesustainability of the raw materials to betapped and transportation plan of rawmaterials.b) Reasons for selecting the preferred optionsdelineated in terms of technical, commercial,social and natural environmental aspectsc) After determining the preliminary options,please provide a summary of the comparativeenvironmental impacts of each alternative.Identification of major components includingtechnical details such as specifications,capacity, number, etc.) TSFSpecify if Extraction only or with Ore/MineralProcessing (mining)Specify the operations and processIdentification of other Support Facilities (i.e.energy/power generating facility, water3

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribed5) Process/TechnologySpecific Data Requirement Page # Acceptable?supply system)Identification of materials/product handlingfacilities, infrastructure requirements(transport—road/rail/ship, energy, watersupply and storage, storm water drainage,sewerage,telecommunications,accommodation and other infrastructure),Identification of Pollution Control devicesand corresponding facility being served orconnected.Identification of waste management facilitiesand devices to address solid wastematerials (domestic and hazardous andchemicals) air emissions, solid wastedisposal, and wastewaterGeneral layout of facilitiesFootprint of proposed layout of projectfacilities (if any)Maps should be provided showing theprecise location of the project area, and inparticular, the location and boundaries ofproject area, location and footprint of projectcomponents, and location of all proposedbuffers.When applicable, contextualize using thePAG-ASA 2020 and 2050 projectedrainfall/temperature data.Method / Technology for:ExtractionOre/mineral processing (indicate type of rawmaterial & final product)Indicative process flow-sheets showingmaterial balances for the processing plant, andthe anticipated rates of inputs, along withsimilar data on products, wastes and recyclestreamsPower & water supply systemREMARKSWaste Management Systems (tailings pond,wastewater treatment facility, siltation ponds,tailings dam, etc.)When applicable, consider the PAG-ASA2020 and 2050 projected rainfall data.6) Project Size Total Amount of Ore/Mineral Reserves in theproject area based on exploration dataTotal amount of Ore/Mineral Reserves to beextracted, rate of extraction and timetableIf with processing, indicate annual productionrateTotal Project Area in square meters orhectares4

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribed7) DevelopmentPlan, Descriptionof Project PhasesandCorrespondingTimeframesSpecific Data Requirement Page # Acceptable?Phases to be described in terms identifyingspecific activities (with special attention onthose with significant environmental impactsas well as climate change adaptation optionsrelevant to the project and project activities)and corresponding projected implementationtimeframes:Pre-construction (e.g. planning, acquisitionof rights to use land, exploration activities)Construction (e.g., land/site clearing,temporary housing, transport of materials,health and other services for the workforce)Operation (projected period of startup/commissioning/fulloperation of variousproject components) include discussion onthe operation of various components (asidentified above) in terms of material/producthandling, infrastructure requirements(transport—road/rail/ship, energy, watersupply and storage, storm water drainage,sewerage,telecommunications,accommodation and other infrastructure),waste management (character andquantities of waste materials, air emissions,Solid waste disposal, wastewater).AbandonmentFinal Rehabilitation/ Decommissioning Plan, toinclude Land/soil restoration, decontaminationor remediation activities and procedures &projected schedule. Discussions shouldinclude strategies and methods for progressiveand final rehabilitation of the environmentdisturbed by the project. The final topographyof any excavations, waste areas and dam sitesshould be shown. The land use suitability ofthe various land disturbance types should alsobe described.The proposed decommissioning plan shouldbe in terms of the following:Procedures for the decommissioning of theproject components;Transport/disposal of equipment and othermaterials used in the plant’s operation;Remediation of contaminated soil andwater resources due to spills and leakageof chemicals and other materials used inthe operation;Alternatives for the future use ofabandoned area;Consistency with long-term zoning and landuse development plan of the municipality;Rehabilitation plans, if anyREMARKS5

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beSpecific Data Requirement Page # Acceptable?Described8) Manpower Tabulate the following per project phase:REMARKSmanpower requirements;expertise/skills needed;nature & estimated number of jobsavailable for men, women, and indigenouspeoples (if sited in IP ancestral land);preferred scheme for sourcing locally fromhost and neighboring LGUs9) Indicative Project Investment Cost (Philippine Peso)General ContentsSpecific Content RequirementPage #Acceptable?REMARKSII. KeyEnvironmentalImpacts andManagement/Monitoring PlanSee attached checklist of contentsWhen applicable, include appropriate climatechange adaptation measures/options(embedded in each sector).III. EnvironmentalRisk AssessmentSee attached checklist of contentsIV. ImpactManagementPlanLimit to most significant impacts per projectphase and per environmental componentarising from key environmental aspects (SeeAnnex 2-17 of RPM for DAO 2003-30)V. SocialDevelopmentPlan (SDP) andIEC FrameworkSDPCommunity development or livelihoodprograms/activities, projected beneficiaries,partner institutions, timeframe ofimplementation as well as source and amountallotted per activity/component (See Annex 2-18 of RPM for DAO 2003-30)IECTarget sector, key messages,scheme/strategy/methods, Informationmedium, timelines and frequency, cost (SeeAnnex 2-19 of RPM for DAO 2003-30)VI. EnvironmentalComplianceMonitoringSelf-Monitoring PlanUse Annex 2-20 of RPM for DAO 2003-30 astemplate6

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral ContentsSpecific Content RequirementPage #Acceptable?REMARKSMulti-Sectoral Monitoring FrameworkTabulate the list of stakeholder-members ofthe MMT, basis of selection, proposed role,and scope of MMT responsibilities andactivities, etc. (See Annex 3-4 of the RPM forDAO 2003-30).Environmental Guarantee Fund Commitments,if with processingVII. EmergencyPreparednessand ResponsePolicy andGenericGuidelinesPresent a proposed amount of EGF andthe basis for the estimate following theguidelines in annex 3-6 of RPM for DAO2003-30The safety policy and generic guidelines shallbe consistent with the Mines and GeosciencesBureau (MGB) requirements. EmergencyPreparedness should also consider naturalhazards to the infrastructures and facilities.VIII. Abandonment/Decommissioning/Rehabilitation PolicyStatement on proponent’s policies and genericprocedures for Rehabilitation/Decommissioning/Abandonment to besubmitted as post-ECC, within a timeframespecified in the ECC.IX. Institutional Planfor EMPImplementationDiscuss the organizational scheme of theproponent including line of command andreporting procedures as well as manpowercomplement and relationships with otheroperating departments.7

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Applications)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningChecklist of EIS ContentsKey Environmental Impacts and Management/Monitoring PlanList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1. THE LAND1.1 Land Use and Classification1.1.1 Change/Inconsistency in Description & Map showing theland useproject area in relation to existing1.1.2 Encroachment inEnvironmentally CriticalAreas (ECAs)1.1.3 Possible tenurial / landissueland use.Identify ECA where the project islocated or near the project area.Identify areas vulnerable/susceptibleto natural hazards where the projectis located or near the project area(include map/s).Identify areas under CARP or withCADC / CADT/CAL/CALT where theproject is located or near the projectarea.Assessment of thecompatibility of theproposed project in relationto land use and/or thecoastal resourcemanagement plan of theLGU, if any. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditions AnalysisPlanPage Page Page Page Remarks2 Geology/Geomorphology1.2.1 Change in surfacelandform/ topography/ terrain/slope1.2.2 Change in sub-surface/underground geomorphology1.2.3Inducement of subsidence,liquefaction, landslides, mud /debris flow, etc.Specify other conflicting tenurial /land issues (e.g., IFMA/CBFMAwithin COC and within MPSA,ownership, informal settlers, smallscale mining, etc.)Slope and Elevation/TopographicMapRegional/General Geological MapGeological Cross-Sections;Sequence Stratigraphic Column ofRock Units; Geomorphological Map:G Factor Contour Maps; SeismicityMap; Differential Settling Map;Bathymetric and Morpho-structuralMap; Results of Petrographic andInclude discussions onimpacts/effects of naturalhazard on the project.8

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Applications)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Mineragraphic Analyses; Results ofGeochemical Analyses of RockSamples (applicable areas); Hazardmaps (NAMRIA, NDRRMC, MGB,PHIVOLCS, PAG-ASA)1.3 Pedology1.3.1 Soil erosion / Loss oftopsoil/overburdenSummary of Soil InvestigationReport on soil type and quality;Erodibility potential; Bank stabilityUSLE / similar modelingwhen applicable for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanPage Page Page Page Remarks1.3.2 Change in soilquality/fertility1.4 Terrestrial Ecology1.4.1 Vegetation removal andloss of habitat1.4.2 Threat to existenceand/or loss of importantlocal species1.4.3Threat to abundance,frequency and distributionof important species1.4.4 Hindrance to wildlifeaccessLaboratory results on soil sampleanalysis for N, P, K, pH, organicmatter, micronutrients and tracemetals e. g. Pb, Hg, As, Cd, Crhexavalent, etc.Flora and fauna species inventoryor survey report;Historical occurrences of pestinfestation, forest/grass fire and/orsimilar incidencesSummary of endemicity /conservation statusSummary of abundance,frequency and distributionEconomic importance and uses ofsignificant flora and faunaSampling / survey map in relation tothe project sitePhysical analysis (waterholding capacity, textureaggregate stability of dam);secondary data: chemicalanalysisQuadrat sampling forfloraUse of mist nets, traps,transect walk for faunaInclude discussions onoverall impact to flora andfauna2. THE WATER2.1 Hydrology/Hydrogeology2.1.1 Change in drainagemorphology / Inducement ofDrainage map; historicalflooding/drought occurrences,Flood simulation/modeling,9

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Applications)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.flooding/ Reduction in streamvolumetric flowstream flow measurements/estimates; Delineation of watershed/sub-watersheds/ floodplain; andidentification of aquifers, if anyconsider extreme weatherconditions and the PAG-ASA 2020 and 2050climate projections for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanPage Page Page Page Remarks2.1.2 Change in stream, lakewater depth2.1.3 Depletion of waterresources / competition in wateruseRegional hydrogeological mapIdentification of current / projectedwater use in the area and adjacentareasSpring and well inventory andlocation map; depth of water tableAssessment should includepotential occurrence oraggravation of flooding innearby areas2.2 Oceanography2.2.1 Change/disruption incirculation patternAnalysis/estimation of wateravailability taking into considerationthe PAG-ASA 2020 and 2050climate projectionsPredicted tides; 24-hour tidal cycles;Surface current system2.2.2 Change in bathymetry Bathymetric map USLE / similar modelingwhen applicable2.3 Water Quality2.3.1 Degradation ofgroundwater quality2.3.2 Degradation of surfacePhysico-Chemical characterizationof water : pH BOD5 CODUse DENR standardmethods and proceduresfor sampling and analysis.Conduct chemical assay ofore and relate to Physico-Chemical characterization10

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Applications)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirements DO Oil and grease TSS Heavy Metals____________________ fecal / total coliform Others:_________________________sampling site mapRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.water qualityof water2.3.3 Degradation ofcoastal/marine water quality2.4 Freshwater Ecology2.4.1 Threat to existenceand/or loss of importantlocal species and habitat2.4.1 Threat to existenceand/or loss of importantlocal species and habitatSummary of endemicity /conservation statusAbundance of ecologically andeconomically important species(fishes, benthos, planktons);Presence of pollution indicatorspeciessampling site mapSummary of endemicity/conservation statusAbundance of ecologically andeconomically important species(fishes, benthos, planktons);Presence of pollution indicatorspeciesFor project with coastal/marine structures and /orsignificant marine / coastaldischarges, conductcirculation / plumemodeling (include worstcase scenario of failure ofWWTF). For project withsignificant heavy metalsdischarges, conductsediment transportmodeling.Include discussions onoverall impact tofreshwater ecology.Include discussions onoverall impact to freshwaterecology. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanPage Page Page Page Remarks2.5 Marine Ecology2.5.1 Threat to existenceand/or loss of important localspecies and habitatsampling site mapAbundance/densities/distributionof ecologically and economicallyQuadrat, transect, lineintercept, spot dive,11

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Applications)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.2.5.2 Threat to abundance,frequency and distribution3. THE AIR3.1 Meteorology/Climatology3.1.1 Change in the localclimate, e.g., local temperatureimportant species (mangroves,fishes, benthos, planktons, coralreefs, algae, seaweeds, seagrasses)Presence of pollution indicatorspeciesHistorical occurrences of red-tide,fish kill or any related eventMarine resource mapsampling site mapMonthly average rainfall andtemperature of the area;Climatological normals/extremes;Wind rose diagrams; Frequency ofTropical cyclones3.2 Air Quality (and Noise)3.2.1 Degradation of air quality Characterization of ambient airquality:3.2.2 Increase in ambient noiselevel TSP PM10 SOx NOx(for sampling methods refer toClean Air Act)sampling site mapCharacterization of ambient noiselevelmanta tow, marineresource characterization(e.g., municipal andcommercial fisheriesdata)Include discussions onoverall impact to marineecologyIn the assessment,consider the PAG-ASAclimate change projectionsfor 2020 and 2050.Use DENR standardmethods and proceduresfor sampling and analysis.If applicable, air dispersionmodeling (include worstcase scenario of failure ofAPCD.Heavy metals (baselineand modeling) apply toselected processingfacilities.Use DENR standardmethods and proceduresfor sampling and for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanPage Page Page Page Remarks12

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Applications)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.sampling site mapmeasurement. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanPage Page Page Page Remarks4. THE PEOPLE4.1 Displacement of settler/sDisplacement /disturbance of propertiesChange/conflict in landownershipChange/conflict in right ofway4.2 In-migrationProliferation of informalsettlers4.3 Cultural/Lifestyle change(especially on IndigenousPeoples, if any)4.4 Threat to delivery of basicservices /resource competitionDemographic data of impact area:- Number of households andhousehold size- Land area- Population- Population density /growth- Gender and age profile- Literacy rate, profile of educationalattainmentSettlements mapCensus of population / property thatwill be displaced / disturbedHousing ownership profile /availability of housing/ number ofinformal settlersDemographic data on IndigenousPeoples (if any) and existingCulture/Lifestyle that may besignificantly affectedAvailability of public services interms of:Water supplyPower supplyIf applicable, noiseattenuation modeling(applicable if there issource capable ofgenerating 200 dB ormore).Discuss how the projectwould affect existingproperties in the area interms of relocation anddevaluationDiscuss the in-migrationpatterns as a result ofproject implementationDiscuss the impacts on IPsand Culture/LifestyleDiscuss how the projectwould affect the delivery ofbasic services and mayresult in resource13

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Applications)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Communications/ transportation competition in the areaHealth resources (Governmentand Private)4.5 Threat to public health and Peace and order / crimesafetyEducation facilitiesRecreational facilities/ sportsfacilitiesStatistical data / information relatedto public services:Literacy rate, profile ofeducational attainmentMorbidity and mortality rates(infants and adults - 5-yeartrend)Common diseases in the areaincluding endemic diseasesEnvironmental Health andSanitation ProfileCrime rateFood securityDiscuss the projectimplementation’s threat topublic health vis-à-vis thebaseline health conditionsin the areaAnalysis of diseases thatmay be affected by climatechange. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanPage Page Page Page Remarks4.6 Generation of LocalBenefits from the projectEnhancement ofemployment andlivelihood opportunitiesIncreased businessopportunities andassociated economicactivitiesSocioeconomic data:Main sources of IncomeEmployment rate/ profileSources of livelihoodPoverty IncidenceCommercial establishments andactivitiesBanking and financialinstitutionsIncreased revenue ofLGUs14

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Applications)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.4.7 Traffic congestion Road network/ systemsTraffic impact assessment,if applicable (includingExisting transportation/traffic capacity of road system insituationterms of load/count) for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanPage Page Page Page RemarksIII.Environmental Risk AssessmentType of Risks Scope of Assessment Report/Output RequiredDuring scoping: Check () required/applicable items; items with are automatically required; write specific instructions ( ifany) on the blanks/spaces provided.Safety Risks- Identification of conditions, events andERA REQUIREMENTcircumstances which could be significant in bringing Fireabout identified safety risks Quantitative Risk Explosion- Description & assessment of the possible accidentAssessment(QRA) Release of toxic scenariossubstances- Assessment of whether the project location isSpecific Instructions:projected to have extreme climate events for 2020 __________________________and/or 2050 that could contribute to the triggeringidentified scenarios Descriptive/Qualitative Risk- Description of the hazards, both immediate (acuteeffects) and delayed (chronic effects) for man andAssessmentthe environment posed by the release of toxicSpecific Instructions :substance, as applicable___________________________ Physical Risks(Failure of Structure whichcould endanger life, propertyand/or the environment)- Identification of conditions, events and “trigger”which could be significant in bringing aboutidentified physical risks- Description & assessment of the possible accidentscenarios- Assessment of whether the project location isprojected to have extreme climate events for 2020and/or 2050 that could contribute to the triggeringidentified scenarios EMERGENCY PLAN :Specific Instructions :____________________________Refer to Annex 2-7e for thedecision criteria outline15 for completeness during procedural screening; page numbersshould be provided upon submission of the EISERA ERP MonitoringPlanPage Page Page Remarks

ECC APPLICATION SCREENING FORM FOR NEW MINING PROJECTS(Requiring EIS for ECC Applications)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningIII.Environmental Risk AssessmentType of Risks Scope of Assessment Report/Output RequiredDuring scoping: Check () required/applicable items; items with are automatically required; write specific instructions ( ifany) on the blanks/spaces provided.- Description of the hazards both immediate (acuteeffects) and delayed (chronic effects) for man andthe environment posed by the failure of structure, asapplicable. for completeness during procedural screening; page numbersshould be provided upon submission of the EISERA ERP MonitoringPlanPage Page Page RemarksNoted By: Signature SignatureReview Committee MembersEMB Representatives1. 1.2. 2.3. 3.4. Project Proponent:5.6. Project Preparer/Consultant:Resource Person1.16

OKAY FOR PRINTING: _____________________________________________ ________________________________Signature over Printed Name DateAnnex 1 - GECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningDate Submitted for Screening: _______________________________________________________________Form of Submission: ___ Hard ___ DigitalProject Title: _____________________________________________________________________________Project Location: _________________________________________________________________________Project Proponent: ________________________________________________________________________Address: ________________________________________________________________________________Contact No:Fax No:______________Contact Person:__________________________EIS Consultant: ___________________________________________________________________________Address: ________________________________________________________________________________Contact No: Fax No: Contact Person:__________________________Project Classification & Type: _______________________________________________________________Project Classification Code (Refer to RPM for DAO 2003-30): _____________________________________Project Size based on Classification: _________________________________________________________Date of Technical Scoping:______________________________________________________________Venue of Technical Scoping:_____________________________________________________________Checklist of Documentary RequirementsTo be filled-up upon submission of EISEnvironmental Impact Statement (EIS) 1Proof of Compatibility with the existing LandUse PlanProof of Authority over the Project SiteAccountability Statements of Preparers &Proponents (see Annexes 2-21 & 2-22 ofRevised Procedural Manual for DAO 2003-30)Photographs or plates of the project site,impact areas and affected areas andcommunitiesDuly Accomplished Project EnvironmentalMonitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d ofRevised Procedural Manual for DAO 2003-30)Acceptable?Yes NoScreening Officer’s RemarksACTION TAKEN: (Please check to indicate corresponding action taken)Document accepted; please submit __ copiesEIARC Needed? ( ) Yes ( ) No Expertise Needed:Processing Fee: PhP _______ (Pay at EMB Cashier) Review Fund: Based on WFP (Pay to the dulyauthorized 3 rd Party Review Fund Manager)Document not acceptedO.R. #DateNOTED BY:___________________________Screening Officer_________________________Section/Division ChiefEMB Regional OfficeScreening OfficeDate:_____________________________1 Please refer to attached checklist of EIS Contents1

