Department of Environment and Natural Resources

Environmental Management Bureau

LEGEND: Reference No:

ALL CAPS BOLD TEXT - Notes
Italicized text - Example
(to be filled up by DENR only)

GENERAL INFORMATION SHEET

Name of the
Sugbo Corporation
Establishment/Facility
Establishment/Facility Street # & Street Name: Kaoshiung St.
Address
Barangay: North Reclamation Area City/Municipality: Mandaue City
(NOT the company of
head office) Province: Cebu
Name of
Sugbo Corporation
Owner/Company
Address Street # & Street Name: Kaoshiung St.
(if address is not the
Barangay: North Reclamation Area City/Municipality: Mandaue City
same as previous
address) Province: Cebu

Phone Number (032) 234-5678 Fax Number (032) 245-6789

DOWNLOAD THE PHILIPPINE STANDARD INDUSTRIAL
e-mail address [email protected] CLASSIFICATION EBOOK BY NSCB FOR THIS SECTION

Type of Business/ Philippine Standard Industry Classification Code No. 31010

Industry
Classification Philippine Standard Industry Descriptor: Manufacture of Wood Furniture

CEO/President. Juan de la Cruz

Tel #: (032) 333-4444 Fax #: (032) 333-4444

Responsible e-mail address: [email protected] THIS SHALL BE THE MANAGING

HEAD TO SIGN THE AFFIDAVIT OF
Officer/s: Plant Manager: Jose Santiago JOINT UNDERTAKING WITH PCO

Tel #: (032) 245-6789 Fax #: (032) 245-6789

e-mail address: [email protected]

Name. Meg Modequillo

Pollution Control
Tel #: (032) 333-8888 Fax #: (032) 333-8888
Officer
e-mail address: [email protected]

 single proprietorship  partnership

Legal Classification  private domestic corporation  government corporation

 Multi-national  ___

PUT YOUR PCO

We hereby certify that the above information are true and correct. ACCREDITATION
NO. HERE
MANAGING HEAD IF CEO/
PRES CANNOT SIGN
MEG MODEQUILLO
JUAN DE LA CRUZ COA No. 2015-RO7-1234
Name/Signature of CEO/President Name/Signature of PCO
 Procedural and Reference Manual for DAO 2003-27

Department of Environment and Natural Resources

Environmental Management Bureau

s t
2016 1 QUARTER SELF-MONITORING REPORT

MODULE 1: GENERAL INFORMATION

Name of the Plant SUGBO CORPORATION

YOU CAN PROVIDE ALL DETAILS NOT MENTIONED IN THE REST OF THE SMR IN THIS SECTION
(INCLUDING INFORMATION ON WTF/APCD BREAKDOWNS, UPDATES ON STATUS OF EXPIRED
PERMITS, ETC.)

Sugbo Corporation was established in January 1990 with a land area of 10,267 m2 and geographical
coordinates 10°18’42.78”N:123°55’16.53”E and 15 meters altitude.
The company employs 120 employees, 40% of which are female and 60% are male. All are regular
employees with 20 assigned to managerial and administrative functions and the remaining 100
involved in manufacturing.

DENR Permits/Licenses/Clearances
Environmental
Permits Date of Issue Expiry Date
Laws
A/C No. N/A N/A N/A
P.D. 984 PO No.
RA 9275 DISCHARGE DP/12/074623-001 10/20/2012 11/20/2015
PERMIT NO.
PD 1586 ECC 1 C-NECCR-1999-01-20-120 1/18/2012 N/A
DENR Registry
ID GR-13-76-0048 N/A N/A
HW
GENERATOR’S ID
RA 6969 CCO Registry N/A N/A N/A
Importer
N/A N/A N/A
Clearance No
Permit to
N/A N/A N/A
Transport
A/C No. N/A N/A N/A
RA 8749
PO No. POA-12-7-074623-001 10/20/2012 11/20/2015
NO FIELD IN THE TABLE ABOVE SHOULD BE LEFT BLANK. PUT “N/A” IF NOT APPLICABLE

Operation
Operating hours/day Operating days/week # of shift/day
Average 24 7 3
Maximum 24 7 3

Operation/Production/Capacity:
Average Daily 20 chairs Total Output this 2,000 chairs
Production Output 5 tables Quarter 500 tables
Total Water Total Electric
Consumption this 309 Consumption this 13,700,000
Quarter (cubic meters) Quarter (KwH)
ATTACH WATER AND ELECTRIC BILLS FOR THIS QUARTER AS PROOF

