PROJECT ENVIRONMENTAL MONITORING AND AUDIT PRIORITIZATION SCHEME (PEMAPS) QUESTIONNAIRE

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 TypeSize 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)

CategoryWasteTypeQuantity

HazardousNon-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)

CategoryPCS/Waste Management Method UsedRemarks

AirPCS 1

PCS 2

PCS N

LiquidPrimary

Secondary

Tertiary

Solid

PATHWAYSPrevailing 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 Water Depth of groundwater table (meter) (select one and mark)0 to less than 3

3 to 10

Greater than 10

RECEIVING MEDIA/RECEPTORSAir (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 waterSpecify number:

Fresh WaterClassification of fresh water(select one and mark)AA

A

B

C

D

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 waterClassification 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

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 PERFORMANCECompliance (pls. take note that this will be double-checked with PCD files)LawViolation(check if any)Type (pls. specify number of times committed)Type of Admin ViolationAdditional Remarks/Status of Compliance

STANDARD

Emission/Effluent/ DischargeAmbientHuman ImpactAdmin/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)Specify number:

(To be filled up by EMB Personnel)

RECOMMENDATION/S:

Assessed By:

Noted By:

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 bring said information to the appropriate Environmental Management Bureau Regional Office.

In witness whereof, I hereby set out my hands this _______________________ day of 200_ at _______________________.

PROJECT PROPONENT

SUBSCRIBED AND SWORN to before me this _______________________ day of _______________________ 200_ at _______________________. Affiant exhibiting to me his/her Community Tax Certificate No. _______________________ issued on _______________________.

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