,Checklist of EIS ContentsI. Executive Summary (maximum of 5 pages)ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningContentsPage #Acceptable?REMARKSProject Fact Sheet PD Summary (1 page)Process Documentation of the conduct of EIA (1 page) (EIA Team, EIAStudy Schedule & Area, EIA Methodology, Public Participation)Summary of Baseline Characterization, Key Environmental Impactsand Management & Monitoring Plan; and EMF Commitments (ifapplicable)Items to beDescribedSpecific Data RequirementPage # Acceptable?REMARKSII. I. Project Description1) Project Location a) Map showing sitio, barangay, municipality,and Areaprovince, region boundaries, vicinity,proposed buffers surrounding the area andprimary & secondary impact areasb) Geographic coordinates (shape file data) ofproject area (use PRS 92 datum - GPSsetting)c) Rationale for selection of primary &secondary impact areasd) Discussion on the accessibility of the projectsite/area2) Project Rationale Cite and focus on the need for the projectbased on current and projected wastegenerationJustification for the Project with particularreference to the economic and socialbenefits, including employment andassociated economic development, whichthe project may provide.3) ProjectAlternativesa) Cite criteria used in determining preliminaryoptions for facility siting, development design,process/technology selection, resourceutilization, including discussion of theconsequences of not proceeding with theproject:Contextualize site selection in terms ofvulnerability/susceptibility to liquefaction,ground shaking, ground rupture,earthquake-induced landslides, volcaniceruptions, rain-induced landslide, stormsurge, tsunami, and flooding as well asextreme climatologic conditions (data canbe obtained from NDRRMC and NAMRIAas well as other mandated agencies)Discuss the alternatives (type andlocation) considered and nominatedduring the course of selecting the best2

,Items to beDescribedECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningSpecific Data RequirementPage # Acceptable?REMARKSoption for which the EIS is prepared;Describe the bases upon which thealternatives were rejected in favor of thepreferred option;Describe the significant differences inenvironmental impacts among thealternatives considered.Siting: Cite alternative project locationsincluding factors significant to the selection,such as perception of affected communitieswith regards to project, ancestral domainissues, land classification, etc. Discuss otheroptions on the siting of major components ofthe project within the project area. Discussalternative location of access roads in casethe preferred locations of the variouscomponents are found environmentally notfeasible.Technology Selection/Operation Processes:Discuss the project’s advantage overalternative technologies, operation processesand engineering design.Discuss alternative measures to preventoccurrence of major impacts.Resources: Discuss the alternativesconsidered in the waste treatment / disposal.Discussion should also include climatechange considerations.b) Reasons for selecting the preferred optionsdelineated in terms of technical, commercial,social and natural environmental aspectsc) After determining the preliminary options,please provide a summary of the comparativeenvironmental impacts of each alternative.4) ProjectComponentsIdentification of major components includingtechnical details such as specifications,capacity, number, etc.Specify the operationsIdentification of other Support FacilitiesIdentification of waste handling facilities,infrastructure requirements (transport,energy, water supply and storage, stormwater drainage, sewerage,telecommunications, and otherinfrastructure),General layout of facilitiesFootprint of proposed layout of projectfacilities (if any)Maps should be provided showing theprecise location of the project area, and in3

,Items to beDescribed5) Process/TechnologyECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningSpecific Data RequirementPage # Acceptable?REMARKSparticular, the location and boundaries ofproject area, location and footprint of projectcomponents, and location of all proposedbuffers.When applicable, contextualize using thePAG-ASA 2020 and 2050 projectedrainfall/temperature data.Technology descriptionFlow chart of operationPower & water supply system6) Project Size Daily waste inputWaste Management Systems (e.g., leachatepond, methane/ landfill gas collection system,etc.)Total Project Area in square meters orhectares/landfill area7) DevelopmentPlan, Descriptionof Project PhasesandCorrespondingTimeframesPhases to be described in terms of identifyingspecific activities (with special attention onthose with significant environmental impacts aswell as climate change adaptation optionsrelevant to the project and project activities)and corresponding projected implementationtimeframes:Pre-construction (e.g., planning, acquisitionof rights to use land,)Construction (e.g., land/site clearing,temporary housing, transport of materials,health and other services for the workforce)Operation (projected period of startup/commissioning/fulloperation of variousproject components) include discussion onthe operation of various components (asidentified above) in terms of material/producthandling, infrastructure requirementsIdentification of waste handling facilities,infrastructure requirements (transport,energy, water supply and storage, stormwater drainage, sewerage,telecommunications, and otherinfrastructure), waste managementAbandonmentFinal Rehabilitation/ Decommissioning Plan, toinclude Land/soil restoration, decontaminationor remediation activities and procedures &projected schedule. The land use suitability ofthe various land disturbance types should alsobe described.The proposed decommissioning plan should be4

,Items to beDescribedECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningSpecific Data RequirementPage # Acceptable?REMARKSin terms of the following:Procedures for the decommissioning of theproject components;Transport/disposal of equipment and othermaterials used in the plant’s operation;Remediation of contaminated soil and waterresources due to spills and leakage ofchemicals and other materials used in theoperation;Alternatives for the future use of abandonedarea;Consistency with long-term zoning and landuse development plan of the municipality;Rehabilitation / restoration plans, if any8) Manpower Tabulate the following per project phase:manpower requirements;expertise/skills needed;nature & estimated number of jobs availablefor men, women, and indigenous peoples (ifsited in IP ancestral land);preferred scheme for sourcing locally fromhost and neighboring LGUs9) Indicative Project Investment Cost (Philippine Peso)General Contents Specific Content Requirement Page # Acceptable? REMARKSII. KeyEnvironmentalImpacts andManagement/Monitoring PlanIII. EnvironmentalRisk AssessmentIV. ImpactManagementPlanV. SocialDevelopmentPlan (SDP) andIEC FrameworkSee attached checklist of contentsWhen applicable, include appropriate climatechange adaptation measures/options(embedded in each sector).See attached checklist of contentsLimit to most significant impacts per projectphase and per environmental componentarising from key environmental aspects (SeeAnnex 2-17 of RPM for DAO 2003-30)SDPCommunity development or livelihoodprograms/activities, projected beneficiaries,partner institutions, timeframe ofimplementation as well as source and amountallotted per activity/component (See Annex 2-18 of RPM for DAO 2003-30)5

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th Screening,General Contents Specific Content Requirement Page # Acceptable? REMARKSIECVI. EnvironmentalComplianceMonitoringTarget sector, key messages,scheme/strategy/methods, Informationmedium, timelines and frequency, cost (SeeAnnex 2-19 of RPM for DAO 2003-30)Self-Monitoring PlanUse Annex 2-20 of RPM for DAO 2003-30 astemplateMulti-Sectoral Monitoring FrameworkTabulate the list of stakeholder-members of theMMT, basis of selection, proposed role, andscope of MMT responsibilities and activities,etc. (See Annex 3-4 of the RPM for DAO 2003-30).Environmental Guarantee and Monitoring FundCommitmentsPresent a proposed amount of EMF(based on a draft AWFP in Annex 3-4 andconsistent with guidelines in Annex 3-5 ofRPM for DAO 2003-30); andVII. EmergencyPreparednessand ResponsePolicy andGenericGuidelinesVIII. Abandonment/Decommissioning /Rehabilitation PolicyIX. Institutional Planfor EMPImplementationPresent a proposed amount of EGF andthe basis for the estimate following theguidelines in Annex 3-6 of RPM for DAO2003-30The safety policy and generic guidelines shouldbe consistent with the regulatory requirements.Emergency Preparedness should also considernatural hazards to the infrastructure andfacilities.Statement on proponent’s policies and genericprocedures for Rehabilitation/Decommissioning/Abandonment.Discuss the organizational scheme of theproponent including line of command andreporting procedures as well as manpowercomplement and relationships with otheroperating departments.6

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningChecklist of EIS ContentsKey Environmental Impacts and Management/Monitoring PlanList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1. THE LAND1.1 Land Use and Classification1.1.1Change/Inconsistency in Description & Map showing the project Assessment of theland usearea in relation to existing land use. compatibility of the1.1.2 Encroachment inIdentify ECA where the project is proposed project inEnvironmentally Critical located or near the project area. relation to land useAreas (ECAs)Identify areas vulnerable/susceptible to and/or the coastalnatural hazards where the project is resource managementlocated or near the project area plan of the LGU, if any.1.1.3 Possible tenurial / landissue(include map/s).Identify areas under CARP or withCADC / CADT/CALT/CALC where theproject is located or near the projectarea. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditions AnalysisPlanPage Page Page Page 1.2 Geology/Geomorphology1.2.1 Change in surfacelandform/ topography/terrain/slope1.2.2Change in sub-surface/underground geomorphology1.2.3 Inducement of subsidence,liquefaction, landslides, mud /debris flow, etc.Specify other conflicting tenurial / landissues (e.g., IFMA/CBFMA within COCand within MPSA, ownership, informalsettlers, etc.)Slope and Elevation/Topographic MapRegional/General Geological MapGeological Cross-Sections; SequenceStratigraphic Column of Rock Units;Geomorphological Map: G FactorContour Maps; Seismicity Map;Differential Settling Map; Hazard Maps(NAMRIA, NDRRMC, MGB,PHIVOLCS, PAG-ASA)Include discussions onimpacts/effects of naturalhazard on the project.7

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1.3 Pedology1.3.1 Soil erosion / Loss oftopsoil/overburden1.3.2 Change in soilquality/fertility1.4 Terrestrial Ecology1.4.1 Vegetation removal andloss of habitat1.4.2 Threat to existence and/orloss of important localspecies1.4.3Threat to abundance,frequency and distributionof important species1.4.4 Hindrance to wildlifeaccessSummary of Soil Investigation Reporton soil type and quality; Erodibilitypotential; Bank stabilityLaboratory results on soil sampleanalysis for N, P, K, pH, organicmatter, micronutrients and tracemetals, e. g. Pb, Hg, As, Cd, Crhexavalent, etc.Flora and fauna species inventory orsurvey report;Historical occurrences of pestinfestation, forest/grass fire and/orsimilar incidencesSummary of endemicity / conservationstatusSummary of abundance, frequencyand distributionEconomic importance and uses ofsignificant flora and faunaSampling / survey map in relation tothe project siteInclude discussions onpotential landcontamination due toproject operations. Relatediscussions to soilcharacteristics.Physical analysis (waterholding capacity, textureaggregate stability ofdam); secondary data:chemical analysisQuadrat sampling forfloraUse of mist nets, traps,transect walk for faunaInclude impactassessment onvegetation (e.g.,likelihood of destruction)and specific managementmeasures (e.g.,protection, balling,transplanting,replacement, etc.) for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditionsAnalysisPlanPage Page Page Page 2. THE WATER2.1 Hydrology/Hydrogeology2.1.1 Change in drainagemorphology / Inducement offlooding/ Reduction in streamvolumetric flowDrainage map; historicalflooding/drought occurrences, streamflow measurements/estimates;Delineation of watershed /subwatersheds/floodplain; andidentification of aquifers, if anyFlood simulation/modeling, considerextreme weatherconditions and the PAG-ASA 2020 and 2050climate projections8

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Assessment shouldinclude potentialoccurrence oraggravation of flooding innearby areas.2.1.2 Change in stream, lake Regional hydrogeological mapwater depth2.1.3 Depletion of waterresources / competition in wateruse2.2 Oceanography2.2.1 Change/disruption incirculation patternIdentification of current / projectedwater use in the area and adjacentareasSpring and well inventory and locationmap; depth of water tableAnalysis/estimation of water availabilitytaking into consideration the PAG-ASA2020 and 2050 climate projectionsPredicted tides; 24-hour tidal cycles;Surface current system2.2.2 Change in bathymetry Bathymetric map USLE / similar modelingwhen applicable2.3 Water Quality2.3.1 Degradation ofgroundwater quality2.3.2 Degradation of surfacewater quality2.3.3 Degradation ofcoastal/marine water qualityPhysico-Chemical characterization ofwater : pH BOD5 COD DO Oil and grease TSS Heavy Metals:____________________ fecal / total coliform Others:__________________________Use DENR standardmethods and proceduresfor sampling andanalysis.Groundwatercontamination modelingshould consider worstcase scenario of failure ofcontrol measures, suchas leachate control,geotextile lining9 for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditionsAnalysisPlanPage Page Page Page

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditionsAnalysisPlanPage Page Page Page 2.4 Freshwater Ecology2.4.1 Threat to existence and/orloss of important localspecies and habitat2.5 Marine Ecology2.5.1 Threat to existence and/orloss of important local speciesand habitat2.5.2 Threat to abundance,frequency and distribution3. THE AIR3.1 Meteorology/Climatology3.1.1 Change in the local climate,e.g., local temperature3.1.2 Contribution in terms ofgreenhouse gas emissionssampling site mapSummary of endemicity /conservation statusAbundance of ecologically andeconomically important species(fishes, benthos, planktons);Presence of pollution indicatorspeciessampling site mapAbundance/densities/distribution ofecologically and economicallyimportant species (mangroves,fishes, benthos, planktons, coralreefs, algae, seaweeds, seagrasses);Presence of pollution indicatorspecies;Historical occurrences of red-tide,fish kill or any related eventMarine resource mapsampling site mapMonthly average rainfall andtemperature of the area; Climatologicalnormals/extremes; Wind rosediagrams; Frequency of TropicalcyclonesData on Greenhouse gasses (i.e.,methane, nitrous oxide, carbondioxide); Calculation of projected GHGemissionInclude discussions onoverall impact tofreshwater ecologyQuadrat, transect, lineintercept, spot dive,manta tow, marineresourcecharacterization (e.g.,municipal andcommercial fisheriesdata)Include discussions onoverall impact tomarine ecologyIn the assessment,consider the PAG-ASAclimate changeprojections for 2020 and2050.Discuss the project’scontribution in terms ofgreenhouse gasemissions (applicable for10

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.power and landfill andpossible for mining anddam)3.2 Air Quality (and Noise)3.2.1 Degradation of air quality Characterization of ambient air quality: TSP PM10 SOx NOx Trace Metals:____________________ others:______________________(for sampling methods refer to CleanAir Act)Use DENR standardmethods and proceduresfor sampling andanalysis. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditionsAnalysisPlanPage Page Page Page 3.2.2 Increase in ambient noiselevel4. THE PEOPLE4.1 Displacement of settler/sDisplacement / disturbanceof propertiesChange/conflict in landownershipsampling site mapCharacterization of ambient noise levelsampling site mapDemographic data of impact area:- Number of households andhousehold size- Land area,- Population,- Population density /growth- Gender and age profile,- Literacy rate, profile of educationalUse DENR standardmethods and proceduresfor sampling andmeasurement.If applicable, noiseattenuation modeling(applicable if there is asource capable ofgenerating 200 dB ormore).Discuss how the projectwould affect existingproperties in the area interms of relocation anddevaluation11

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.Change/conflict in right of attainment,waySettlements map4.2 In-migrationDiscuss the in-migrationCensus of population / property that patterns as a result ofProliferation of informal will be displaced / disturbedproject implementationsettlersHousing ownership profile / availability4.3 Cultural/Lifestyle change(especially on IndigenousPeoples, if any)4.4 Threat to delivery of basicservices /resource competition4.5 Threat to public health andsafetyof housing/ number of informal settlersDemographic data on IndigenousPeoples (if any) and existingCulture/Lifestyle that may besignificantly affectedAvailability of public services in termsof:Water supplyPower supplyCommunications /transportationHealth resources (Governmentand Private)Peace and order / crimeEducation facilitiesRecreational facilities / sportsfacilitiesStatistical data / information related topublic services:Literacy rate, profile of educationalattainmentMorbidity and mortality rates(infants and adults - 5-year trend)Common diseases in the areaincluding endemic diseasesEnvironmental Health andSanitation ProfileCrime rateFood securityDiscuss the impacts onIPs and Culture/LifestyleDiscuss how the projectwould affect the deliveryof basic services and mayresult in resourcecompetition in the areaDiscuss the projectimplementation’s threat topublic health vis-à-vis thebaseline health conditionsin the areaAnalysis of diseases thatmay be affected byclimate change.12 for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditionsAnalysisPlanPage Page Page Page

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.4.6 Generation of LocalBenefits from the projectEnhancement of employmentand livelihood opportunitiesIncreased business opportunitiesand associated economicactivitiesSocioeconomic data:Main sources of IncomeEmployment rate/ profileSources of livelihoodPoverty incidenceCommercialand activitiesBanking and financialinstitutionsestablishmentsIncreased revenue of LGUs4.7 Traffic congestion Road network/ systemsExisting transportation/traffic situationTraffic impactassessment, if applicable(including capacity ofroad system in terms ofload/count) for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan Monitoring RemarksConditionsAnalysisPlanPage Page Page Page 13

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningIII.Environmental Risk AssessmentType of Risks Scope of Assessment Report/Output RequiredDuring scoping: Check () required/applicable items; items with are automatically required; write specific instructions ( ifany) on the blanks/spaces provided. Physical Risks- Identification of conditions, events and ERA REQUIREMENT“trigger” which could be significant in(Failure of Structure which bringing about identified physical risks Descriptive/Qualitative Riskcould endanger life, property- Description & assessment of the possible Assessmentand/or the environment)accident scenarios- Assessment of whether the projectSpecific Instructions :location is projected to have extreme _____________________________climate events for 2020 and/or 2050 thatcould contribute to the triggering EMERGENCY PLAN :identified scenarios- Description of the hazards bothSpecific Instructions :immediate (acute effects) and delayed ______________________________(chronic effects) for man and theenvironment posed by the failure of Refer to Annex 2-7e for the decisionstructure, as applicable.criteria outline for completeness during procedural screening; page numbersshould be provided upon submission of the EISERA ERP MonitoringPlanPage Page Page Remarks14

ECC APPLICATION SCREENING FORM FOR SANITARY LANDFILL PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningNoted By: Signature SignatureReview Committee MembersEMB Representatives1. 1.2. 2.3. 3.4. Project Proponent:5.6. Project Preparer/Consultant:Resource Person1.15

OKAY FOR PRINTING: _____________________________________________ ________________________________Signature over Printed Name DateAnnex 1 - HECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningDate Submitted for Screening: _______________________________________________________________Form of Submission: ___ Hard ___ DigitalProject Title: _____________________________________________________________________________Project Location: _________________________________________________________________________Project Proponent: ________________________________________________________________________Address: ________________________________________________________________________________Contact No:Fax No:______________Contact Person:__________________________EIS Consultant: ___________________________________________________________________________Address: ________________________________________________________________________________Contact No: Fax No: Contact Person:__________________________Project Classification & Type: _______________________________________________________________Project Classification Code (Refer to RPM for DAO 2003-30): _____________________________________Project Size based on Classification: _________________________________________________________Date of Technical Scoping:______________________________________________________________Venue of Technical Scoping:_____________________________________________________________Checklist of Documentary RequirementsTo be filled-up upon submission of EISEnvironmental Impact Statement (EIS) 1Proof of Compatibility with the existing LandUse PlanProof of Authority over the Project SiteAccountability Statements of Preparers &Proponents (see Annexes 2-21 & 2-22 ofRevised Procedural Manual for DAO 2003-30)Photographs or plates of the project site,impact areas and affected areas andcommunitiesDuly Accomplished Project EnvironmentalMonitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d ofRevised Procedural Manual for DAO 2003-30)Acceptable?Yes NoScreening Officer’s RemarksACTION TAKEN: (Please check to indicate corresponding action taken)Document accepted; please submit __ copiesEIARC Needed? ( ) Yes ( ) No Expertise Needed:Processing Fee: PhP _______ (Pay at EMB Cashier) Review Fund: Based on WFP (Pay to the dulyauthorized 3 rd Party Review Fund Manager)Document not acceptedO.R. #DateNOTED BY:___________________________Screening Officer_________________________Section/Division ChiefEMB Regional OfficeScreening OfficeDate:_____________________________1 Please refer to attached checklist of EIS Contents1

Checklist of EIS ContentsI. Executive Summary (maximum of 5 pages)ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningCONTENTSPage #Acceptable?REMARKSProject Fact Sheet PD Summary (1 page)Process Documentation of the conduct of EIA (1 page) (EIA Team,EIA Study Schedule & Area, EIA Methodology, Public Participation)Summary of Baseline Characterization, Key Environmental Impacts,Management & Monitoring Plan, and EMF and EGF CommitmentsItems to beDescribedII. I. Project Description1) Project Locationand AreaSpecific Data Requirement Page # Acceptable?a) Map showing sitio, barangay, municipality,province, region boundaries, vicinity,proposed buffers surrounding the area andprimary & secondary impact areasb) Geographic coordinates (shape file data) ofproject area (use PRS 92 datum - GPSsetting)c) Rationale for selection primary & secondaryimpact areasd) Discussion on the accessibility of the projectsite/area2) Project Rationale Cite and focus on the need for the projectbased on national and regional/localeconomic development in terms ofcontribution to sustainable developmentagenda or current development thrusts.Describe the justification for the Projectwith particular reference to the economicand social benefits, including employmentand associate economic development,which the project may provide. The statusof the project should be discussed in aregional and national context.3) ProjectAlternativesa) Cite criteria used in determining preliminaryoptions for facility siting, developmentdesign, process/technology selection,resource utilization, including discussion ofthe consequences of not proceeding withthe project:Contextualize site selection in terms ofvulnerability/susceptibility to liquefaction,ground shaking, ground rupture,earthquake-induced landslides, volcaniceruptions, rain-induced landslide, stormsurge, tsunami, and flooding as well asextreme climatologic conditions (datacan be obtained from NDRRMC andNAMRIA as well as other mandatedagencies)REMARKS2

