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PROJECT ENVIRONMENTAL MONITORING AND AUDIT PRIORITIZATION
SCHEME (PEMAPS) QUESTIONNAIRE
Project Name : _______________________________________________________
Project Location : _______________________________________________________
Proponent : _______________________________________________________Pollution Control Officer : _______________________________________________________
Tel. No./Fax No./Email : _______________________________________________________
Project Type : _______________________________________________________
Project Status : _______________________________________________________
I. PROJECT CONSIDERATIONS
Size and Type
Size based on number of employeesSpecify number of employees: ____________
TypeECP ____________ Non-ECP but in ECA /Non-ECP and Non-ECA ____________
Waste Generation and ManagementEnumerate Waste Type and Specify Quantity of Wastes generated in your facility. (Identify
/Enumerate)
Category Waste
Type
QuantityHazardous Non-Hazardous
AirWaste 1
Waste 2
Waste N
Liquid
Solid
Pollution Control System (PCS)Enumerate PCS or Waste Management Method Used in your facility.
(Identify /Enumerate)
Category PCS/Waste Management Method Used Remarks
Air
PCS 1
PCS 2
PCS N
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Liquid
Primary
Secondary
Tertiary
Solid
II. PATHWAYS
Prevailing wind towards barrio or city? (mark the corresponding point) Yes ____ No ____
Rainfall (impacts surface & groundwater pathways) Average annual net rainfall:
Specify amount: ____________
Maximum 24-hour rainfall:Specify amount: ____________
Terrain (select one and mark) Flat ____ Steep ____
Is the facility located in a flood-prone area? (select one and mark) Yes ____ No ____
Ground WaterDepth of groundwater table (meter) (select one and mark)
0 to less than 3 ____________ 3 to 10 ____________ Greater than 10 ____________
III. RECEIVING MEDIA/RECEPTORS
Air (Distance to nearest community) (select one and mark)0 to less than 0.5 km ____________ 0.5 to 1 km ____________ Greater than 1 km ____________
Receiving Surface Water BodyDistance to receiving surface water: (select one and mark)
0 to less than 0.5 km ____________ 0.5 to 1 km ____________ Greater than 1 km ____________
Size of population using receiving surface water
Specify number: ____________
Fresh WaterClassification of fresh water (select one and mark)
AA ____________ A ____________ B ____________ C ____________ D ____________
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Size of fresh water bodySpecify size: ____________
Economic value of water use (may select more than one of the criteria below) Drinking ____________
Domestic ____________
Recreational ____________
Fishery ____________ Industrial ____________ Agricultural ____________
Salt water Classification of salt water (select one and mark)
SA ____________ SB ____________ SC ____________ SD ____________
Economic value of water use (may select more than one of the criteria below) Fishery ____________ Tourist zone or park
____________
Recreational ____________ Industrial ____________
Ground WaterDistance to nearest recharge area (select one and mark)
0 to less than 0.5 km ____________ 0.5 to 1 km ____________ Greater than 1 km ____________
Distance to nearest well used (select one and mark)
0 to less than 0.5 km ____________
0.5 to 1 km ____________ Greater than 1 km ____________
Groundwater use within the nearest well(may select more than one of the criteria below)
Drinking ____________ Industrial ____________ Agricultural ____________
LandIndicate current/actual land uses within 0.5 km radius:
(may select more than one of the criteria below)
Residential ____________
Commercial/Institutional ____________ Industrial ____________ Agricultural/Recreational ____________ Protected Area ____________
Potential/proposed land uses within 0.5 km(may select more than one of the criteria below)
Residential ____________ Commercial/Institutional ____________
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Industrial ____________ Agricultural/Recreational ____________ Protected Area ____________
Number of affected Environmentally Critical Areas within 1 km:Specify number: ____________
Distance to nearest ECA (select one and mark) 0 to less than 0.5km ____________
0.5 to 1 km ____________ Greater than 1 km ____________
IV. ENVIRONMENTAL PERFORMANCE
Compliance (pls. take note that this will be double-checked with PCD files)
Law
Violation
(check if
any)
Type (pls. specify number of times committed)Type of
AdminViolation
Additional
Remarks/Statuof Compliance
STANDARD
Emission/Effluent/
DischargeAmbient
Human
Impact
Admin/
ECC
RA 8749
RA 9275
RA 6969
PD 1586
RA 9003
Number of Valid ComplaintsCitizen and NGOs
Specify number: ____________
Others (other Govt. Agencies, Private Institutions)
(To be filled up by EMB Personnel)
RECOMMENDATION/S:
_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
Assessed By: ____________________________
Noted By: ________________________
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ACCOUNTABILITY STATEMENT OF PROJECT PROPONENT
This is to certify that all information in the submitted Project Environmental
Monitoring And Audit Prioritization Scheme (PEMAPS) Questionnaire of
_______________________ located at _______________________ is true, accurate and
complete. Should I learn of any information, which makes this inaccurate, I shall bringsaid information to the appropriate Environmental Management Bureau Regional Office.
In witness whereof, I hereby set out my hands this _______________________day of 2012 at _______________________.
_______________________________
PROJECT PROPONENT
SUBSCRIBED AND SWORN to before me this _______________________
day of _______________________ 2012 at _______________________ . Affiant exhibiting to
me his/her Community Tax Certificate No. _______________________ issued on
_______________________ .
Doc. No. ___________ Page No. ___________Book No. ___________Series of 200_