Preparation and Submission of SMR 2

 Procedural and Reference Manual for DAO 2003-27

MODULE 2: RA 6969

A. CCO Report (please accomplish this section for each chemical/substance)

MODULE 2.A IS TO BE ACCOMPLISHED ONLY BY FACILITIES INVOLVED WITH CHEMICALS UNDER CCO
Common Name/IUPAC/CAS Index Name. ___
CAS No.: ___
Trade Name: ___

For importers only:

Import
Quantity Date of Quantity Port of Country of Country of
Clearance
Requested Arrival Received* Entry Origin Manufacture
No.

Total Quantity Total Quantity

Requested (annual) Received (annual)
* attach copy/s of Bill of Lading

For distributors (importers/non-importers)

Name of Client License No. Quantity Date of Distribution

Total Quantity Distributed

For non-importer users:

Name of Distributor Quantity Date of Purchase

Total Quantity Purchased from Distributor

For producers
Average Daily Total Output this
Production Output Quarter
Quantity of Stock Quantity of Stock
Inventory (Start of Inventory (End of
Quarter) Quarter)
Name of Buyer Quantity Date of Purchase

Total Quantity Sold

Used in Production (please fill up only if chemical/substance is not main product)

Average Daily Total Output this
Production Output Quarter

Preparation and Submission of SMR 3

 Procedural and Reference Manual for DAO 2003-27

Average Quantity Used Total Quantity Used

per month this Quarter
Describe any changes in Production/Process/Operations:

Stock Inventory/Waste Chemical Generated:

Average Quantity of Total Quantity of Waste
Waste Chemical Chemical Generated
Generated per month this Quarter
Quantity of Stock Quantity of Stock
Inventory (Start of Inventory (End of
Quarter) Quarter)
Other Information:
 storage on-site  Treatment on-site
Manner of handling
hazardous wastes
 storage off-site  Treatment off-site

 Yes (please attach copy of revised plan)

Changes in Safety
Management System
 No

 Yes (please attach copy if not submitted/included in previous report/s or

Chemical Substitute had been revised)
Plan
 No

B. Hazardous Wastes Generator MODULE 2.B IS TO BE ACCOMPLISHED BY ALL GENERATORS

OF HAZARDOUS WASTE (BASICALLY EVERYONE)
HW Generation:
Remaining HW from
Previous Report HW Generated
HW HW HW GENERATED FROM
(FOR THIS QUARTER
HW PREVIOUS QUARTER
HW Class Natur Cataloguin ONLY)
No. STILL STORED IN YOUR
e g
PLANT
Quantity Unit Quantity Unit
Empty paint 0 pcs 45 pcs
J20
containers (5 Solid Toxic (0) (tons) (0.03) (tons)
1
gallons size)
J20 Empty paint thinner 10 pcs 20 pcs
Solid Toxic
1 drums (0.0001) (tons) (0.0002) (tons)
Contaminated rags Toxic, 50 pcs 50 pcs
I104 (with oil) Solid Flammabl (0.005) (tons) (0.005) (tons)
e
Dried paint/residual Toxic, 11 kg 9 kg
F60
from water curtain Solid Flammabl (0.011) (tons) (0.009) (tons)
1
e
D40 Busted lamps 25 pcs 25 Pcs
Solid Toxic
7 (0.05) (tons) (0.05) (tons)
F60 Paint sludge from Sludg 3 kg 15 kg
Toxic
1 WTF e (0.003) (tons) (0.015) (tons)
H80 Grease Sludg 60 kg 60 kg
Toxic
2 e (0.06) (tons) (0.06) (tons)
Used oil Toxic, 25 liters 25 liters
I101 Liquid Flammabl (0.02) (tons) (0.02) (tons)
e

Preparation and Submission of SMR 4

 Procedural and Reference Manual for DAO 2003-27

Waste Storage, Treatment and Disposal:(Please fill-up one table per HW)
THERE SHOULD BE ONE WSTD TABLE PER HW ITEM LISTED IN THE HW GENERATION TABLE ABOVE.
IN THIS EXAMPLE, 8 ITEMS OF HW ARE ENUMERATED SO WE EXPECT 8 WSTD TABLES AS WELL

HW No,: J201 (Empty Containers)