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data Requirement Page # Acceptable?Discuss the alternatives (type andlocation) considered and nominatedduring the course of selecting the bestoption for which the EIS is prepared;Describe the bases upon which thealternatives were rejected in favor of thepreferred option;Describe the significant differences inenvironmental impacts among thealternatives considered.Siting: Cite alternative project locationsincluding factors significant to the selection,such as perception of affected communitieswith regards to project, ancestral domainissues, land classification, etc. Discussother options on the siting of majorcomponents of the project within the projectarea.Technology Selection/Operation Processes:Discuss the project’s advantage overalternative technologies, operationprocesses and engineering design.Discuss alternative measures to preventoccurrence of major impacts.REMARKS4) ProjectComponentsResources: Discuss the alternativesconsidered for power generation and howthe decisions were made. Discussionshould also be in the context of climatechange (e.g., use of non renewable vs.renewable energy).b) Reasons for selecting the preferred optionsdelineated in terms of technical,commercial, social and naturalenvironmental aspects.c) After determining the preliminary options,please provide a summary of the comparativeenvironmental impacts of each alternative.Identification of major components includingtechnical details such as specifications,capacity, number, etc.), including thecooling water systemSpecify the operations and processIdentification of other Support FacilitiesIdentification of materials/product handlingfacilities, infrastructure requirements(transport—road/rail/ship, energy, watersupply and storage, storm water drainage,sewerage, telecommunications,accommodation and other infrastructure)3

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribed5) Process/TechnologySpecific Data Requirement Page # Acceptable?Identification of pollution control devicesincluding other waste management andcorresponding facility being served orconnectedIdentification of safety devices/ emergencyfacilities to be used in the occurrence ofindustrial accidents/emergencies (ie. fire,explosion, accidental oil spillage etc.)General layout of facilitiesFootprint of proposed layout of projectfacilities (if any)Maps should be provided showing theprecise location of the project area, and inparticular, the location and boundaries ofproject area, location and footprint of projectcomponents, and location of all proposedbuffers.When applicable, contextualize using thePAG-ASA 2020 and 2050 projectedrainfall/temperature data.Technology Description and PerformanceSpecificationsInclude process flow-sheets for the operationsand the anticipated rates of inputs, wastesand recycle streamsPower & water supply systemREMARKSWaste Management Systems(water/wastewater treatment facility,electrostatic precipitators, baghouse filter,desulfurizer, other air pollution controldevices, ash disposal, cooling system, etc.)6) Project Size Total power generating capacity, filter plantcapacity, and port capacity and dimensionTotal Project Area in square meters orhectares7) DevelopmentPlan, Descriptionof Project PhasesandCorrespondingTimeframesPhases to be described in terms identifyingspecific activities (w/ special attention onthose with significant environmental impactsas well as climate change adaptation optionsrelevant to the project and project activities)and corresponding projected implementationtimeframes:Pre-construction (e.g., planning,acquisition of rights to use land, etc.)Construction (e.g., land/site clearing,temporary housing, transport of materials,health and other services for the workforce)Operation (projected period of startup/commissioning/fulloperation of variousproject components) include discussion onthe operation of various components (as4

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningItems to beDescribedSpecific Data Requirement Page # Acceptable?identified above) in terms of raw materialsand fuel requirements, infrastructurerequirements (transport—road/rail/ship,power, water supply and storage, stormwater drainage, sewerage,telecommunications, accommodation andother infrastructure), waste management(characteristics and quantities of wastematerials: wastewater, air emissions, solidwastes - toxic and hazardous, non toxic andnon hazardous)AbandonmentFinal Rehabilitation/ Decommissioning Plan,to include land/soil restoration,decontamination or remediation activities andprocedures & projected schedule. Thereshould also be discussions about strategiesand methods for final rehabilitation of theenvironment disturbed by the project. Theland use suitability of the various landdisturbance types should likewise bedescribed.The proposed decommissioning plan shouldbe in terms of the following:REMARKSProcedures for the decommissioning of theproject components;Transport/disposal of equipment and othermaterials used in the plant’s operation;Remediation of contaminated soil andwater resources due to spills and leakageof chemicals and other materials used inthe operation;Alternatives for the future use ofabandoned area;Consistency with long-term zoning andland use development plan of themunicipality;Rehabilitation / Restoration plans, if any8) Manpower Tabulate the following per project phase:manpower requirements;expertise/skills needed;nature & estimated number of jobsavailable for men, women, and indigenouspeoples (if sited in IP ancestral land);preferred scheme for sourcing locally fromhost and neighboring LGUs9) Indicative Project Investment Cost (Philippine Peso)5

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral Contents Specific Content RequirementPage # Acceptable? REMARKSII. KeyEnvironmentalImpacts andManagement/Monitoring PlanIII. EnvironmentalRisk AssessmentIV. ImpactManagement PlanV. SocialDevelopment Plan(SDP) and IECFrameworkSee attached checklist of contentsWhen applicable, include appropriate climatechange adaptation measures/options(embedded in each sector).See attached checklist of contentsLimit to most significant impacts per projectphase and per environmental componentarising from key environmental aspects (SeeAnnex 2-17 of RPM for DAO 2003-30)SDPCommunity development or livelihoodprograms/activities, projected beneficiaries,partner institutions, timeframe ofimplementation as well as source and amountallotted per activity/component (See Annex 2-18 of RPM for DAO 2003-30)IECVI. EnvironmentalComplianceMonitoringTarget sector, key messages,scheme/strategy/methods, Informationmedium, timelines and frequency, cost (SeeAnnex 2-19 of RPM for DAO 2003-30)Self-Monitoring PlanUse Annex 2-20 of RPM for DAO 2003-30 astemplateMulti-Sectoral Monitoring FrameworkTabulate the list of stakeholder-members ofthe MMT, basis of selection, proposed role,and scope of MMT responsibilities andactivities, etc. (See Annex 3-4 of the RPM forDAO 2003-30).Environmental Guarantee and MonitoringFund CommitmentsPresent a proposed amount of EMF(based on a draft AWFP in Annex 3-4and consistent with guidelines in Annex3-5 of RPM for DAO 2003-30); andPresent a proposed amount of EGF andthe basis for the estimate following theguidelines in Annex 3-6 of RPM for DAO2003-30.6

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningGeneral Contents Specific Content RequirementPage # Acceptable? REMARKSVII. EmergencyPreparedness andResponse Policyand GenericGuidelinesThe safety policy and generic guidelinesshould be consistent with the regulatoryrequirements. Emergency Preparednessshould also consider natural hazards to theinfrastructures and facilities.Note: The proponent’s final safety/contingency/emergency guidelines (based onsafety assessment eg. HAZOP) must besubmitted to EMB prior to operation.VIII. Abandonment/Decommissioning/Rehabilitation PolicyIX. Institutional Planfor EMPImplementationStatement on proponent’s policies andgeneric procedures for Rehabilitation/Decommissioning/Abandonment to besubmitted as post-ECC, within a timeframespecified in the ECC.Discuss the organizational scheme of theproponent including line of command andreporting procedures as well as manpowercomplement and relationships with otheroperating departments.7

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningChecklist of EIS ContentsKey Environmental Impacts and Management/Monitoring PlanList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1. THE LAND1.1 Land Use and Classification1.1.1 Change/Inconsistency in Description & Map showing the projectland usearea in relation to existing land use.1.1.2 Encroachment inEnvironmentally CriticalAreas (ECAs)Identify ECA where the project islocated or near the project area.Identify areas vulnerable/susceptible tonatural hazards where the project islocated or near the project area(include map/s).Assessment of thecompatibility of theproposed project inrelation to land useand/or the coastalresource managementplan of the LGU, if any. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditions AnalysisPlanRemarksPage Page Page Page 1.1.3 Possible tenurial / landissueIdentify areas under CARP or withCADC / CADT / CALT / CALC wherethe project is located or near theproject area.Specify other conflicting tenurial/landissues (eg. ROW, informal settlersetc.)1.2 Geology/Geomorphology1.2.1 Change in surfacelandform/ topography/terrain/slope1.2.2 Change in sub-surface/underground geomorphologySlope and Elevation/Topographic MapRegional/General Geological Map8

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.1.2.3 Inducement of subsidence, Geological Map as needed.; hazard Include discussions onliquefaction, landslides, maps (NAMRIA, NDRRMC, MGB, impacts/effects of naturalmud / debris flow, etc. PHIVOLCS, PAG-ASA)hazard on the project. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanRemarksPage Page Page Page 1.3 Pedology1.3.1 Soil erosion / Loss oftopsoil/overburden1.4 Terrestrial Ecology1.4.1 Vegetation removal andloss of habitat1.4.2 Threat to existence and/orloss of important localspecies1.4.3Threat to abundance,frequency and distributionof important species1.4.4 Hindrance to wildlifeaccess2. THE WATER2.1 Hydrology/Hydrogeology2.1.1 Change in drainagemorphology / Inducement ofSummary of Soil Investigation Reporton soil type and quality; Erodibilitypotential; Bank stabilityFlora and fauna species inventory orsurvey report;Historical occurrences of pestinfestation, forest/grass fire and/orsimilar incidencesSummary of endemicity / conservationstatusSummary of abundance, frequencyand distributionEconomic importance and uses ofsignificant flora and faunaSampling / survey map in relation tothe project siteDrainage map; historicalflooding/drought occurrences, streamInclude discussions onpotential landcontamination due toproject operations. Relatediscussions to soilcharacteristics.Quadrat sampling forfloraUse of mist nets, traps,transect walk for faunaInclude discussions onoverall impact to floraand faunaInclude impactassessment onvegetation (e.g.,likelihood of destruction)and specific managementmeasures (e.g.,protection, balling,transplanting,replacement, etc.)Discuss possible impactsof the project on the9

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.flooding/ Reduction in streamvolumetric flowflow measurements/estimates;Delineation of watershed /subwatersheds/floodplain; andidentification of aquifers, if anyoccurrence of floodingand vice versa. Considerextreme weatherconditions and the PAG-ASA 2020 and 2050climate projections. for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanRemarksPage Page Page Page 2.1.2 Change in stream, lakewater depth2.1.3 Depletion of waterresources / competition in wateruse2.2 Oceanography2.2.1 Change/disruption incirculation patternRegional hydrogeological mapIdentification of current / projectedwater use (groundwater/surface water)in the area and adjacent areasSpring and well inventory and locationmap; depth of water tableAnalysis/estimation of water availabilitytaking into consideration the PAG-ASA2020 and 2050 climate projectionsPredicted tides; 24-hour tidal cycles;Surface current systemAssessment shouldinclude potentialoccurrence oraggravation of flooding innearby areas.For project withsignificant waterrequirement, conductwater balance / budgetanalysis2.2.2 Change in bathymetry Bathymetric map USLE / similar modelingwhen applicable2.3 Water Quality2.3.1Degradation of groundwaterqualityPhysico-Chemical characterization ofwater:Use DENR standardmethods and procedures10

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.2.3.2 Degradation of surfacefor sampling andwater qualityanalysis.2.3.3 Degradation ofcoastal/marine water quality2.4 Freshwater Ecology2.4.1 Threat to existence and/orloss of important localspecies and habitat pH BOD5 COD DO Oil and grease TSS HeavyMetals:____________________ fecal / total coliform Others:__________________________sampling site mapSummary of endemicity /conservation statusAbundance of ecologically andeconomically important species(fishes, benthos, planktons)Presence of pollution indicatorspeciesFor project withcoastal/marine structuresand /or significant marine/coastal discharges,conduct circulation /plume modeling (includeworst case scenario offailure of WWTF).Include discussions onpossible contaminationdue to leaks/spillsProvide Aquifer(Groundwater)vulnerability Assessment(i.e., discussions ongroundwatercontamination due toproject operation).Include discussionsonoverall impact tofreshwater ecology for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanRemarksPage Page Page Page sampling site map11

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.2.5 Marine Ecology2.5.1 Threat to existence and/or Abundance/densities/distribution ofloss of important local speciesand habitat2.5.2 Threat to abundance,frequency and distributionecologically and economicallyimportant species (mangroves,fishes, benthos, planktons, coralreefs, algae, seaweeds, seagrasses)Presence of pollution indicatorspeciesHistorical occurrences of red-tide,fish kill or any related eventMarine resource mapsampling site mapQuadrat, transect, lineintercept, spot dive,manta tow, marineresourcecharacterization (e.g.,municipal andcommercial fisheriesdata)Include discussions onoverall impact tomarine ecology for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanRemarksPage Page Page Page 3. THE AIR3.1 Meteorology/Climatology3.1.1 Change in the localclimate, e.g., local temperature3.1.2 Contribution in terms ofgreenhouse gas emissionsMonthly average rainfall andtemperature of the area; Climatologicalnormals/extremes; Wind rosediagrams; Frequency of TropicalcyclonesData on Greenhouse gasses (i.e.,carbon dioxide, nitrous oxide);Calculation of projected GHG emissionIn the assessment,consider the PAG-ASAclimate changeprojections for 2020 and2050.Discuss the project’scontribution in terms ofgreenhouse gasemissions3.2 Air Quality (and Noise)3.2.1 Degradation of air quality Characterization of ambient air quality: TSP PM10 SOxUse DENR standardmethods and proceduresfor sampling andanalysis.12

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided. NOxProvide air dispersionmodeling (include worst Trace Metals (for coal fired power case scenario of failure ofplant only) :_________________ APCD) for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanRemarksPage Page Page Page 3.2.2 Increase in ambient noiselevel4. THE PEOPLE4.1 Displacement of settler/sDisplacement / disturbanceof propertiesChange/conflict in landownershipChange/conflict in right ofway others:__________________________(for sampling methods refer to CleanAir Act)sampling site mapCharacterization of ambient noise levelsampling site mapDemographic data of impact area:- Number of households andhousehold size- Land area,- Population,- Population density /growth- Gender and age profile,- Literacy rate, profile of educationalattainment,Use DENR standardmethods and proceduresfor sampling andmeasurement.If applicable, noiseattenuation modeling(applicable if there is asource capable ofgenerating 200 dB ormore).Discuss how the projectwould affect existingproperties in the area interms of relocation anddevaluation13

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsProliferation of informalsettlersBaseline Data ParameterRequirementsCensus of population / property thatwill be displaced / disturbedRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.4.2 In-migrationSettlements mapDiscuss the in-migrationpatterns as a result ofproject implementation for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanRemarksPage Page Page Page 4.3 Cultural/Lifestyle change(especially on IndigenousPeoples, if any)4.4 Threat to delivery of basicservices /resource competition4.5 Threat to public health andsafetyHousing ownership profile / availabilityof housing/ number of informal settlersDemographic data on IndigenousPeoples (if any) and existingCulture/Lifestyle that may besignificantly affectedAvailability of public services in termsof:Water supplyPower supplyCommunications /transportationHealth resources (Governmentand Private)Peace and order / crimeEducation facilitiesRecreational facilities / sportsfacilitiesStatistical data / information related topublic services:Literacy rate, profile of educationalattainmentMorbidity and mortality rates(infants and adults - 5-year trend)Common diseases in the areaincluding endemic diseasesEnvironmental Health andSanitation ProfileCrime rateFood securityDiscuss the impacts onIPs and Culture/LifestyleDiscuss how the projectwould affect the deliveryof basic services and mayresult in resourcecompetition in the areaDiscuss the projectimplementation’s threat topublic health vis-à-vis thebaseline health conditionsin the areaAnalysis of diseases thatmay be affected byclimate change.14

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningList of Key ImpactsBaseline Data ParameterRequirementsRequired AssessmentMethodology/ApproachDuring scoping: Unless otherwise specified as agreed during scoping, all items listed are required. Writespecific instructions (if any) on the blanks/spaces provided.4.6 Generation of Local Benefitsfrom the projectEnhancement of employmentand livelihood opportunitiesIncreased business opportunitiesand associated economicactivitiesSocioeconomic data:Main sources of IncomeEmployment rate/ profileSources of livelihoodPoverty IncidenceCommercial establishments andactivitiesBanking and financial institutions for completeness during procedural screening; page numbers should be providedupon submission of the EISBaseline Impact Mgmt. Plan MonitoringConditionsAnalysisPlanRemarksPage Page Page Page Increased revenue of LGUs4.7 Traffic congestion Road network/ systemsExisting transportation/traffic situationTraffic impactassessment, if applicable(including capacity ofroad system in terms ofload/count)15

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningIII.Environmental Risk AssessmentType of Risks Scope of Assessment Report/Output RequiredDuring scoping: Check () required/applicable items; items with are automatically required; write specific instructions ( ifany) on the blanks/spaces provided.Safety Risks- Identification of conditions, events andERA REQUIREMENTcircumstances which could be significant in Quantitative Risk Firebringing about identified safety risksAssessment(QRA) - Report for Explosion- Description & assessment of the possiblesubmission prior to operation Release of toxic accident scenariossubstances- Assessment of whether the project location isprojected to have extreme climate events for2020 and/or 2050 that could contribute to the Specific Instructions :triggering identified scenarios- Description of the hazards, both immediate________________________(acute effects) and delayed (chronic effects) Descriptive/Qualitative Riskfor man and the environment posed by therelease of toxic substance (include unloadingAssessmentof raw materials/fuel), as applicable Physical Risks(Failure of Structure whichcould endanger life, propertyand/or the environment)- Identification of conditions, events and “trigger”which could be significant in bringing aboutidentified physical risks- Description & assessment of the possibleaccident scenarios- Assessment of whether the project location isprojected to have extreme climate events for2020 and/or 2050 that could contribute to thetriggering identified scenarios- Description of the hazards both immediate(acute effects) and delayed (chronic effects)for man and the environment posed by thefailure of structure, as applicable.Specific Instructions :__________________________ EMERGENCY PLAN :Specific Instructions :________________________Refer to Annex 2-7e for the decisioncriteria outline for completeness during procedural screening; page numbersshould be provided upon submission of the EISERA ERP MonitoringPlanPage Page Page Remarks16

ECC APPLICATION SCREENING FORM FOR THERMAL POWER PLANT PROJECTS(Requiring EIS for ECC Application)Control No: __________ 1 st 2 nd 3 rd ___ th ScreeningNoted By: Signature SignatureReview Committee MembersEMB Representatives1. 1.2. 2.3. 3.4. Project Proponent:5.6. Project Preparer/Consultant:Resource Person1.17

1Annex 2 - AINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforBATCHING AND CRUSHING PLANT PROJECTSThis IEE Checklist Report Form shall be used for proposed BATCHING AND CRUSHING PLANTPROJECTS required an IEE Report / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affected areasand communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS)Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects2PROJECT FACT SHEETName of the ProjectProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTIONPlease check project type and indicate size Project Type Project SizeBatching & Crushing PlantProject SizeParameterannual productionrateOther Description Details:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitude

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects3I.2 PROJECT COMPONENTSFacilities1. Raw material storage facility(e.g., aggregate, cement, etc.No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks2. Fuel storage facility3. Product storage facility/warehouse/stockpile4. Processing facility (e.g.,crushing, mixing, screening, etc.(please enumerate; useseparate sheet, if necessary5. Support facilities (e.g., conveyorbelt, generators, admin building,workers’ quarter, etc.)(please enumerate; useseparate sheet, if necessary)6. Water source/supply7. Waste water managementfacility8. Solid waste management facility9. Drainage system10. Others, specify____________________________________Use additional sheets, if necessary

