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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_