HW Details Qty of HW Treated: 0.03 Unit: tons
TSD Location: off-site
Storage
WHO AND HOW HW IS
Name: Sugbo Corporation (HW storage shed)
STORED FOR THIS Method: collected in metal pail
QUARTER
Transporter
WHO TRANSPORTED
ID: 03-14-0003 Name: Inchem Environmental Inc.
THE HW FROM YOUR Date: January 18, 2016
FACILITY
Treater
WHO TREATED YOUR ID: 03-14-005 Name: Inchem Environmental Inc.
HW FOR THIS Method: Physico-chemical treatment Date: 2/01/2016
QUARTER
Disposal
WHO DISPOSED THE
ID: 03-14-07 Name: Inchem Environmental Inc.
TREATED HW FOR Method: Date:
THIS QUARTER

HW No,: J201 (Empty Paint Thinner Drums)

HW Details Qty of HW Treated: 0.003 Unit: tons
TSD Location: off-site

Name: Sugbo Corporation (HW storage shed)

Storage
Method: collected in metal pail

ID: 03-14-0003 Name: Inchem Environmental Inc.

Transporter
Date: BLANK ENTRY MEANS NOT YET TRANSPORTED ___

ID: 03-14-005 Name: Inchem Environmental Inc.

Treater
Method: BLANK ENTRY MEANS NOT YET TREATED Date:

ID: 03-14-07 Name: Inchem Environmental Inc.

Disposal
Method: BLANK ENTRY MEANS NOT YET DISPOSED Date:

On-Site Self Inspection of Storage Area:

Premises/Area Findings & Corrective Action
Date Conducted
Inspected Observations Taken (if any)
No adverse findings
Arrange schedule with
1/15/2016 HW storage area aside from build-up of
contractor
wastes
Used lead-acid Arrange schedule with
2/28/2016 HW storage area
batteries accumulating contractor
One of the steel drums
3/4/2016 HW storage area used to store used oil Container replaced
has leak

MODULE 2.C IS TO BE ACCOMPLISHED ONLY BY FACILITIES THAT

TREAT/ RECYCLE HW (TSD FACILITIES)

Preparation and Submission of SMR 5

 Procedural and Reference Manual for DAO 2003-27

C. Hazardous Wastes Treater/Recycler

HW Stored and/or Untreated as of End of Quarter:

Type of
HW Transport Storage Time
Wastes Date of
Numbe Permit/Dat Valid until Quantity Container/ Table for
Generator Transport
r e of Issue # of Treatment
containers
NAME OF
COMPANY
WHICH
GENERATED
HW TO BE
TREATED

HW Treated and/or Recycled as of End of Quarter:

Type &
Type of
Quantity
Transport Treatment
Type of HW Wastes Date of of
Permit/Dat Quantity or
Wastes Number Generator Transport Recycled
e of Issue Recycling
or Treated
Process
Product

Residual Wastes Generated from the Treatment and/or Recycling Operation:

Type of
Process by
Storage
Type of which the Disposal Time Table
HW Number Quantity Container/
Wastes Wastes is Option for Disposal
# of
Generated
containers

MODULE 3: P.D. 984 (Water Pollution)

Water Pollution Data THIS IS AN ENUMERATION OF THE SOURCES OF WASTEWATER OF THE PLANT
Domestic wastewater Process wastewater
2.61 0.1 (recycled)
(cubic meters/day) (cubic meters/day)
Cooling water Others: ___________
N/A N/A
(cubic meters/day) (cubic meters/day)
Wash water, Wash water, floor
N/A N/A
equipment (m3/day) (cubic meters/day)

Record of Cost of Treatment (Separate entries for separate facilities)

Month 1 Month 2 Month 3
Person employed, (# of
5 5 5
employees)
Person employed,
P 115,000 P 115,000 P 115,000
(cost)
Cost of Chemicals
Incorporated with the contractors/third party fees
used by WTP
Utility Costs of WTP
P 12,200 P 12,200 P 12,200
(electricity & water)
Administrative and none none none

Preparation and Submission of SMR 6

 Procedural and Reference Manual for DAO 2003-27

Overhead Costs
Cost of operating in-
Incorporated with the contractors/third party fees
house laboratory
New/Additional
Investments in WTP none none none
(Description)
Cost of New/Add
P 45,000 none none
Investments

WTP Discharge Location PLANT’S RECEIVING WATERBODY IS FOUND IN THE DISCHARGE PERMIT
Outlet
Location of the Outlet Name of Receiving Water Body
Number
1 Behind plant parking lot Mactan Channel (Class SC)
2
3