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects4I.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is not obtained fromthe local water utility)Water(Rainwater Collection System)m 3 /daym 3 /dayWater Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects5Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Totalb. Operation PhaseManpower Requirement Expertise/Skills TotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialBaseline Environment Preventive/ Mitigating MeasuresImpactsMonitoring Parameters/ImplementationCost of Mitigation/Monitoring6LAND Consistency withland useCurrent land use w/in 1kmradius (as per zoningordinance): See attached proof of compatibilitywith land use Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________Actual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________ Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged or Annual inspection ofarea replanted/ revegetated Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects7PossibleEnvironmental/ SocialBaseline Environment Preventive/ Mitigating MeasuresImpacts Others, specify____________destroyed vegetation where possible(e.g., tree planting)Monitoring Parameters/ImplementationCost of Mitigation/Monitoring7 Change in surfacelandform/topography/terrain/slope Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify____________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify_________________ Slope/ Erosion ControlCost: ___________ Others, specify_________________ Soil/Landcontamination dueto improper solidwaste disposalIs the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS as hazardprone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement Ecological Solid WasteManagement Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Implement proper collection,labeling and storage of hazardouswaste Provide receptacles / bins for solidwastes Coordinate with the municipal / city Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_________________ Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects8PossibleEnvironmental/ SocialBaseline Environment Preventive/ Mitigating MeasuresImpactswaste collectors Engage third party company forwaste collection Others, specify________________Monitoring Parameters/ImplementationCost of Mitigation/Monitoring8 Impairment ofvisual aesthetics Devaluation of landvaluesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints from adjacentproperty owners Cost integrated in theconstruction/ operationcostWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify_____________Specify nearest/receivingwater body:_____________________Distance to nearest/receivingwater body: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest/receiving water bodyis fresh water, specifyclassification: AA A B C D Provide ring canals around fuellingtanks/ motor pool/ maintenanceareas Set up proper and adequate sanitaryfacilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Provide wastewater treatmentfacility (e.g., septic tank, oil andwater separator, etc.) Set up silt trap/settling ponds tominimize downstream siltation Others, specify______________Regular (ocular) inspectionof water body for: Turbidity and/or siltedcondition Floating wastes or debris Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects9PossibleEnvironmental/ SocialBaseline Environment Preventive/ Mitigating MeasuresImpactsIf nearest/receiving water bodyis coastal or marine water,specify classification:Monitoring Parameters/ImplementationCost of Mitigation/Monitoring9 SA SB SC SD Competition inwater use Depletion of waterresourcesCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalSize of population usingreceiving surface water: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsAvailable/nearest watersource. Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures Others, specify_________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring foroccurrences of watershortages Others, specify_______________ Cost integrated in theconstruction/ operationcost Deepwell Water district/LGU Surface water Others, specify________________

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects10PossibleEnvironmental/ SocialBaseline Environment Preventive/ Mitigating MeasuresImpacts Increasedoccurrence offloodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Limit the depth and area ofworkspace Regularly remove debris and othermaterials that may obstruct waterflow Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify____________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring forincreased frequency offlooding Others, specify__________________Cost of Mitigation/Monitoring Cost integrated in theconstruction/ operationcost10AIR/NOISEAir quality degradationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g., vehicles,generator, etc.) Install, when applicable, theappropriate air pollution controldevice/s Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Conduct water spraying tosuppress dust sources andminimize discomfort to nearbyresidents Use covered vehicles to delivermaterials that may generate dust Others, specify__________________ Regular monitoring forpresence/absence ofcomplaintsRegular (ocular) inspectionof: Absence of white orblack smoke fromvehicles, generator,etc. Presence of truckcover duringdeliveriesQuarterly monitoring ofambient air for the following: TSP PM10 NOx Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects11PossibleEnvironmental/ SocialBaseline Environment Preventive/ Mitigating MeasuresImpactsMonitoring Parameters/ImplementationCost of Mitigation/Monitoring11 Nuisance due tonoise generationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allnoise sources (e.g., vehicles,generator, etc.) Install, when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Implement appropriate operatinghours Provide adequate buffer(e.g., Perimeter planting of trees toserve as sound buffer and greenbelt) Others, specify_________________ SOx CO / CO2 Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofbuffer zones Quarterly monitoring ofnoise level Cost integrated in theconstruction/ operationcostPEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunities Increased revenuesfor LGU Disruption/Competition inSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsClassification of hostbarangay: Urban RuralAvailable services within/nearthe host barangay: Schools (e.g.elementary, high Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regular coordination with LGU Conduct prior consultation andcoordination to minimize disruption ofdaily domestic activities and toensure respect for IP rights andcultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc. Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify______________ Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects12PossibleEnvironmental/ SocialBaseline Environment Preventive/ Mitigating MeasuresImpactsdelivery of publicservices (e.g.,education, peaceand order, etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflow Impacts oncommunity healthand safety Others, specify_______________school, college) Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify________________ Others, specify_________________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Implement appropriate safetyprograms for both community andworkers Strictly comply with fire, safety andsimilar regulatory requirements Strictly comply with requirements ofRA 6969 Others, specify___________________________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify____________________Cost of Mitigation/Monitoring Cost integrated in theconstruction/ operationcost12

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects1313III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:4.1. Abandonment Plan (if Applicable)(same with III)

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects1414Attach drawing/plan of waste water treatment facility (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects15Process 15 flow

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects1616Attach drawing/plan of pollution source and control installations (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Batching & Crushing Plant Projects1717SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

1Annex 2 - BINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforFISHERY / AQUACULTURE PROJECTSThis IEE Checklist Report shall be used for proposed FISHERY / AQUACULTURE PROJECTSrequired an IEE Report or IEE Checklist Report for ECC Application.This IEE Checklist Report shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affectedareas and communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal actions and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

II.Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects2PROJECT FACT SHEETName of theProjectProponent NameProponentAddressContact Person Name: Designation:Proponent Meansof ContactLandline No.Mobile No.Fax No.Email Address:I. PROJECT DESCRIPTIONPlease check project type and indicate sizeInland Based Fishery/Aquaculture ProjectsCoastal Area Based Fishery/Aquaculture ProjectsProject Type Project Size Project SizeParameterHectaresHectaresOther Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e. industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Project/Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects3Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedLongitudeLatitudeon OCT/TCT/etc)I.2 PROJECT COMPONENTSFacilities1. Fish cages/pens/pondsNo. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks2. Hatchery / Nursery3. Support Facilities (e.g. feeders,aerators, generators, etc.)4. Storage facility5. Postharvest facility6. Solid waste management facility7. Others, specify____________________________________Use additional sheets, if necessary

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects4I.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/ElectricityKWh(From Renewable Energy Sources)Water (Total)m 3 /day(Fill-up table below if water is notobtained from the local water utility)Waterm 3 /day(Rainwater Collection System)Water Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects5Energy/Water EfficiencyUtilitiesPower/ElectricityEstimatedSavingsKWhProposed Efficiency/Conservation MeasuresWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpowerRequirementExpertise/SkillsTotalb. Operation PhaseManpowerRequirementExpertise/SkillsTotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleBaseline EnvironmentEnvironmental/ SocialImpactsPreventive/ MitigatingMeasuresMonitoring Parameters/ImplementationCost of Mitigation/MonitoringLAND Consistency withland useCurrent land use w/in 1km radius (asper zoning ordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify____________________ See attached proof ofcompatibility with land useActual land uses w/in 1km radius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify____________________ Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify_____________________ Comply with conditions ofDENR/LGU SLUP, TreeCutting Permit, ROW, PCAPermit Limit land clearing as muchas possible Provide temporary fencingfor vegetation that will beretained Promote restoration ofdamaged or destroyedvegetation where possible(e.g., tree planting) Annual inspection ofarea replanted/re-vegetated Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects7PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ MitigatingMeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Change in surfacelandform/topography/terrain/slope Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion controland slope protectionmeasures Designate a Spoils StorageArea, with topsoil set asidefor later use and allowmaximum re-use of spoils Construct during dryseason Stabilize embankment withgrasses or other soil cover Others, specify____________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify______________ Slope/ Erosion ControlCost: ___________ Others, specify______________ Impairment of visualaesthetics Devaluation of landvaluesIs the project site located in an areaidentified by MGB/PAG-ASA/PHIVOLCS as hazard prone? Yes NoPresence of visually significantlandforms/landscape/structures? Yes No Comply with the DENRAdministrative Order No.2003-30 and DENRAdministrative Order No.2000-28, ImplementingGuidelines on EngineeringGeological and GeohazardAssessment(EGGA). Implement landscapingand other beautificationmeasures Provide adequate buffer Compensate adjacentproperty owners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints fromadjacent propertyowners Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects8WATER Water qualitydegradation Others, specify____________Current Water Use: Fishery Tourist Zone / Park Recreational Industrial Agricultural Set up proper andadequate sanitary facilities Strictly observe properwaste handling anddisposalRegular (ocular) inspectionof water body for: Drainage/canal system Cost integrated in theconstruction/ operationcostDistance of project area to the nearestwell used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of nearest well: Drinking/Domestic Industrial Agricultural Increasedoccurrence offloodingIs the project site located in an areaidentified by MGB/ PAG-ASA asflood prone? Yes No Use appropriate design forproject facilities Implement appropriatedrainage system Regularly remove debrisand other materials thatmay obstruct water flow Use appropriatetechnology (e.g., raisedhand-pumps) to protectdrinking water from floodcontamination Others, specify__________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concernedagencies Regular monitoring forincreased frequency offlooding Others, specify_________________ Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects9PEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunities Increased revenuesfor LGU Disruption/Competition indelivery of publicservices (e.g.,education, peaceand order, etc.) Enhanced delivery ofpublic services (e.g.,education, peaceand order, etc.) Increase in trafficvolume andworsening of trafficflow Depletion of localfish populations bystocking of wildfry/fingerlings inpondsSize of population of host barangay: ≤ 1,000 persons >1,000 and ≤ 5,000 persons >5,000 personsClassification of host barangay: Urban RuralAvailable services within/near the hostbarangay: Schools (e.g. elementary, highschool, college) Health facilities (e.g., clinics,hospitals, etc.) Peace and order (e.g., policeoutpost, Brgy. Tanod, etc.) Recreation and sports facilities Others, specify___________________ Providerelocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxesand other financialobligations Regular coordination withLGU Prior consultation andcoordination to minimizedisruption on dailydomestic activities & toensure respect for IPrights and cultural practices Ensure participation of IPsin consultations anddialogues Provide appropriatetraffic/warning signs,lighting, etc Others, specify_________________ Presence/Absence ofcomplaints Regular coordinationwith LGU Others, specify_________________ Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects1010 10III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as dismantling and waste disposal.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects1111 11Attach drawing/plan of pollution source and control installations (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Fishery/Aquaculture Projects1212 12SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

1Annex 2 - CINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforFOOD, FOOD BY-PRODUCT AND BEVERAGES MANUFACTURING/PROCESSING PLANT PROJECTSThis IEE Checklist Report Form shall be used for proposed FOOD, FOOD BY-PRODUCTAND BEVERAGES MANUFACTURING/PROCESSING PLANT PROJECTS required an IEEReport / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affectedareas and communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE ChecklistReport Form. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processingof an ECC application using the IEE Checklist Report within twenty (20)working days upon receipt of completed/duly-accomplished form.Misleading or erroneous answers are grounds for legal action and/or denial of ECC issuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects22PROJECT FACT SHEETName of theProjectProponent NameProponentAddressContact Person Name: Designation:Proponent Meansof ContactLandline No.Mobile No.Fax No.Email Address:I. PROJECT DESCRIPTIONPlease check project type and indicate sizeProject TypeAnimal products processing (fish/meat processing,canning, slaughterhouses, etc.)Coconut processing plants (including production ofcoconut based products)Distillation and Fermentation Plants ( e.g., bio-ethanolproject)Fruit and vegetable processingOther types of food (and other food by-products,additives, etc.) processing industriesProcessing of dairy productsSugar MillsActualProject SizeProject SizeParameterDailyproduction rateMonthlyproduction rateAnnualproduction rateDailyproduction rateAnnualproduction rateof finishedproductMonthlyproduction rateAnnualproduction rateThresholds forIEE Checklist≥ 500 kg but

II.IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects33I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e. industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Project/Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc)LongitudeLatitudeI.2 PROJECT COMPONENTS (Put “NA if Not Applicable)Facilities1. Material storage facilityRaw materials (e.g., coconut,sugarcane, meat, milk, etc.)Chemical/process materials(e.g., additives, acids, etc.)Fuel, lubricants and similarmaterialsFinished product (e.g.,warehouse, freezer, etc.)No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/RemarksOthers, specify__________________2. Processing facilityMaterial preparation andhandling (e.g., screening,sorting, conveyor belt, etc.)Material sizereduction/agglomerationHeating/Drying (directheat/energy application)Processing (e.g., mixing,blending, refining, milling,pasteurization, etc.)Distillation and fermentation

IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects44FacilitiesFinishing (e.g., freezing, filling,packaging, etc.)Others, specify______________No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks3. Support Facilities (e.g.,emergency generators, boilers,steam generators, etc.)4. Admin support (e.g., canteen,office, clinic, quarters, etc.)5. Water source / supply6. Waste water managementfacility7. Solid waste management facility8. Drainage system9. Others, specify________________________________________Use additional sheets, if necessaryI.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/ElectricityKWh(From Renewable Energy Sources)Water (Total)m 3 /day(Fill-up table below if water is notobtained from the local water utility)Waterm 3 /day(Rainwater Collection System)

IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects55Water Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)Energy/Water EfficiencyUtilities Estimated Savings Proposed Efficiency/Conservation MeasuresPower/ElectricityKWhWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpowerRequirementExpertise/SkillsTotal

IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects66b. Operation PhaseManpowerRequirementExpertise/SkillsTotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

IEE Checklist Report for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects777III. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ Social Baseline EnvironmentImpactsLAND Consistency with landuseCurrent land use w/in 1km radius(as per zoning ordinance):Preventive/ Mitigating Measures See attached proof ofcompatibility with land useMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify___________________Actual land uses w/in 1km radius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify___________________ Disturbance to wildlifedue to vegetationclearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify____________________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damagedor destroyed vegetation wherepossible (e.g., tree planting) Annual inspection ofarea replanted/re-vegetated Cost integrated inthe construction/operation cost

IEE Checklist Report for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects888PossibleEnvironmental/ SocialImpacts Change in surfacelandform/ topography/terrain/slope Soil ErosionBaseline EnvironmentSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%)Preventive/ Mitigating Measures Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use ofspoils Construct during dry season Stabilize embankment withgrasses or other soil cover Others, specify____________Monitoring Parameters/Implementation Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areasnear the site Others, specify___________Cost of Mitigation/Monitoring Slope/ ErosionControl Cost:___________ Others, specify____________ Soil/Landcontamination due toimproper solid wastedisposalIs the project site located in anarea identified by MGB/PAG-ASA/PHIVOLCS as hazard prone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan(ESWMP) Set up temporary fence aroundthe construction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal ofdomestic wastes in designatedareas Provide receptacles / bins forsolid wastes Coordinate with the municipal /city waste collectors Engage third party company forwaste collection Daily inspection ofwaste/recycling binsfor segregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_____________ Cost integrated inthe construction/operation cost

IEE Checklist Report for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects999PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Others, specify________________ Impairment of visualaesthetics Devaluation of landvaluesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regularly monitorpresence/absence ofcomplaints fromadjacent propertyowners Cost integrated inthe construction/operation costWATER Increased siltation dueto project activities Water qualitydegradation Others, specify___________________Specify nearest/receiving waterbody:____________________________Distance to nearest/receiving waterbody: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest/receiving water body isfresh water, specify classification: AA A B C D Set up proper and adequatesanitary facilities Strictly require the contractor andits workers to observe properwaste disposal and propersanitation Strictly observe proper wastehandling and disposal Provision of wastewater treatmentfacility (e.g., septic tank, oil andwater separator, etc.) Set up silt trap/stilling ponds tominimize downstream siltation Provision of three-chamberedseptic tank for domestic sewage Provide ring canals aroundfuelling tanks/ motorpool/maintenance areas Others, specify______________________Regular (ocular)inspection of: Drainage / canalsystems Water treatmentfacility (i.e., greasetrap, septic tank, etc.)Quarterly monitoring of thefollowing: pH TSS concentration BOD Total Coliform Color Oil and Grease Cost integrated inthe construction/operation cost

IEE Checklist Report for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects101010PossibleEnvironmental/ SocialImpactsBaseline EnvironmentIf nearest/receiving water body iscoastal or marine water, specifyclassification:Preventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring SA SB SC SDCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of the nearest well: Drinking/Domestic Industrial Agricultural

IEE Checklist Report for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects111111PossibleEnvironmental/ SocialImpacts Competition in wateruse Depletion of waterresourcesBaseline EnvironmentSize of population using receivingsurface water: ≤ 1,000 persons >1,000 and ≤ 5,000 persons >5,000 personsAvailable/nearest water source. Deepwell Water district/LGU Surface water Others, specify________________________Preventive/ Mitigating Measures Implement rainwater harvestingand similar measures as analternative source of water Observe water conservationmeasures; Carefully select project site toavoid disruption of traditionalwater uses Obtain Water Permit from NWRB Improve efficiency of watersupply and distribution system Others, specify_____________________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concernedagencies Regularly monitoroccurrences of watershortages Others, specify____________Cost of Mitigation/Monitoring Cost integrated inthe construction/operation cost Increased occurrenceof floodingIs the project site located in anarea identified by MGB/PAG-ASAas flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris andother materials that may obstructwater flow Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify_____________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concernedagencies Regular monitoring forincreased frequency offlooding Others, specify_________________ Cost integrated inthe construction/operation cost

IEE Checklist Report for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects121212PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/MonitoringAIR / NOISE Air quality degradation Nuisance due to noisegenerationDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g. vehicles,pumps, generator, etc) Install when applicable, theappropriate air pollution controldevice/s Strictly enforce goodhousekeeping practices Control vehicle speed to lessensuspension of road dust Conduct water spraying tosuppress dust sources andminimize discomfort to nearbyresidents Use covered vehicles to delivermaterials that may generate dust Other, specify___________________ Properly operate and maintain allnoise sources (e.g. vehicles,pumps, generator, etc) Install, when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Implement appropriate operatinghours Provide adequate buffer and/or Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofthe following: TSP NOx SOxFrequency Annual Semi-annualRegular (ocular)inspection of: Absence of whiteor black smokefrom vehicles,heavy equipmentand generator Presence of truckcover duringdeliveries Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofbuffer zones Cost integrated inthe construction/operation cost Cost integrated inthe construction/operation cost

IEE Checklist Report for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects131313PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating Measuresplanting of trees Others, specify______________________Monitoring Parameters/ImplementationCost of Mitigation/MonitoringPEOPLE Displacement ofresidents in the projectsite and within itsvicinity Displacement ofIndigenous People Enhancedemployment and/orlivelihoodopportunities Reduced employmentand/or livelihoodopportunities Increased revenuesfor LGU Disruption/Competitionin delivery of publicservices (e.g.,education, peace andorder, etc.) Enhanced delivery ofpublic services (e.g.,education, peace andorder, etc.) Increase in trafficvolume and worseningof traffic flowSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤ 5,000 persons >5,000 personsClassification of host barangay: Urban RuralAvailable services within/near thehost barangay: Schools (e.g., elementary, highschool, college) Health facilities (e.g., clinics,hospitals, etc.) Peace and order (e.g., policeoutpost, Brgy. Tanod, etc.) Recreation and sports facilities Others, specify_____________________ Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes andother financial obligations Regularly coordinate with LGU Conduct prior consultation &coordination to minimizedisruption on daily domesticactivities and to ensure respect forIP rights and cultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify_________________ Cost integrated inthe construction/operation cost

IEE Checklist Report for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects141414PossibleEnvironmental/ SocialImpacts Impacts on communityhealth and safetySafety Risks FireBaseline EnvironmentSource of risks Flammable substances Others_________________________Preventive/ Mitigating Measures Regularly coordinate with LGU Observe proper housekeeping Strictly comply with fire, safetyand similar regulatoryrequirements Others, specify___________________________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofbuffer zones Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify_________________Cost of Mitigation/Monitoring Cost integrated inthe construction/operation cost

IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects151515III. ABANDONMENT /DECOMMISSIONING/REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects161616Attach drawing/plan of waste water treatment facility (with dimensions and descriptions)

IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects171717Process Flow

IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects181818Attach drawing/plan of pollution source and control installations (with dimensions and descriptions)

IEE Checklist Report Form for Food & Food By-product & Beverages Manufacturing/Processing Plant Projects191919SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

11Annex 2 - D1INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforNON-FOOD (Textile, Rubber, Chemical) MANUFACTURING PLANT PROJECTSThis IEE Checklist Report Form shall be used for proposed NON-FOOD (Textile, Rubber,Chemical) MANUFACTURING PLANT PROJECTS required an IEE Report / IEE Checklist forECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affected areasand communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS)Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 2PROJECT FACT SHEETName of the ProjectProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTIONManufacture of Other ProductsGlass-based productsPlease check project type and indicate sizeMetal-based products (including semi-conductor / electronicindustries)Paper and plastic-based productsChemical IndustriesProject Type Project Size Project SizeParameterannual production rateannual production rateannual production rateManufacturing, processing and/or use of substances included in thePriority Chemical ListManufacture of agri-chemicals and other industrial chemicals not inthe PCLPharmaceutical industries and manufacture of soap and detergents,health and beauty products, and other consumer products.Surface coating industries (paints, pigments, varnishes, lacquers, anticapacityfouling coating, printing inks)Textile, Wood, Rubber IndustriesTextile, Wood, Rubber IndustriesLeather and related industriesMineral Ore ProcessingMetallic Mineral or Ore Processing (e.g., copper, lead, nickel, cobalt,zinc, silver, magnesium, and manganese, gold, placer with metalcontent) with Physical or Mechanical Processingquantity of toxicchemicals to be usedper monthannual production rateannual production rateannual production rateannual production rateDaily processing rate ofraw hidesAnnual processing rate(inputs)Other Description Details:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 3I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitudeI.2 PROJECT COMPONENTSFacilitiesNo. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks1. Material storage facilityRaw, chemical and processmaterialsFuel, lubricants and similar materialsFinished product (e.g. equipmentfacilities, silo, hopper, etc.)Others, specify________________2. Processing facilityMaterial preparation and handling(e.g., screening, sorting, conveyorbelt, etc.)Material sizereduction/agglomerationHeating/Drying (direct heat/energyapplication)Processing (e.g., mixing, blending,refining, milling, etc.)Finishing (e.g., sorting, filling,packaging, etc.)Others, specify________________3. Support Facilities (e.g. emergencygenerators, boilers, steamgenerators, etc.)4. Admin support (e.g., canteen, office,clinic, quarters, etc.)

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 4Facilities5. Water source / supply6. Waste water management facility7. Solid waste management facility8. Drainage system9. Others, specify__________________________________________No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/RemarksUse additional sheets, if necessaryI.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater Collection System)m 3 /daym 3 /dayWater Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 5Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Totalb. Operation PhaseManpower Requirement Expertise/Skills TotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationLAND Consistency withland useCurrent land use w/in 1kmradius (as per zoningordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________ See attached proof of compatibilitywith land useCost of Mitigation/MonitoringActual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________ Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify_______________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged ordestroyed vegetation where possible(e.g., tree planting) Annual inspection ofarea replanted/re-vegetated Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 7PossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationCost of Mitigation/Monitoring Change in surfacelandform/topography/terrain/slope Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify____________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify_________________ Slope/ Erosion ControlCost: ___________ Others, specify__________________ Soil/Landcontamination dueto improper solidwaste disposalIs the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS as hazardprone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Implement proper collection andprocessing of animal waste intoorganic fertilizer Implement proper collection,labeling and storage of hazardouswaste Provide receptacles / bins for solidwastes Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_______________ Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 8PossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation Coordinate with the municipal / citywaste collectors Engage third party company forwaste collection Others, specify________________Cost of Mitigation/Monitoring Impairment ofvisualaesthetics Devaluation ofland valuesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints from adjacentproperty owners Cost integrated in theconstruction/ operationcostWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify_______________Specify nearest/receivingwater body:________________________Distance to nearest/receivingwater body: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest/receiving water bodyis fresh water, specifyclassification: AA A B C D Provide wastewater treatmentfacility (e.g., septic tank, oil andwater separator, etc.) Provide ring canals around fuellingtanks/ motor pool/ maintenanceareas Set up proper and adequate sanitaryfacilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Set up silt trap/stilling ponds tominimize downstream siltation Others, specify_________________Regular (ocular) inspectionof water body for: Turbidity and/orsilted condition Floating wastes ordebrisMonthly monitoring of thefollowing: pH TSS concentration BOD Total Coliform Color Oil and Grease Trace Metals (Pb,Cd, Hg, Cr6, As) Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 9PossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationIf nearest/receiving water bodyis coastal or marine water,specify classification: SA SB SC SDCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of the nearest well: Drinking/Domestic Industrial AgriculturalCost of Mitigation/Monitoring Competition inwater use Depletion of waterresourcesSize of population usingreceiving surface water: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 persons Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures Carefully select project site to avoiddisruption of traditional water uses Obtain Water Permit from NWRB Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring foroccurrences of watershortages Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 10PossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationAvailable/nearest watersource. Deepwell Water district/LGU Surface water Others, specify________________ Improve efficiency of water supplyand distribution system Others, specify____________________ Others, specify_____________Cost of Mitigation/Monitoring Increasedoccurrence offloodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify____________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring forincreased frequency offlooding Others, specify________________ Cost integrated in theconstruction/ operationcostAIR / NOISEAir quality degradationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g. vehicles,boiler, generator, etc) Install, when applicable, theappropriate air pollution controldevice/s Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Regular monitoring forpresence/absence ofcomplaints Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 11PossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation Conduct water spraying tosuppress dust sources andminimize discomfort to nearbyresidents Use covered vehicles to delivermaterials that may generate dust Others, specify___________________Regular (ocular) inspectionof: Absence of white orblack smoke fromvehicles, generator,etc. Presence of truckcover duringdeliveriesQuarterly monitoring ofambient air for the following: TSP PM10 NOx SOx CO / CO2Cost of Mitigation/Monitoring Nuisance due tonoise generationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g. vehicles,boiler, generator, etc) Install, when applicable, theappropriate air pollution controldevice/s Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Conduct water spraying to suppressdust sources and minimizediscomfort to nearby residents Use covered vehicles to delivermaterials that may generate dust Others, specify____________________ Regular monitoring forpresence/absence ofcomplaints Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 12PossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationCost of Mitigation/MonitoringPEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunities Increased revenuesfor LGU Disruption/Competition in delivery ofpublic services(e.g., education,peace and order,etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflowSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤5,000persons >5,000personClassification of hostbarangay: Urban RuralAvailable services within/nearthe host barangay: Schools (e.g.,elementary, highschool, college) Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify_________________ Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regular coordination with LGU Conduct prior consultation andcoordination to minimize disruptionof daily domestic activities and toensure respect for IP rights andcultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify_________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify_____________ Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 13PossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationCost of Mitigation/Monitoring Impacts oncommunity healthand safety Others, specify_____________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Implement appropriate safetyprograms for both community andworkers Strictly comply with fire, safety andsimilar regulatory requirements Strictly comply with requirements ofRA 6969 Others, specify__________________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify__________________ Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 14III. ABANDONMENT / DECOMMISSIONING/ REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as, dismantling and waste disposal._________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 15Process Flow

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 16Attach drawing/plan of waste water treatment facility (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 17Attach drawing/plan of pollution source and control installations (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Non-Food Manufacturing Plant Projects 18SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial Environmental Examination(IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A. No.6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Act of1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000), R.A.No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749 (PhilippineClean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

1Annex 2 - EINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforSUBDIVISIONS AND HOUSING PROJECTSThis IEE Checklist Report Form shall be used for proposed SUBDIVISIONS AND HOUSINGPROJECTS required an IEE Report / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affected areasand communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS)Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 2Name of the ProjectPROJECT FACT SHEETProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTIONPlease Check Project Type (indicate total land area below)Low Cost Subdivision or Resettlement HousingEconomic & Socialized HousingOpen Market HousingOther similar Horizontal Land DevelopmentTotal land area, including all common, open and other areas : ___________________ HectaresOther Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 3Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitudeI.2 PROJECT COMPONENTSFacilities1. Residential lotsNo. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks2. Commercial Area (e.g., banks,restaurants, outlets, stores, etc.3. Institutional Area (e.g.,swimming pools, gym, chapel,club house, etc.)4. Open/Common Spaces (e.g.,reception area, garden, parks,etc.)5. Road systemPrimary/Main RoadSecondary RoadAlley6. Common Parking Area7. Water supply system8. Drainage system9. Waste water managementfacility10. Support facilities (e.g.,emergency generators, guardhouses/posts, etc.)11. Waste water managementfacility12. Solid waste management facility13. Others, specify____________________________________Use additional sheets, if necessary

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 4I.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater Collection System)m 3 /daym 3 /dayWater Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 5Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Totalb. Operation PhaseManpower Requirement Expertise/Skills TotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating MeasuresLAND Consistency withland useCurrent land use w/in 1kmradius (as per zoningordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________ See attached proof of compatibilitywith land useMonitoring Parameters/ImplementationCost of Mitigation/MonitoringActual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________ Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing for Annual inspection ofarea replanted/re-vegetated Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 7PossibleEnvironmental/ SocialImpactsBaseline Environment Mangrove Wetland Others, specify____________Preventive/ Mitigating Measuresvegetation that will be retained Promote restoration of damaged ordestroyed vegetation where possible(e.g., tree planting)Monitoring Parameters/ImplementationCost of Mitigation/Monitoring Change in surfacelandform/topography/terrain/slope Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify____________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify______________ Slope/ Erosion ControlCost: ___________ Others, specify_____________ Soil/Landcontamination dueto improper solidwaste disposalIs the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS ashazard prone? Yes NoExisting soil type in the area: sandy clay sandy-loamOthers, specify_________________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Provide receptacles / bins for solidwastes Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_______________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 8PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Coordinate with the municipal / citywaste collectors Engage third party company forwaste collection Others, specify________________ Impairment ofvisualaesthetics Devaluation ofland valuesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints from adjacentproperty owners Cost integrated in theconstruction/operationcostWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify____________Specify nearest water body:____________________Distance to nearest waterbody: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest water body is freshwater, specify classification: AA A Set up proper and adequate sanitaryfacilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Provide wastewater treatmentfacility (e.g., oil and water separator,etc.) Set up silt trap/stilling ponds tominimize downstream siltation Provide three-chambered septictank for domestic sewage Others, specify___________Regular (ocular) inspectionof: Drainage / canalsystems Water treatment facility(i.e., grease trap, septictank, etc.)Quarterly monitoring of thefollowing: pH TSS concentration BOD Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 9PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring B C D Total Coliform Color Oil and GreaseIf nearest water body iscoastal or marine water,specify classification: SA SB SC SDCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of the nearest well: Drinking/Domestic Industrial Agricultural

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 10PossibleEnvironmental/ SocialImpacts Competition inwater use Depletion of waterresourcesBaseline EnvironmentSize of population usingproposed water source: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsAvailable/nearest watersource. Deepwell Water district/LGU Surface water Others, specify_____________Preventive/ Mitigating Measures Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures Careful selection of project site toavoid disruption of traditional wateruses Obtain Water Permit from NWRB Improve efficiency of water supplyand distribution system Others, specify_____________________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring foroccurrences of watershortages Others, specify_______________Cost of Mitigation/Monitoring Cost integrated in theconstruction/operationcost Increasedoccurrence offloodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify_________________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring forincreased frequency offlooding Others, specify_________________ Cost integrated in theconstruction/operationcostAIR / NOISEAir quality degradationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g. vehicles,generator, etc) Strictly enforce good housekeepingpractices Regular monitoring forpresence/absence ofcomplaints Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 11PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating Measures Control vehicle speed to lessensuspension of road dust Conduct water spraying tosuppress dust sources andminimize discomfort to nearbyresidents Use covered vehicles to delivermaterials that may generate dust Others, specify_________________Monitoring Parameters/ImplementationRegular (ocular) inspectionof: Absence of white orblack smoke fromvehicles, generator,etc. Presence of truckcover duringdeliveriesCost of Mitigation/Monitoring Nuisance due tonoise generationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allnoise sources (e.g., vehicles,generator, etc.) Install, when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Implement appropriate operatinghours Provide adequate buffer and/orplanting of trees Others, specify_____________________ Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofbuffer zones Cost integrated in theconstruction/operationcostPEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤5,000persons >5,000person Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regularly coordinate with LGU Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify_________________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects 12PossibleEnvironmental/ SocialImpactslivelihoodopportunities Reducedemployment and/orlivelihoodopportunities Increased revenuesfor LGU Disruption/Competition indelivery of publicservices (e.g.,education, peaceand order, etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflow Impacts oncommunity healthand safety Others, specify______________Baseline EnvironmentClassification of hostbarangay: Urban RuralAvailable services within/nearthe host barangay: Schools (e.g.,elementary, highschool, college) Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify__________________Preventive/ Mitigating Measures Conduct prior consultation andcoordination to minimize disruptionon daily domestic activities and toensure respect for IP rights andcultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify_________________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Implement appropriate safetyprograms for both community andworkers Strictly comply with fire, safety andsimilar regulatory requirements Others, specify__________________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify_______________Cost of Mitigation/Monitoring Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects334 13III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects334 14Attach drawing/plan of sewerage treatment facilities (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Subdivision & Housing Projects334 15SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

1Annex 2 - FINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforBUILDING PROJECTSThis IEE Checklist Report Form shall be used for proposed BUILDING PROJECTS(Commercial, Institutional, Land Transport Terminal, Motels, Hotels,Condominiums/Apartelles, and Non-Hazardous/non-Toxic Materials Storage Facilities)required an IEE Report / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affectedareas and communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes □. Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE ChecklistReport Form. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processingof an ECC application using the IEE Checklist Report within twenty (20)working days upon receipt of duly-accomplished forms with completeattachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects 2Name of theProjectProponent NamePROJECT FACT SHEETProponentAddressContact Person Name: Designation:Proponent Meansof ContactLandline No.Mobile No.Fax No.Email Address:I. PROJECT DESCRIPTIONPlease Check Project Type (indicate total gross floor area below)Commercial [Business centers with residential units (mixed use), malls, supermarkets, publicmarkets]• Fast food/Restaurant Projects• Commercial Establishments (i.e., Showrooms)Commercial [office spaces only]Institutional and other related facilities: religious, government, and educationalMedical facilities and other related/similar Institutional facilitiesInstitutional Structures with laboratory facilitiesMotels, Hotels, Condominium/ Apartelles (residential) with commercial space 10% or less of thetotal floor areaStorage facilities, non-toxic/hazardous materials, substances or products (e.g., warehouses)Land transport terminal (for buses, jeepneys and other modes of transportation)Total gross floor area, including parking and other areas: _____________HectaresOther Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects 3I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e. industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Project/Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc)LongitudeLatitudeI.2 PROJECT COMPONENTSFacilities1. Residential component (e.g.,rooms, units, etc.)No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks2. Commercial component (e.g.,banks, restaurants, outlets,stores, etc.)3. Institutional componentoffices, classroom and othersimilar facilitieslaboratory, hospital rooms andother medical facilitiesOthers (please specify)4. Storage/Warehouse component5. Amenities (e.g. swimming pools,gym, etc.)6. Open/Common Spaces (e.g.reception area, garden parks,etc.)7. Parking area8. Terminal/Passenger Area9. Waste water managementfacility10. Solid waste managementfacilities

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects 4Facilities11. Drainage system12. Others (please specify):____________________No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks____________________Use additional sheets, if necessaryComparative Matrix for Parking LotsNational BuildingCodeLocal RequirementProject ProvisionsStatutory RequirementsCalculations/Computations(number of parking lots)1.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater Collection System)m 3 /daym 3 /day

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects 5Water Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)Energy/Water EfficiencyPower/ElectricityUtilitiesEstimated SavingsKWhProposed Efficiency/ConservationMeasuresWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpowerRequirementExpertise/SkillsTotal

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects 6b. Operation PhaseManpowerRequirementExpertise/SkillsTotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects7II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialImpactsLAND Consistency withland useBaseline EnvironmentCurrent land use w/in 1kmradius (as per zoningordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________Actual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________Preventive/ Mitigating Measures See attached proof of compatibilitywith land useMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify____________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged ordestroyed vegetation where possible(e.g., tree planting) Annual inspection ofarea replanted/ revegetated Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects8PossibleEnvironmental/ SocialImpacts Change in surfacelandform/topography/terrain/slopeBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify____________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify______________ Slope/ Erosion ControlCost: ___________ Others, specify_________________ Soil/Landcontamination dueto improper solidwaste disposalIs the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS as hazardprone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify________________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Provide receptacles / bins for solidwastes Coordinate with the municipal / citywaste collectors Engage third party company forwaste collection Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_______________ Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects9PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Others, specify________________ Impairment ofvisual aesthetics Devaluation of landvaluesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints from adjacentproperty owners Cost integrated in theconstruction/operationcostWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify____________Specify nearest/receivingwater body:____________________Distance to nearest/receivingwater body: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest/receiving water bodyis fresh water, specifyclassification: AA A B C D Set up proper and adequate sanitaryfacilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Provide wastewater treatmentfacility (e.g., oil and water separator,etc.) Set up silt trap/stilling ponds tominimize downstream siltation Provide three-chambered septictank for domestic sewage Others, specify___________Regular (ocular) inspectionof water body for: Drainage/canal systems Water treatment facility(i.e., grease trap, septictank, etc.Quarterly monitoring of thefollowing: pH TSS concentration BOD Total Coliform Color Oil and Grease Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects10PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/MonitoringIf nearest/receiving water bodyis coastal or marine water,specify classification: SA SB SC SDCurrent Use of nearest/receiving water body: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Competition inwater use Depletion of waterresourcesUse of nearest well: Drinking/Domestic Industrial AgriculturalSize of population usingproposed water source: ≤ 1,000 persons >1,000 and ≤ 5,000persons Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects11PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring >5,000 personsAvailable/nearest watersource. Deepwell Water district/LGU Surface water Others, specify_____________ Carefully select project site to avoiddisruption of traditional water uses Obtain Water Permit from NWRB Improve efficiency of water supplyand distribution system Others, specify_________________ Regular monitoring foroccurrences of watershortages Others, specify______________ Increasedoccurrence offloodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify_____________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring forincreased frequency offlooding Others, specify_________________ Cost integrated in theconstruction/operationcostAIR / NOISEAir quality degradationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g. vehicles,generator, etc) Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Regular monitoring forpresence/absence ofcomplaintsRegular (ocular) inspectionof: Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects12PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Conduct water spraying tosuppress dust sources andminimize discomfort to nearbyresidents Use covered vehicles to delivermaterials that may generate dust Others, specify_________________ Absence of white or blacksmoke from vehicles,generator, etc. Presence of truck coverduring deliveries Nuisance due tonoise generationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allnoise sources (e.g., vehicles,generator, etc.) Install, when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Provide adequate buffer andplanting of trees Others, specify_________________ Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofbuffer zones Cost integrated in theconstruction/ operationcostPEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunitiesSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsClassification of hostbarangay: Urban Rural Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regularly coordinate with LGU Conduct prior consultation andcoordination to minimize disruptionof daily domestic activities and toensure respect for IP rights andcultural practices Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify______________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects13PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Increased revenuesfor LGU Disruption/Competition indelivery of publicservices (e.g.,education, peaceand order, etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflow Impacts oncommunity healthand safety Others, specify_______________Available services within/nearthe host barangay: Schools (e.g. elementary,high school, college) Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify__________________ Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify_________________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Implement appropriate safetyprograms for both community andworkers Strictly comply with fire, safety andsimilar regulatory requirements Others, specify_________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify______________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects 14III. ABANDONMENT /DECOMMISSIONING/REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects 15Attach drawing/plan of waste water treatment facility (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects 16Attach drawing/plan of air pollution source and control installations (with dimensions anddescriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Building Projects 17SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

Annex 2 - G1INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforCEMETERY, FUNERAL PARLORS, CREMATORIUM, AND COLUMBARIUM PROJECTSThis IEE Checklist Report Form shall be used for proposed CEMETERY, FUNERALPARLORS, CREMATORIUM, AND COLUMBARIUM PROJECTS required an IEE Report /IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affectedareas and communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE ChecklistReport Form. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processingof an ECC application using the IEE Checklist Report within twenty (20)working days upon receipt of completed/duly-accomplished form.Misleading or erroneous answers are grounds for legal action and/or denial of ECC issuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

II.Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects 2Name of theProjectProponent NamePROJECT FACT SHEETProponentAddressContact Person Name: Designation:Proponent Meansof ContactLandline No.Mobile No.Fax No.Email Address:I. PROJECT DESCRIPTIONCemeteryFuneral ParlorCrematoriumColumbariumPlease check project type and indicate sizeProject TypeActual ProjectSize (hectare)Project Size ParameterArea to be developedtotal/gross floor areaincluding parking andother areasOther Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e. industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Project/Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects 3Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedLongitudeLatitudeon OCT/TCT/etc)I.2 PROJECT COMPONENTSCemetery and Funeral HomesFacilities1. Area for internment, vaults,columbarium, etc.2. Commercial Area (e.g.,restaurants, food outlets, etc.)3. Crematorium4. Wake Chapel, viewing area,and similar facilities5. Support facilities (e.g., morgue,embalming facility, showroom,etc.)6. Amenities (e.g., rest room, etc.)7. Open/Common Spaces (e.g.,reception area, garden, parks,etc.)8. Parking area9. Waste water managementfacility10. Solid waste managementfacilities11. Drainage System12. Others (please specify):____________________No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks____________________Use additional sheets, if necessary

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects 4I.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)Water (Total)KWhm 3 /day(Fill-up table below if water is notobtained from the local water utility)Waterm 3 /day(Rainwater Collection System)Water Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)Energy/Water EfficiencyUtilitiesPower/ElectricityEstimatedSavingsKWhProposed Efficiency/Conservation MeasuresWaterm 3 /day

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects 5I.4 MANPOWERa. Construction PhaseManpowerRequirementExpertise/SkillsTotalb. Operation PhaseManpowerRequirementExpertise/SkillsTotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating MeasuresLAND Consistency withland useCurrent land use w/in 1kmradius (as per zoningordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________ See attached proof of compatibilitywith land useMonitoring Parameters/ImplementationCost of Mitigation/MonitoringActual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________ Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged or Annual inspection ofarea replanted/ revegetated Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects7PossibleEnvironmental/ SocialImpactsBaseline Environment Others, specify____________Preventive/ Mitigating Measuresdestroyed vegetation where possible(e.g., tree planting)Monitoring Parameters/ImplementationCost of Mitigation/Monitoring Change in surfacelandform/topography/terrain/slope Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify___________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify________________ Slope/ Erosion ControlCost: ___________ Others, specify______________ Soil/Landcontamination dueto improper solidwaste disposalIs the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS ashazard prone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Implement proper collection,labeling and storage of hazardouswaste Provide receptacles / bins for solid Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_________________ Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects8PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating Measureswastes Coordinate with the municipal / citywaste collectors Engage third party company forwaste collection Others, specify________________Monitoring Parameters/ImplementationCost of Mitigation/Monitoring Impairment ofvisual aesthetics Devaluation of landvaluesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints from adjacentproperty owners Cost integrated in theconstruction/operationcostWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify____________Specify nearest water body:___________________Distance to nearest waterbody: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest water body is freshwater, specify classification: AA A B Set up proper and adequate sanitaryfacilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Provide wastewater treatmentfacility (e.g., septic tank, oil andwater separator, etc.) Set up silt trap/settling ponds tominimize downstream siltation Others, specify ______________ Provide three-chambered septictank for domestic sewageRegular (ocular) inspectionof water body for: Drainage/canal systems Water treatment facility(i.e., grease trap, septictank, etc.Regular (ocular) inspectionof water body for: Turbidity and/or siltedcondition Floating wastes or debris Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects9PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring C DIf nearest/receiving water bodyis coastal or marine water,specify classification: SA SB SC SDCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less 0.5 km 0 to 1 km More than 1 km Competition inwater use Depletion of waterresourcesUse of nearest well: Drinking/Domestic Industrial AgriculturalSize of population usingreceiving surface water: ≤ 1,000 persons >1,000 and ≤ 5,000persons Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects10PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring >5,000 personsAvailable/nearest watersource. Deepwell Water district/LGU Surface water Others, specify_____________ Others, specify_________________ Regular monitoring foroccurrences of watershortages Others, specify________________ Increasedoccurrence offloodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Others, specify__________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring forincreased frequency offlooding Others, specify_________________ Cost integrated in theconstruction/operationcostAIR / NOISEAir quality degradationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 kmMore than 1 km Properly operate and maintain allemission sources (e.g., generator,crematorium, etc) Installappropriate air pollutioncontrol device/s for the_______________ Strictly enforce good housekeepingpractices Others, specify___________________ Regular monitoring forpresence/absence ofcomplaintsRegular (ocular) inspectionof: Absence of white orblack smoke fromvehicles, generator,etc. Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects11PEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunities Increased revenuesfor LGU Disruption/Competition in delivery ofpublic services(e.g., education,peace and order,etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflowSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsClassification of hostbarangay: Urban RuralAvailable services within/nearthe host barangay: Schools (e.g.elementary, highschool, college) Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify_________________ Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regularly coordinate with LGU Conduct prior consultation andcoordination to minimize disruptionon daily domestic activities and toensure respect for IP rights andcultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify_________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify________________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects12 Impacts oncommunity healthand safety Others, specify_______________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Others, specify_________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify________________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects 13III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as, dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects 14Attach drawing/plan of air pollution source and control installations (with dimensions anddescriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Cemetery & Other Funeral Facilities Projects 15SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

1Annex 2 - HINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforLIVESTOCK/POULTRY PROJECTSThis IEE Checklist Report Form shall be used for proposed LIVESTOCK/POULTRY PROJECTSrequired an IEE Report / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affected areasand communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS)Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects2PROJECT FACT SHEETName of the ProjectProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTIONPlease check project type and indicate size Project Type Project SizeLivestock Production: Pigs / GoatsPoultry / BirdsProject SizeParameterMaximum StockPopulationMaximum StockPopulationOther Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects3Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitudeI.2 PROJECT COMPONENTSMaximum Stock Production (per growing season): ____________________________FacilitiesCages / Pens / EnclosuresNo. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks1. Gestating/Nursery Compartment/ Hatchery2. Support Facilities (e.g. feeders,generators, admin building,workers’ quarter, etc.)3. Storage facility4. Water source / supply5. Waste water managementFacility6. Solid waste management facility7. Drainage system8. Others (please specify):________________________________________Use additional sheets, if necessary

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects4I.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater Collection System)m 3 /daym 3 /dayWater Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects5Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Totalb. Operation PhaseManpower Requirement Expertise/Skills TotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/Social Baseline EnvironmentImpactsLANDPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Consistency with landuseCurrent land use w/in 1kmradius (as per zoningordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify__________________ See attached proof of compatibilitywith land useActual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify__________________ Disturbance to wildlifedue to vegetationclearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify__________________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged ordestroyed vegetation wherepossible (e.g., tree planting) Annual inspection ofarea replanted/re-vegetated Cost integrated inthe construction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects7PossibleEnvironmental/SocialImpacts Change in surfacelandform/ topography/terrain/slopeBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use ofspoils Construct during dry season Stabilize embankment withgrasses or other soil cover Others, specify_______________________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify_________________ Slope/ ErosionControl Cost:___________ Others, specify_________________ Soil/Landcontamination due toimproper solid wastedisposalIs the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS ashazard prone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan(ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Implement proper collection,labeling and storage of hazardouswaste Provide receptacles / bins for solidwastes Coordinate with the municipal / city Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_________________ Cost integrated inthe construction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects8PossibleEnvironmental/SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoringwaste collectors Engage third party company forwaste collection Others, specify________________ Impairment ofvisual aesthetics Devaluation ofland valuesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints fromadjacent propertyowners Cost integrated inthe construction/operation costWATER Increased siltation dueto project activities Water qualitydegradation Others, specify_______________Specify nearest/receiving waterbody:_________________________Distance to nearest/receivingwater body: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest/receiving water bodyis fresh water, specifyclassification: AA A B Set-up proper and adequatesanitary facilities Strictly require the contractor andits workers to observe properwaste disposal and propersanitation Strictly observe proper wastehandling and disposal Provide wastewater treatmentfacility (e.g., septic tank, oil andwater separator, etc.) Provide biogas generator or similarwaste treatment measures Set up silt trap/settling ponds tominimize downstream siltation Others, specify_____________________Regular (ocular) inspectionof: Drainage / canalsystems Water treatment facility(i.e., grease trap, septictank, etc.)Quarterly monitoring of thefollowing: pH TSS concentration BOD Total Coliform Color Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects9PossibleEnvironmental/SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring C D Oil and GreaseIf nearest/receiving water bodyis coastal or marine water,specify classification: SA SB SC SDCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of the nearest well: Drinking/Domestic Industrial Agricultural

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects10PossibleEnvironmental/SocialImpacts Competition in wateruse Depletion of waterresourcesBaseline EnvironmentSize of population usingreceiving surface water: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsAvailable/nearest water source. Deepwell Water district/LGU Surface water Others, specify________________Preventive/ Mitigating Measures Implement rainwater harvestingand similar measures as analternative source of water Observe water conservationmeasures; Carefully select project site toavoid disruption of traditional wateruses Obtain Water Permit from NWRB Improve efficiency of water supplyand distribution system Others, specify_________________________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concernedagencies Regular monitoring foroccurrences of watershortages Others, specify________________Cost of Mitigation/Monitoring Cost integrated in theconstruction/operation cost Increased occurrenceof floodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others,specify___________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concernedagencies Regular monitoring forincreased frequency offlooding Others, specify____________________ Cost integrated in theconstruction/operation costAIR / NOISEAir quality degradationDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g. vehicles,generator, etc) Strictly enforce goodhousekeeping practices Regular monitoring forpresence/absence ofcomplaintsRegular (ocular) inspectionof: Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects11PossibleEnvironmental/SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Control vehicle speed to lessensuspension of road dust Conduct water spraying tosuppress dust sources andminimize discomfort to nearbyresidents Use covered vehicles to delivermaterials that may generate dust Others, specify___________________ Absence of whiteor black smokefrom vehicles,generator, etc. Presence of truckcover duringdeliveries Nuisance due to noisegenerationDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIs the wind direction blowingtowards the nearest communitymost of the year? Yes No Regular clean-up of animal houses Use environment-friendlydeodorizer or odor maskingsubstances Use sprays with natural / microbialdisinfectants Provide adequate buffer and/orplanting of trees Others, specify____________________ Regular monitoring forpresence/absence ofcomplaints Cost integrated in theconstruction/operation costPEOPLE Displacement ofresidents in the projectsite and within itsvicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reduced employmentand/or livelihoodSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsClassification of host barangay: Urban Rural Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regular coordination with LGU Conduct prior consultation andcoordination to minimize disruptionof daily domestic activities and toensure respect for IP rights andcultural practices Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify_________________ Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects12PossibleEnvironmental/SocialImpactsopportunities Increased revenuesfor LGU Disruption/Competition in delivery of publicservices (e.g.,education, peace andorder, etc.) Enhanced delivery ofpublic services (e.g.,education, peace andorder, etc.) Increase in trafficvolume and worseningof traffic flowBaseline EnvironmentAvailable services within/nearthe host barangay: Schools (e.g.,elementary, high school,college) Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify___________________Preventive/ Mitigating Measures Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify_________________Monitoring Parameters/ImplementationCost of Mitigation/Monitoring Impacts on communityhealth and safety Others, specify_______________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Provide on-site medical servicesfor any emergency. Participate in public awarenessprograms on health and safety Regularly spray disinfectant,pesticides and other similarsubstances when applicable Strictly comply with fire, safety andsimilar regulatory requirements Others, specify__________________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify________________ Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects 13III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects 14Attach site development/layout plan (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects 15Attach drawing/plan of waste water treatment facility (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Livestock/Poultry Projects 16SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

1Annex 2 - IINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforRESORTS AND OTHER TOURISM / LEISURE PROJECTSThis IEE Checklist Report Form shall be used for proposed RESORTS AND OTHER TOURISM /LEISURE PROJECTS required an IEE Report / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affected areasand communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS)Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects2PROJECT FACT SHEETName of the ProjectProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTIONResortsOther Tourism ProjectsPlease check project type and indicate sizeProject Type Project Size Project SizeParameterArea to bedevelopedArea to bedevelopedI.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitude

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects3I.2 PROJECT COMPONENTSFacilities1. RoomsNo. ofUnitsArea (sq/m)/CapacitySpecifications/Description/Remarks2. Villas3. Public washrooms/toilets4. Swimming pools5. Function/Convention Hall6. Lobby/Reception Area7. Restaurant8. Parking area9. Water sports facilities10. Wharf / Jetty11. Mini zoo/Park12. Ecological trail13. Garden/Landscaping14. Waste water treatment facility15. Solid waste managementfacilities16. Drainage system17. Others, specify:__________________________________________Use additional sheets, if necessary

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects4I.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater Collection System)m 3 /daym 3 /dayWater Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects5Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Totalb. Operation PhaseManpower Requirement Expertise/Skills TotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating MeasuresLAND Consistency withland useCurrent land use w/in 1kmradius (as per zoningordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________Actual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify___________________ See attached proof of compatibilitywith land useMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify____________________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged ordestroyed vegetation where possible(e.g., tree planting) Annual inspection of areareplanted/re-vegetated Cost integrated inthe construction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects7PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Change in surfacelandform/topography/terrain/slope Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify__________________________ Regular inspection of slopeprotection measures inerosion-prone areas Regular inspection for neweroded areas near the site Others, specify_________________ Slope/ ErosionControl Cost:___________ Others, specify__________________Is the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS as hazardprone? Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Soil/Landcontamination dueto improper solidwaste disposal Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Implement the Ecological SolidWaste Management Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Implement proper collection andprocessing of animal waste intoorganic fertilizer Implement proper collection,labeling and storage of hazardouswaste Provide receptacles / bins for solidwastes Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixed garbagein the facility Weekly inspection of wasteaccumulated Others, specify___________________ Cost integrated inthe construction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects8PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Coordinate with the municipal / citywaste collectors Engage third party company forwaste collection Others, specify__________________________ Impairment ofvisualaesthetics Devaluation ofland valuesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring of bufferzones Regular monitoring forpresence/absence ofcomplaints from adjacentproperty owners Cost integrated inthe construction/operation costWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify_______________Specify nearest/receivingwater body:______________________Distance to nearest/receivingwater body: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest/receiving water bodyis fresh water, specifyclassification: AA A B C D Set up proper and adequate sanitaryfacilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Provide wastewater treatmentfacility (e.g. septic tank, oil andwater separator, etc.) Set up silt trap/stilling ponds tominimize downstream siltation Installation of drainage canals Others, specify ___________Regular (ocular) inspection of: Drainage / canal systems Water treatment facility (i.e.,grease trap, septic tank,etc.)Quarterly monitoring of thefollowing: pH TSS concentration BOD Total Coliform Color Oil and Grease Cost integrated inthe construction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects9PossibleEnvironmental/ SocialImpactsBaseline EnvironmentIf nearest/receiving water bodyis coastal or marine water,specify classification: SA SB SC SDPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/MonitoringCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of the nearest well: Drinking/Domestic Industrial Agricultural

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects10PossibleEnvironmental/ SocialImpacts Competition inwater use Depletion of waterresourcesBaseline EnvironmentSize of population usingreceiving surface water: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsAvailable/nearest watersource. Deepwell Water district/LGU Surface water Others, specify________________Preventive/ Mitigating Measures Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures Carefully select project site to avoiddisruption of traditional water uses Obtain Water Permit from NWRB Improve efficiency of water supplyand distribution system Use drought resistant species whichrequire less water input and hencehave less impact on water tables Others, specify______________________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular coordination withconcerned agencies Regular monitoring foroccurrences of watershortages Others, specify___________________Cost of Mitigation/Monitoring Cost integrated inthe construction/operation cost Increasedoccurrence offloodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify__________________________ Regular monitoring forpresence/absence ofcomplaints Regular coordination withconcerned agencies Regular monitoring forincreased frequency offlooding Others, specify___________________ Cost integrated inthe construction/operation costAIR / NOISEAir quality degradationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km Properly operate and maintain allemission sources (e.g. vehicles,generator, etc) Install, when applicable, the Regular monitoring forpresence/absence ofcomplaintsRegular (ocular) inspection of: Cost integrated inthe construction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects11PossibleEnvironmental/ SocialImpactsBaseline Environment More than 1 kmPreventive/ Mitigating Measuresappropriate air pollution controldevice/s Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Conduct water spraying tosuppress dust sources andminimize discomfort to nearbyresidents Use covered vehicles to delivermaterials that may generate dus Others, specify___________________Monitoring Parameters/Implementation Absence of white orblack smoke fromvehicles, generator, etc. Presence of truck coverduring deliveriesCost of Mitigation/Monitoring Nuisance due togeneration ofobnoxious/unpleasant odor Nuisance due tonoise generationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIs the wind direction blowingtowards the nearestcommunity most of the year? Yes No Regularly clean up animal houses Use environment-friendly deodorizeror odor masking substances Use sprays with natural / microbialdisinfectants Provide adequate buffer and/orplanting of trees Others, specify ___________ Properly operate and maintain allnoise sources (e.g., vehicles,generator, etc.) Install when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Implement appropriate operatinghours Provide adequate buffer(e.g., Perimeter planting of trees toserve as sound buffer and greenbelt) Regular monitoring forpresence/absence ofcomplaints Regular monitoring forpresence/absence ofcomplaints Regular monitoring of bufferzones Quarterly monitoring ofnoise level Cost integrated inthe construction/operation cost Cost integrated inthe construction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects12PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Others, specify_____________________PEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunities Increased revenuesfor LGU Disruption/Competition indelivery of publicservices (e.g.,education, peaceand order, etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflowSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤5,000persons >5,000personClassification of hostbarangay: Urban RuralAvailable services within/nearthe host barangay: Schools (e.g.,elementary, highschool, college) Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify________________ Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regular coordination with LGU Conduct prior consultation andcoordination to minimize disruptionof daily domestic activities and toensure respect for IP rights andcultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify____________________________ Regular monitoring forpresence/absence ofcomplaints Regular coordination withLGU Others, specify_____________________ Cost integrated inthe construction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects13PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Impacts oncommunity healthand safety Others, specify____________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Implement appropriate safetyprograms for both community andworkers Strictly comply with fire, safety andsimilar regulatory requirements Regular monitoring forpresence/absence ofcomplaints Regular coordination withLGU Regular submission ofreports to concerned agency Others, specify_____________ Cost integrated inthe construction/operation cost Strictly comply with requirements ofRA 6969 Others, specify_____________________

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects 14III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects 15Attach drawing/plan of waste water treatment facility (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Resorts & Other Tourism/Leisure Projects 16SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

111Annex 2 - JINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforROAD AND BRIDGE PROJECTSThis IEE Checklist Report Form shall be used for proposed ROAD AND BRIDGE PROJECTSrequired an IEE Report / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affectedareas and communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme(PEMAPS) Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processingof an ECC application using the IEE Checklist Report within twenty (20)working days upon receipt of duly-accomplished forms with completeattachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects2PROJECT FACT SHEETName of the ProjectProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTIONBridges and viaducts, new constructionRoads, new construction, widening(including RO-RO facilities)Elevated roads, flyover/cloverleaf/ interchangesPlease check project type and indicate sizeProject Type Project Size Project SizeParameterLengthlength with no criticalslope, ORlength with critical slopeTunnels and sub-grade roads and railwaysLengthPedestrian passagesOther Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects3Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitudeI.2 PROJECT COMPONENTSFacilitiesNo. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks1. Road2. Intersections3. Bridge/s4. Access roads/Ramp5. Drainage facilities(i.e. Reinforced Concrete BoxCulverts (RCBC);ReinforcedConcrete Pipe Culverts (RCPC),others)6. Associated facilities (i.e.Guardrails, Traffic signs, etc.)7. Solid waste management facility8. Others, specify____________________________________________Use additional sheets, if necessary

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects4I.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater Collection System)m 3 /daym 3 /dayWater Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects5Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /dayI.3 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Totalb. Operation PhaseManpower Requirement Expertise/Skills TotalI.4 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating MeasuresLAND Consistency withland useCurrent land use w/in 1kmradius (as per zoningordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________Actual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________ See attached proof of compatibilitywith land useMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify____________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged ordestroyed vegetation wherepossible (e.g., tree planting) Annual inspection ofarea replanted/re-vegetated Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects7PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Change in surfacelandform/topography/terrain/slope Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify____________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify_________________ Slope/ Erosion ControlCost: ___________ Others, specify__________________ Soil/Landcontamination dueto improper solidwaste disposalIs the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS ashazard prone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Comply with the DENRAdministrative Order No. 2003-30and DENR Administrative Order No.2000-28, Implementing Guidelineson Engineering Geological andGeo-hazard Assessment (EGGA). Implement Ecological Solid WasteManagement Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Implement proper collection,labeling and storage of hazardouswaste Provide receptacles / bins for solidwastes Coordinate with the municipal / citywaste collectors Engage third party company forwaste collection Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_________________ Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects8PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Others, specify________________ Encroachment intoprotected areas orecologicallysensitiveareasIs the project area nearprotected areas or ecologicallysensitiveareas? Yes No Obtain appropriatepermits/clearances from concernedagencies Provide adequate buffer Others, specify________________ Regular coordinationwith concerned agencies Cost integrated in theconstruction/ operationcost Impairment ofvisual aesthetics Devaluation ofland valuesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints fromadjacent propertyowners Cost integrated in theconstruction/ operationcostWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify_______________Specify nearest water body:__________________________Distance to nearest water body: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest water body is freshwater, specify classification: AA A B C Set up proper and adequatesanitary facilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Set up silt trap(Gabions,Fascines)/settling ponds tominimize downstream siltation Others, specify___________Regular (ocular) inspectionof: Drainage / canalsystems Sanitation facilitiesRegular (ocular) inspectionof water body for: Turbidity and/or siltedcondition Floating wastes ordebris Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects9PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring DIf nearest water body is coastalor marine water, specifyclassification: SA SB SC SDCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Competition inwater use Depletion of waterresourcesUse of the nearest well: Drinking/Domestic Industrial AgriculturalSize of population using watersource: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 persons Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures Others, specify_________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring foroccurrences of watershortages Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects10PossibleEnvironmental/ SocialImpactsBaseline EnvironmentAvailable/nearest water source. Deepwell Water district/LGU Surface water Others, specify________________Preventive/ Mitigating MeasuresMonitoring Parameters/Implementation Others, specify________________Cost of Mitigation/Monitoring Increasedoccurrence offloodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Others, specify___________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring forincreased frequency offlooding Others, specify____________________ Cost integrated in theconstruction/ operationcostAIR / NOISEAir quality degradationDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g. vehicles,generator, etc) Install, when applicable, theappropriate air pollution controldevice/s Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Conduct water spraying tosuppress dust sources andminimize discomfort to nearbyresidents Use covered vehicles to deliver Regular monitoring forpresence/absence ofcomplaintsRegular (ocular) inspectionof: Absence of white orblack smoke fromvehicles, generator,etc. Presence of truckcover duringdeliveries Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects11PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating Measuresmaterials that may generate dust Others, specify___________________Monitoring Parameters/ImplementationCost of Mitigation/Monitoring Nuisance due tonoise generationDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allnoise sources (e.g., vehicles,generator, etc.) Install, when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Implement appropriate operatinghours Provide adequate buffer and/orplanting of trees Others, specify_____________________ Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofbuffer zones Cost integrated in theconstruction/ operationcostPEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenousPeoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunities IncreasedSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤5,000persons >5,000 personsClassification of host barangay: Urban RuralAvailable services within/nearthe host barangay: Schools (e.g.,elementary, high school,college) Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regularly coordinate with LGU Conduct prior consultation andcoordination to minimize disruptionof daily domestic activities and toensure respect for IP rights andcultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc. Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify_________________ Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects12PossibleEnvironmental/ SocialImpactsrevenues for LGU Disruption/Competition indelivery of publicservices (e.g.,education, peaceand order, etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflow Impacts oncommunity healthand safety Others, specify_______________Baseline Environment Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify___________________Preventive/ Mitigating Measures Others, specify_________________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Implement appropriate safetyprograms for both community andworkers Others, specify_____________________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify________________Cost of Mitigation/Monitoring Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects13III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects14Attach design/plan/alignment of project (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Road and Bridge Projects15SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

11Annex 2 - KINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforWATER SUPPLY PROJECTSThis IEE Checklist Report Form shall be used for proposed WATER SUPPLY PROJECTSrequired an IEE Report / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affected areasand communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS)Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects22PROJECT FACT SHEETName of the ProjectProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTIONProject TypeWater Supply Systems (Complete System)Water Supply System (Distribution Only)Please check project type and indicate sizeActual ProjectSizeProject Size Parameter# of wells and other systems(e.g., infiltration gallery, etc.)LevelOther Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects33Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitudeI.2. PROJECT COMPONENTSFacilitiesNo. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks1. Water collectionProduction wellsInfiltration galleryDiversion/Collection WeirOthers, specify2. Water treatment facilityChemical treatment (e.g.,precipitation, coagulation, etc.)Physical treatment (e.g.,screening, sedimentation, etc.)Disinfection (e.g., chlorination,etc.)3. Water distribution system (Indicate service area in m 2 andnumber of households served)__________________ squaremeters__________________ householdsCommunal box/faucet (new)Communal box/faucet (forrehabilitation)Water pipelines, distributionmain (new)Water pipelines distribution main(for rehabilitation)Water pipelines, service line(new)Water pipelines service line (forrehabilitation)Pumping stations4. Chemical storage facility5. Waste water managementfacility6. Solid waste management facility

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects44Facilities7. Drainage System8. Others, specify____________________________________No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/RemarksUse additional sheets, if necessaryI.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is not obtained fromthe local water utility)Water(Rainwater Collection System)m 3 /daym 3 /dayWater Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects55Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Totalb. Operation PhaseManpower Requirement Expertise/Skills TotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationLAND Consistency withland useCurrent land use w/in 1kmradius (as per zoningordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify________________ See attached proof of compatibilitywith land useCost of Mitigation/MonitoringActual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify_________________ Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify__________________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged ordestroyed vegetation where possible(e.g., tree planting) Annual inspection ofarea replanted/re-vegetated Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects7PossibleEnvironmental/ SocialImpacts Change in surfacelandform/topography/terrain/slope Soil Erosion Soil/Landcontamination dueto improper solidwaste disposalBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%)Is the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS as hazardprone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify____________ Comply with the DENRAdministrative Order No. 2003-30and DENR Administrative Order No.2000-28, Implementing Guidelineson Engineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Implement proper collection,labeling and storage of hazardouswaste Provide receptacles / bins for solidwastes Coordinate with the municipal / citywaste collectors Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify______________ Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_______________Cost of Mitigation/Monitoring Slope/ Erosion ControlCost: ___________ Others, specify_______________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects8PossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation Engage third party company forwaste collection Others, specify________________Cost of Mitigation/Monitoring Impairment ofvisualaesthetics Devaluation ofland valuesPresence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints from adjacentproperty owners Cost integrated in theconstruction/operationcostWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify_____________Specify nearest/receivingwater body:________________________Distance to nearest/receivingwater body: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest/receiving water bodyis fresh water, specifyclassification: AA A B Set up proper and adequate sanitaryfacilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Provide wastewater treatmentfacility Set up silt trap/stilling ponds tominimize downstream siltation Provide ring canals around fuellingtanks/ motorpool/ maintenanceareas Others, specify______________Regular (ocular) inspectionof: Drainage / canalsystems Water treatment facility(i.e., grease trap, septictank, etc.)Quarterly monitoring of thefollowing: pH TSS concentration BOD Total Coliform Color Oil and Grease Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects9PossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation C DCost of Mitigation/MonitoringIf nearest/receiving water bodyis coastal or marine water,specify classification: SA SB SC SDCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of the nearest well: Drinking/Domestic Industrial Agricultural

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects10PossibleEnvironmental/ SocialImpacts Competition inwater use Depletion of waterresourcesBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationSize of population usingreceiving surface water: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsAvailable/nearest watersource. Deepwell Water district/LGU Surface water Others, specify________________ Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures; Careful selection of project site toavoid disruption of traditional wateruses Obtain Water Permit from NWRB Improve efficiency of water supplyand distribution system Implement community ponds andsimilar measures as alternativewater source for non-domestic uses Increase, when practical, storagecapacities of water supply structuresfor resilience to greater climatevariations and extremes Others, specify_______________________Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring foroccurrences of watershortages Others, specify________________Cost of Mitigation/Monitoring Cost integrated in theconstruction/operationcost Increasedoccurrence offloodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify________________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring forincreased frequency offlooding Others, specify__________________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects11PossibleEnvironmental/ SocialImpactsAIR / NOISEAir quality degradationBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ImplementationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g. vehicles,pumps, generator, etc) Install, when applicable, theappropriate air pollution controldevice/s Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Conduct water spraying tosuppress dust sources andminimize discomfort to nearbyresidents Use covered vehicles to delivermaterials that may generate dust Others, specify_________________ Regular monitoring forpresence/absence ofcomplaintsRegular (ocular) inspectionof: Absence of white orblack smoke fromvehicles, generator,etc. Presence of truckcover duringdeliveriesCost of Mitigation/Monitoring Cost integrated in theconstruction/operationcost Nuisance due tonoise generationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allnoise sources (e.g., vehicles,pumps, generator, etc.) Install, when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Implement appropriate operatinghours Provide adequate buffer and/orplanting trees Others, specify_________________ Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofbuffer zones Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects12PEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunities Increased revenuesfor LGU Disruption/Competition indelivery of publicservices (e.g.,education, peaceand order, etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflow Impacts oncommunity healthand safety Others, specify_______________Size of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsClassification of hostbarangay: Urban RuralAvailable services within/nearthe host barangay: Schools (e.g.,elementary, highschool, college) Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify__________________ Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regular coordination with LGU Conduct prior consultation andcoordination to minimize disruptionof daily domestic activities and toensure respect for IP rights andcultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify_________________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify______________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Regular submission of Cost integrated in theconstruction/operationcost Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects13 Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Implement appropriate safetyprograms for both community andworkers Strictly comply with fire, safety andsimilar regulatory requirements Strictly comply with requirements ofRA 6969 Others, specify________________reports to concernedagency Others, specify________________

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects14III. ABANDONMENT /DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects15Attach drawing/plan of air pollution source and control installations (with dimensions anddescriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects16Process flow

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects17Attach drawing/plan of waste water treatment facility (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Water Supply Projects18SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

1Annex 2 - LINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforIRRIGATION / FLOOD CONTROL/ MINOR DAM PROJECTSThis IEE Checklist Report Form shall be used for proposed IRRIGATION / FLOOD CONTROL/MINOR DAM PROJECTS required an IEE Report / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affected areasand communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS)Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects2PROJECT FACT SHEETName of the ProjectProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTIONPlease check project type and indicate sizeProject TypeImpounding System or Flood Control ProjectIrrigation System (Distribution System Only)Minor DamActualProject SizeProject Size Parameterreservoir flooded area(hectare) or water storagecapacity (m 3 )service area (hectare)reservoir flooded area(hectare) or water storagecapacity (m 3 )Other Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects3Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitudeI.2 PROJECT COMPONENTSFacilities1. Dam2. Diversion headworks (i.e.,diversion weir, canal headregulator, etc.)No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks3. Impounding System4. Irrigation canal system5. Drainage canals6. Access roads / Farm to marketroads (if applicable)7. Post harvest facility (ifapplicable)8. Others, specify:__________________________________________Use additional sheets, if necessary

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects4I.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater Collection System)m 3 /daym 3 /dayWater Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects5Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Totalb. Operation PhaseManpower Requirement Expertise/Skills TotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialImpactsBaseline Environment Preventive/ Mitigating MeasuresLAND Consistency withland useCurrent land use w/in 1kmradius (as per zoningordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify___________________Actual land uses w/in 1kmradius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify__________________ See attached proof of compatibilitywith land useMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify___________________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged ordestroyed vegetation where possible(e.g., tree planting) Annual inspection ofarea replanted/re-vegetated Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects7PossibleEnvironmental/ SocialImpacts Change in surfacelandform/topography/terrain/slopeBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify_________________________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areas nearthe site Others, specify_____________ Slope/ Erosion ControlCost: ___________ Others, specify______________ Soil/Landcontamination dueto improper solidwaste disposalIs the project site located in anarea identified by MGB/PAG-ASA/ PHIVOLCS ashazard prone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Implement proper collection,labeling and storage of hazardouswaste Provide receptacles / bins for solidwastes Coordinate with the municipal / citywaste collectors Engage third party company for Daily inspection ofwaste/recycling bins forsegregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_____________ Cost integrated in theconstruction /operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects8PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating Measureswaste collection Others, specify________________Monitoring Parameters/ImplementationCost of Mitigation/MonitoringWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify_______________Specify nearest water body:________________________Distance to nearest waterbody: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest water body is freshwater, specify classification: AA A B C DIf nearest water body iscoastal or marine water,specify classification: SA SB SC SDCurrent Water Use: Fishery Set up proper and adequate sanitaryfacilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Provide wastewater treatmentfacility (e.g., septic tank, oil andwater separator, etc.) Set up silt trap/settling ponds tominimize downstream siltation Others, specify______________Regular (ocular) inspectionof: Drainage/canal systems Water treatment facility(i.e., grease trap, septictank, etc.Regular (ocular) inspectionof water body for: Turbidity and/or siltedcondition Floating wastes or debris Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects9PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of nearest well: Drinking/Domestic Industrial Agricultural Competition inwater use Depletion of waterresourcesSize of population usingproposed water source: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsAvailable/nearest watersource. Deepwell Water district/LGU Surface water Others, specify________________ Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures Carefully select project site to avoiddisruption of traditional water uses Obtain Water Permit from NWRB Improve efficiency of water supplyand distribution system Implement community ponds andsimilar measures as alternativewater source and options for fishcultivation Increase, when practical, storagecapacities of water supply structuresfor resilience to greater climatevariations and extremes Use drought resistant species which Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitoring foroccurrences of watershortages Others, specify_____________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects10PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating Measuresrequire less water input and hencehave less impact on water tables Modify irrigation techniques,including amount, timing ortechnology Improve water management toprevent water logging, erosion andleaching Modify crop calendars and/orimplement seasonal climateforecasting (e.g., timing or locationof cropping activities) Others, specify_____________________Monitoring Parameters/ImplementationCost of Mitigation/Monitoring Increasedoccurrence offloodingIs the project site located in anarea identified by MGB/PAG-ASA as flood prone? Yes No Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify_______________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concerned agencies Regular monitor ofincreased frequency offlooding Others, specify_________________ Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects11PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/MonitoringAIR / NOISEAir quality degradationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g., vehicles,pumps, generator, etc.) Install, when applicable, theappropriate air pollution controldevice/s Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Conduct water spraying to suppressdust sources and minimizediscomfort to nearby residents Use covered vehicles to delivermaterials that may generate dust Others, specify__________________ Regular monitoring forpresence/absence ofcomplaintsRegular (ocular) inspectionof: Absence of white orblack smoke fromvehicles, generator,etc. Presence of truckcover duringdeliveries Cost integrated in theconstruction/operationcost Nuisance due tonoise generationDistance to nearestcommunity: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allnoise sources (e.g., vehicles,pumps, generator, etc.) Install, when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Implement appropriate operatinghours Provide adequate buffer and/orplanting of trees Others, specify_____________________ Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofbuffer zones Quarterly monitoring ofnoise level Cost integrated in theconstruction/operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects12PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/MonitoringPEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunities Increased revenuesfor LGU Disruption/Competition in delivery ofpublic services(e.g., education,peace and order,etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflowSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsClassification of hostbarangay: Urban RuralAvailable services within/nearthe host barangay: Schools (e.g.,elementary, highschool, college) Health facilities (e.g.,clinics, hospitals, etc.) Peace and order (e.g.,police outpost, Brgy.Tanod, etc.) Recreation and sportsfacilities Others, specify________________ Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regular coordination with LGU Conduct prior consultation andcoordination to minimize disruptionof daily domestic activities and toensure respect for IP rights andcultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify__________________________ Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify___________________ Cost integrated in theconstruction/operationcost Impacts oncommunity healthand safety Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Regular monitoring forpresence/absence ofcomplaints Cost integrated in theconstruction/ operationcost

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects13PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Others, specify______________ Observe proper housekeeping Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Implement appropriate safetyprograms for both community andworkers Others, specify_____________________ Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify_____________

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects 14III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Irrigation / Flood Control / Minor Dam Projects 15SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

1Annex 2 - MINITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMforWASTE MANAGEMENT PROJECTSThis IEE Checklist Report Form shall be used for proposed WASTE MANAGEMENT PROJECTSrequired an IEE Report / IEE Checklist for ECC Application.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any,following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affected areasand communitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS)Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided orotherwise check () the appropriate boxes . Boxes with check marks are mandatoryrequirements. Use additional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist ReportForm. The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECCissuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects2PROJECT FACT SHEETName of the ProjectProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTIONCompost/Fertilizer makingPlease check project type and indicate sizeProject TypeDomestic waste water treatment facilityMaterials recovery facilityReceiving facilities, paper, plastic and other materialrecyclingSanitary landfill for domestic waste onlyActual ProjectSize (MT)Project Size ParameterDaily production rateQuantity of waste to betreated annuallyKind of activityQuantity of waste to betreated annuallyDaily waste inputOther Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects3Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitudeI.2 PROJECT COMPONENTS (Use additional sheets, if necessary)Facilities1. Receiving facilityTransfer stationSegregation/Sorting facilitiesMechanized Materials RecoveryTransport and Facility (MRTF)Recycling facilityWaste inspection and quarantineareaWeigh BridgeVehicle Washing FacilitiesCrasherOthers (Please specify)2. Treatment and disposal facilityWaste reception areaWaste quarantine areaWaste emplacement cellsPonds and lagoonsComposting areaOthers, specify_______________No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks3. Support FacilitiesRoad/access systemDrainage systemLandfill Gas Collection/Recovery FacilityGas venting/temporary flareLeachate collection andtreatment facilityElectrical / Genset RoomBuilding for Composting PlantPump RoomFuel storage and dispensingfacilityPower Supply SystemWater Supply System

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects4FacilitiesOthers, specify___________________No. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks4. Admin supportAdministration BuildingGuard HouseEngineering OfficeClinicMess Hall/CanteenPersonal QuartersMotor PoolStalls/StorageTrucks Wait Area/ ParkingPublic ToiletLaboratoryOthers, specify_____________________5. Water source / supply6. Others, specify:__________________________________________I.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)KWhWater (Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater Collection System)m 3 /daym 3 /day

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects5Water Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /dayI.4 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Total

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects6b. Operation PhaseManpower Requirement Expertise/Skills TotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects7II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleBaseline EnvironmentEnvironmental/ SocialImpactsLAND Consistency withland useCurrent land use w/in 1km radius(as per zoning ordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify___________________Preventive/ Mitigating Measures See attached proof of compatibilitywith land useMonitoring Parameters/ImplementationCost of Mitigation/MonitoringActual land uses w/in 1km radius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify__________________ Disturbance towildlife due tovegetation clearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify___________________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged ordestroyed vegetation wherepossible (e.g., tree planting) Annual inspection ofarea replanted/re-vegetated Cost integrated in theconstruction /operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects8PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Change in surfacelandform/topography/terrain/slope Soil ErosionSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Comply with the standard criteria forsanitary landfill in DAO 49 and 50 Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify__________________________ Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspection fornew eroded areasnear the site Others, specify__________________ Slope/ ErosionControl Cost:___________ Others, specify_______________ Soil/Landcontamination dueto improper solidwaste disposalIs the project site located in anarea identified by MGB/PAG-ASA/PHIVOLCS as hazard prone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Implement proper collection,labeling and storage of hazardouswaste Provide receptacles / bins for solidwastes Coordinate with the municipal / citywaste collectors Daily inspection ofwaste/recycling binsfor segregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify___________________ Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects9PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Engage third party company forwaste collection Comply with the minimum standardfor sanitary landfill liner system perIRR of RA 9003 Others, specify_______________________ Impairment of visualaesthetics Devaluation of landvalues Encroachment intoprotected areas orecologicallysensitiveareasPresence of visually significantlandforms/landscape/structures? Yes NoIs the project area near protectedareas or ecologically-sensitiveareas? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify_______________________ Obtain appropriatepermits/clearances from concernedagencies Provide adequate buffer Others, specify________________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring ofbuffer zones Regular monitoring forpresence/absence ofcomplaints fromadjacent propertyowners Regular coordinationwith concernedagencies Cost integrated in theconstruction/operation cost Cost integrated in theconstruction/operation costWATER Increased siltationdue to projectactivities Water qualitydegradation Others, specify_____________Specify nearest water body:________________________Distance to nearest water body: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Set up proper and adequatesanitary facilities Strictly require the contractor and itsworkers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposalRegular (ocular) inspectionof: Drainage / canalsystems Water treatmentfacility (i.e., greasetrap, septic tank, etc.) Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects10PossibleEnvironmental/ SocialImpactsBaseline EnvironmentIf nearest water body is freshwater, specify classification: AA A B C DIf nearest water body is coastal ormarine water, specifyclassification: SA SB SC SDPreventive/ Mitigating Measures Provide wastewater treatmentfacility (e.g., septic tank, oil andwater separator, etc.) Set up silt trap/settling ponds tominimize downstream siltation Provide ring canals around fuellingtanks/ motor pool/ maintenanceareas Limit, where possible, the extent ofimpervious (paved) areas Installation of biogas digester/ssystem Provide at least 50 meters distancebetween the landfill and anyperennial lake, stream or river Provide the minimum standard forsanitary landfill liner system Install underdrain systemMonitoring Parameters/ImplementationMonthly monitoring of thefollowing: pH TSS concentration BOD Total Coliform Color Oil and GreaseMonthly monitoring of thefollowing: Trace Metals (Pb, Cd,Hg, Cr6, As)Cost of Mitigation/Monitoring Increasedoccurrence offloodingCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalIs the project site located in anarea identified by MGB/ PAG-ASA as flood prone? Yes No Separate at least two (2) metersbetween the top of the liner systemand the underlying groundwater Others, specify__________________________ Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith concernedagencies Regular monitoring forincreased frequency of Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects11PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating Measures Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify________________________Monitoring Parameters/Implementationflooding Others, specify_________________Cost of Mitigation/MonitoringAIR / NOISEAir quality degradation Nuisance due togeneration ofobnoxious/unpleasant odorDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g. vehicles,boiler, generator, etc) Install, when applicable, theappropriate air pollution controldevice/s Install methane recovery facility Install biogas and compostingfacility Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Conduct water spraying to suppressdust sources and minimizediscomfort to nearby residents Use covered vehicles to delivermaterials that may generate dustOther, specify _________________ Use environment-friendlydeodorizer or odor maskingsubstances Use sprays with natural / microbialdisinfectants Apply soil cover daily Regular monitoring forpresence/ absence ofcomplaintsRegular (ocular) inspectionof: Absence of white orblack smoke fromvehicles, generator,etc. Presence of truckcover during deliveriesQuarterly monitoring ofambient air for thefollowing: TSP PM10 NOx SOx CO / CO2 Regular monitoring forpresence/absence ofcomplaints Cost integrated in theconstruction/operation cost Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects12PossibleEnvironmental/ SocialImpactsBaseline EnvironmentIs the wind direction blowingtowards the nearest communitymost of the year? Yes NoPreventive/ Mitigating Measures Provide adequate buffer and/orplanting of trees Others, specify_______________________Monitoring Parameters/ImplementationCost of Mitigation/Monitoring Nuisance due tonoise generationDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allnoise sources (e.g., vehicles, boiler,generator, etc.) Install, when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Implement appropriate operatinghours Provide adequate buffer and platingof treesOthers, specify________________________ Regular monitoring forpresence/absence ofcomplaints Regular monitoring ofbuffer zones Cost integrated in theconstruction/operation costPEOPLE Displacement ofresidents in theproject site andwithin its vicinity Displacement ofIndigenous Peoples Enhancedemployment and/orlivelihoodopportunities Reducedemployment and/orlivelihoodopportunities Increased revenuesfor LGUSize of population of hostbarangay: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000 personsClassification of host barangay: Urban RuralAvailable services within/near thehost barangay: Schools (e.g. elementary, high Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regularly coordinate with LGU Conduct prior consultation andcoordination to minimize disruptionon daily domestic activities and toensure respect for IP rights andcultural practices Ensure participation of IPs inconsultations and dialogues Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Others, specify________________ Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects13PossibleEnvironmental/ SocialImpacts Disruption/Competition indelivery of publicservices (e.g.,education, peaceand order, etc.) Enhanced deliveryof public services(e.g., education,peace and order,etc.) Increase in trafficvolume andworsening of trafficflow Impacts oncommunity healthand safety Others, specify_______________Baseline Environmentschool, college) Health facilities (e.g., clinics,hospitals, etc.) Peace and order (e.g., policeoutpost, Brgy. Tanod, etc.) Recreation and sports facilities Others, specify___________________Preventive/ Mitigating Measures Provide appropriate traffic/warningsigns, lighting, etc Others, specify_________________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Regularly spray disinfectant,pesticides and other similarsubstances when applicable Implement appropriate safetyprograms for both community andworkers Strictly comply with fire, safety andsimilar regulatory requirements Strictly comply with requirements ofRA 6969 Others, specify__________________Monitoring Parameters/Implementation Regular monitoring forpresence/absence ofcomplaints Regular coordinationwith LGU Regular submission ofreports to concernedagency Others, specify______________Cost of Mitigation/Monitoring Cost integrated in theconstruction/operation cost

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects 14III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as final sealing of the filled landfill, subsidenceprocess and the monitoring and inspection activity.IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONInclude in the plan a discussion on how to improve coordination within and among affected stakeholderswho are organizing and providing scientific, technical and managerial personnel on climate change.Provide institutional mechanisms including identification of responsible entities in the event ofabandonment.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Organization Chart:

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects 15Attach sketch plan/lay-out of the project(Use additional sheet, if necessary)

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects 16Attach site development/layout plan (with dimensions and descriptions)

Initial Environmental Examination (IEE) Checklist Report Form for Waste Management Projects 17SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________

1Annex 2 - NGENERIC INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORMThis Generic IEE Checklist Report Form shall be used as the interim pro-forma EIA Reportrequirement for projects required an IEE Report / IEE Checklist for ECC Application and where acustomized IEE Checklist Report Form has not yet been developed.This IEE Checklist Report Form shall be submitted along with the following documents:Proof of Compatibility with the existing Land Use PlanProof of Authority over the Project SiteAccountability Statements of Proponent (see attached form) and the Preparer (if any, followingAnnexes 2-22 of Revised Procedural Manual for DAO 2003-30)Photographs or plates/vicinity map of the project site showing impact areas and affected areas andcommunitiesDuly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS)Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO 2003-30)(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14.)Read the questions carefully and write the required information on the spaces provided or otherwisecheck () the appropriate boxes . Boxes with check marks are mandatory requirements. Useadditional sheets if necessary and indicate this in the appropriate space.Project proponents are strongly discouraged from engaging the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE Checklist Report Form.The Report Forms have been designed to be user-friendly.Furthermore, the EMB Regional Office is required to complete the processing of anECC application using the IEE Checklist Report within twenty (20) working days uponreceipt of duly-accomplished forms with complete attachments.Misleading or erroneous answers are grounds for legal action and/or denial of ECC issuance.OK FOR PRINTING:________________________________________Signature over Printed Name___________________________Date

Generic Initial Environmental Examination (IEE) Checklist Report Form 2PROJECT FACT SHEETName of the ProjectProponent NameProponent AddressProponent Means ofContactName:Landline No.Designation:Fax No.Mobile No.Email:I. PROJECT DESCRIPTION1I.1 PROJECT LOCATION AND AREA:Street/Sitio/BarangayZone/Classification (i.e., industrial, residential)City/Municipality Province RegionTotal Project Land AreaTotal Building Footprint AreaSee attached vicinity map/s and photographs of the project site and site development/layout plan.Geographic coordinates of the project area (Preferably use PRS 92 datum; otherwise, specify datum used).Perimeter/Boundary points (basedon OCT/TCT/etc.)LongitudeLatitudeOther Description Details:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Generic Initial Environmental Examination (IEE) Checklist Report Form 3I.2 PROJECT COMPONENTSFacilitiesNo. ofUnitsArea (sq/M)/CapacitySpecifications/Description/Remarks1. Material storage facilityRaw, chemical and processmaterialsFuel, lubricants and similarmaterialsFinished product (e.g.,equipment facilities, silo, hopper,etc.)Others, specify________________2. Processing facilityMaterial preparation andhandling (e.g., screening,sorting, conveyor belt, etc.)Material sizereduction/agglomerationHeating/Drying (directheat/energy application)Processing (e.g., mixing,blending, refining, milling, etc.)Finishing (e.g., sorting, filling,packaging, etc.)Others, specify________________3. Support Facilities (e.g.,emergency generators, boilers,steam generators, etc.)4. Admin support (e.g., canteen,office, clinic, quarters, etc.)5. Water source / supply6. Waste water managementfacility7. Solid waste management facility8. Drainage system9. Others, specify__________________________________________(Please list facilities by module/grouping. Use additional sheets if needed)

Generic Initial Environmental Examination (IEE) Checklist Report Form 4I.3 UTILITIES/REQUIREMENTS (Operation Phase)Utilities Source Estimated Demand/ConsumptionPower/Electricity (Total)KWhPower/Electricity(From Renewable Energy Sources)Water (Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater Collection System)KWhm 3 /daym 3 /dayWater Source□ ground water □ well □ spring □ others: ____________________________□ surface water □ river □ lake □ others: ____________________________Location of water source____________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)Energy/Water EfficiencyUtilitiesEstimated SavingsProposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm 3 /day

Generic Initial Environmental Examination (IEE) Checklist Report Form 5I.4 MANPOWERa. Construction PhaseManpower Requirement Expertise/Skills Totalb. Operation PhaseManpower Requirement Expertise/Skills TotalI.5 INDICATIVE PROJECT COSTProject Cost (PhP): ______________________

Generic Initial Environmental Examination (IEE) Checklist Report Form6II. ENVIRONMENTAL IMPACT AND MANAGEMENT PLANPossibleEnvironmental/ SocialBaseline EnvironmentImpactsLAND Consistency with landuseCurrent land use w/in 1km radius (asper zoning ordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify___________________Preventive/ Mitigating Measures See attached proof of compatibilitywith land useMonitoring Parameters/ImplementationCost of Mitigation/MonitoringActual land uses w/in 1km radius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify___________________ Disturbance to wildlifedue to vegetationclearingExisting vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify____________________ Comply with conditions ofDENR/LGU SLUP, Tree CuttingPermit, ROW, PCA Permit Limit land clearing as much aspossible Provide temporary fencing forvegetation that will be retained Promote restoration of damaged ordestroyed vegetation wherepossible (e.g., tree planting) Annual inspection ofarea replanted/re-vegetated Cost integratedin theconstruction/operation cost

Generic Initial Environmental Examination (IEE) Checklist Report Form7PossibleEnvironmental/ SocialImpacts Change in surfacelandform/ topography/terrain/slope Soil ErosionBaseline EnvironmentSlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%)Preventive/ Mitigating Measures Provide erosion control and slopeprotection measures Designate a Spoils Storage Area,with topsoil set aside for later useand allow maximum re-use of spoils Construct during dry season Stabilize embankment with grassesor other soil cover Others, specify___________________________Monitoring Parameters/Implementation Regular inspection ofslope protectionmeasures in erosionproneareas Regular inspectionfor new eroded areasnear the site Others, specify_________________Cost of Mitigation/Monitoring Slope/ ErosionControl Cost:__________ Others, specify____________ Soil/Land contaminationdue to improper solidwaste disposalIs the project site located in an areaidentified by MGB/PAG-ASA/PHIVOLCS as hazard prone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify_________________________ Comply with DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines onEngineering Geological and GeohazardAssessment (EGGA). Implement the Ecological SolidWaste Management Plan (ESWMP) Set up temporary fence around theconstruction area Implement re-use and recycling ofwaste materials Implement proper segregation,collection and disposal of domesticwastes in designated areas Provide receptacles / bins for solidwastes Coordinate with the municipal / citywaste collectors Engage third party company forwaste collection Others, specify___________________________ Daily inspection ofwaste/recycling binsfor segregation Daily inspection forpresence of mixedgarbage in the facility Weekly inspection ofwaste accumulated Others, specify_________________ Cost integratedin theconstruction/operation cost

Generic Initial Environmental Examination (IEE) Checklist Report Form8PossibleEnvironmental/ SocialImpacts Impairment of visualaesthetics Devaluation of landvaluesBaseline EnvironmentPresence of visually significantlandforms/landscape/structures? Yes NoPreventive/ Mitigating Measures Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent propertyowners Others, specify________________Monitoring Parameters/Implementation Regular inspection oflandscaping andother beautificationactivities Regular monitoring ofbuffer zones Regularly monitorpresence/absence ofcomplaints fromadjacent propertyownersCost of Mitigation/Monitoring Cost integratedin theconstruction/operation costWATER Increased siltation dueto project activities Water qualitydegradation Others, specify___________________Specify nearest/receiving waterbody:____________________________Distance to nearest/receiving waterbody: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest/receiving water body isfresh water, specify classification: AA A B C DIf nearest/receiving water body iscoastal or marine water, specifyclassification: SA SB SC Set up proper and adequatesanitary facilities Strictly require the contractor andits workers to observe proper wastedisposal and proper sanitation Strictly observe proper wastehandling and disposal Provide wastewater treatmentfacility (e.g., septic tank, oil andwater separator, etc.) Set up silt trap/stilling ponds tominimize downstream siltation Provide three-chambered septictank for domestic sewage Provide ring canals around fuellingtanks/ motorpool/ maintenanceareas Others, specify____________________________Regular (ocular)inspection of: Drainage / canalsystems Water treatmentfacility (i.e., greasetrap, septic tank, etc.)Quarterly monitoring ofthe following: pH TSS concentration BOD Total Coliform Color Oil and Grease Cost integratedin theconstruction/operation cost

Generic Initial Environmental Examination (IEE) Checklist Report Form9PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring SDCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of the nearest well: Drinking/Domestic Industrial Agricultural Competition in wateruse Depletion of waterresourcesSize of population using receivingsurface water: ≤ 1,000 persons >1,000 and ≤ 5,000 persons >5,000 personsAvailable/nearest water source. Deepwell Water district/LGU Surface water Others, specify________________________ Implement rainwater harvesting andsimilar measures as an alternativesource of water Observe water conservationmeasures; Carefully select project site to avoiddisruption of traditional water uses Obtain Water Permit from NWRB Improve efficiency of water supplyand distribution system Others, specify_____________________ Regular monitoringfor presence/absenceof complaints Regular coordinationwith concernedagencies Regular monitoringfor occurrences ofwater shortages Others, specify__________________ Cost integratedin theconstruction/operation cost

Generic Initial Environmental Examination (IEE) Checklist Report Form10PossibleEnvironmental/ SocialImpacts Increased occurrence offloodingBaseline EnvironmentIs the project site located in an areaidentified by MGB/PAG-ASA asflood prone? Yes NoPreventive/ Mitigating Measures Use appropriate design for projectfacilities Implement appropriate drainagesystem Regularly remove debris and othermaterials that may obstruct waterflow Use appropriate technology (e.g.,raised hand-pumps) to protectdrinking water from floodcontamination Others, specify_____________________Monitoring Parameters/Implementation Regular monitoringfor presence/absenceof complaints Regular coordinationwith concernedagencies Regular monitoringfor increasedfrequency of flooding Others, specify__________________Cost of Mitigation/Monitoring Cost integratedin theconstruction/operation costAIR / NOISE Air quality degradationDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allemission sources (e.g., vehicles,pumps, generator, etc.) Install, when applicable, theappropriate air pollution controldevice/s Strictly enforce good housekeepingpractices Control vehicle speed to lessensuspension of road dust Conduct water spraying to suppressdust sources and minimizediscomfort to nearby residents Use covered vehicles to delivermaterials that may generate dust Others, specify___________________ Regular monitoringfor presence/absenceof complaints Regular monitoring ofthe following: TSP NOx SOxFrequency Annual Semi-annualRegular (ocular)inspection of: Absence of white orblack smoke fromvehicles, heavyequipment andgenerator Cost integratedin theconstruction/operation cost

Generic Initial Environmental Examination (IEE) Checklist Report Form11PossibleEnvironmental/ SocialImpactsBaseline EnvironmentPreventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Nuisance due to noisegenerationDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain allnoise sources (e.g. vehicles,pumps, generator, etc) Install when applicable, theappropriate noise control device/s(e.g., mufflers, silencer, soundbarriers, etc.) Implement appropriate operatinghours Provide adequate buffer and/orplanting of trees Others, specify______________________ Presence of truckcover duringdeliveries Regularly monitorpresence/absence ofcomplaints Regular monitoring ofbuffer zones Cost integratedin theconstruction/operation costPEOPLE Displacement ofresidents in the projectsite and within itsvicinity Displacement ofIndigenous People Enhanced employmentand/or livelihoodopportunities Reduced employmentand/or livelihoodopportunities Increased revenues forLGU Disruption/Competitionin delivery of publicservices (e.g.,education, peace andSize of population of host barangay: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000personClassification of host barangay: Urban RuralAvailable services within/near thehost barangay: Schools (e.g. elementary, highschool, college) Health facilities (e.g., clinics,hospitals, etc.) Peace and order (e.g., policeoutpost, Brgy. Tanod, etc.) Provide relocation/disturbancecompensation packages Prioritize local residents foremployment Promptly pay local taxes and otherfinancial obligations Regular coordination with LGU Prior consultation & coordination tominimize disruption on dailydomestic activities & respect for IPrights and cultural practices Ensure participation of IPs inconsultations and dialogues Provide appropriate traffic/warningsigns, lighting, etc Others, specify________________ Regular monitoringfor presence/absenceof complaints Regular coordinationwith LGU Others, specify_________________ Cost integratedin theconstruction/operation cost

Generic Initial Environmental Examination (IEE) Checklist Report Form12PossibleEnvironmental/ SocialImpactsorder, etc.) Enhanced delivery ofpublic services (e.g.,education, peace andorder, etc.) Increase in trafficvolume and worseningof traffic flowBaseline Environment Recreation and sports facilities Others, specify_____________________Preventive/ Mitigating MeasuresMonitoring Parameters/ImplementationCost of Mitigation/Monitoring Impacts on communityhealth and safetySafety Risks Fire Explosion Release of toxicmaterialsSource of risks Explosives Flammable substances Toxic substances Others, specify_________________________ Regularly coordinate with LGU Provide appropriate warning signs,lighting and barricades, wheneverpracticable Observe proper housekeeping Provide on-site medical services forany emergency. Participate in public awarenessprograms on health and safety Implement appropriate safetyprograms for both community andworkers Strictly comply with fire, safety andsimilar regulatory requirements Strictly comply with requirements ofRA 6969 Others, specify___________________________ Regular monitoringfor presence/absenceof complaints Regular monitoring ofbuffer zones Regular coordinationwith LGU Regular submissionof reports toconcerned agency Others, specify_________________ Cost integratedin theconstruction/operation cost

Generic Initial Environmental Examination (IEE) Checklist Report Form13 13III. ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERICGUIDELINES (if Applicable)Project Life or Service: ___________ yearsProvide description of the Abandonment activities, such as, dismantling and waste disposal.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:

Generic Initial Environmental Examination (IEE) Checklist Report Form14 14Attach drawing/plan of waste water treatment facility (with dimensions and descriptions)

Generic Initial Environmental Examination (IEE) Checklist Report Form15 15Attach drawing/plan of air pollution source and control installations (with dimensions anddescriptions)

Generic Initial Environmental Examination (IEE) Checklist Report Form16 16SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this Initial EnvironmentalExamination (IEE) Checklist Report are accurate and complete to the best of my knowledge.By the authority vested in me by the (Company Name)____________as ___(Position/Designation) , I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEE ChecklistReport as well as the following:. Conform to pertinent provisions of applicable environmental laws e.g., R.A.No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Actof 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000),R.A. No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749(Philippine Clean Air Act of 1999).Abide and conform to LGU development plan and guidelines.Promptly pay local taxes and other financial obligations.Regularly submit reports to concerned agencies.I hereby bind myself to answer any penalty that may be imposed arising from anymisrepresentation or failure to state material information in this IEE Checklist.In witness whereof, I hereby set my hand this ____ day of ___________________ at_______________________________.____________________________________NAME OF PROPONENT HEAD_____________________________________Signature____________________________________Position____________________________________Company NameSUBSCRIBED AND SWORN TO before me this _____ day of ____________ 201__, affiant exhibitinghis/her Community Tax Certificate No. ___________________ issued at ______________________ on__________________________.Doc No. ___________________________Page No. __________________________Book No. __________________________Series of __________________________