Detailed Report of Wastewater Characteristics for Conventional Pollutants

FOR ALL DISCHARGE PERMIT HOLDERS, THE MONTHLY/ QUARTERLY ANALYSIS AND QUARTERLY
REPORTING OF WASTEWATER QUALITY IS A MANDATORY REQUIREMENT. LEAVING THIS TABLE
BLANK IS GROUNDS FOR VIOLATION OF ONE OF THE CONDITIONS OF YOUR DISCHARGE PERMIT
Outlet No. 1
Effluent DO
Oil & Temp (name)
Flow BOD TSS
DATE Color pH Grease rise mg/L
Rate (mg/L) (mg/L)
(mg/L) (ºC)
(m3/day) (unit)
1/15/16 3.5 14 24 8.2 1 2
2/15/16 3.6 20 13 6.9 <1.0 3
3/15/16 3.8 21 67 7.0 2 1
Please fill-up/accomplish separate form/s for other outlet/s.

Detailed Report of Wastewater Characteristics for Other Pollutants

Outlet No. 1
_______ _______ _______ _______ _______ _______
Effluent COD
_ _ _ _ _ _
Flow (name)
DATE (name) (name) (name) (name) (name) (name)
Rate mg/L
(m3/day) (unit)
(unit) (unit) (unit) (unit) (unit) (unit)
1/15/16 3.5 90
2/15/16 3.6 80
3/15/16 3.8 92
Please fill-up/accomplish separate form/s for other outlet/s.
Please use additional sheet/s if necessary.

Preparation and Submission of SMR 7

 Procedural and Reference Manual for DAO 2003-27

MODULE 4: R.A. 8749 (Air Pollution)

Summary of APSE/APCF ENUMERATE THE APSEs/APCFs LISTED IN YOUR PERMIT TO OPERATE

# of hrs of operations
Process Equipment Location
(FOR THIS QTR)
Two (2) units 5 kW Band Saw Production area 1,440
Two (2) units 5.5 kW Panel Saw Production area 1,440
Two (2) units 5 kW Planer Production area 1,440
One (1) unit 4 kW Belt Sander Production area 1,440
Two (2) units 1 kW Jigsaw Machine Production area 1,440
Two (2) units 9 kW Multiple Boring
Production area 1,440
Machine
One (1) unit 25 kW Carving Machine Production area 1,440
One (1) unit 3 kW Edge Banding
Production area 1,440
Machine
One (1) unit 2.5 kW Edge Sander Production area 1,440
One (1) unit 3kW Edge Trimmer
Production area 1,440
Machine
Four (4) units Spray Gun Production area 1,440
Quantity # of hrs of
Fuel Burning Equipment Location Fuel Used Consumed operations
(FOR THIS QTR) (FOR THIS QTR)
One (1) unit 625 kVA
Powerhouse Diesel 1,500 L 12.4
“Cummins” Generator Set
# of hrs of operations
Pollution Control Facility Location
(FOR THIS QTR)
One (1) units Critical Muffler with
Production area 1,440
insulation and aluminum/cladding
Five (5) units 1.4 HP portable bag
Production area 1,440
filter
One (1) unit centralized dust collector
system ( size: 2.5 m x 2.5 m x 4 m)
consisting of two lines ducting system Production area 1,440
equipped with 22 HP suction fan in
each line
Two (2) units spray booth equipped
Production area 1,440
with water curtain and exhaust fan

Cost of Treatment
Month 1 Month 2 Month 3
Cost of Person
1 1 1
employed, (salary)
Total Consumption of
20 20 20
Water (cubic meters)
Total Cost of chemicals
used (e.g., activated N/A N/A N/A
carbon, KMnO4)
Total Consumption of
13,000 13,000 13,000
Electricity (KwH)
Administrative and
P20,000.00 P20,000.00 P20,000.00
Overhead Costs
Cost of operating in- N/A N/A N/A

Preparation and Submission of SMR 8

 Procedural and Reference Manual for DAO 2003-27

house laboratory, if any

Improvement or
Regular Cleaning of
modification, if any. None None
smoke stacks
(Description)
Cost of improvement of
N/A N/A N/A
modification

Detailed Report of Air Emission Characteristics

FOR SOME PERMIT TO OPERATE HOLDERS, THE REGULAR TESTING AND REPORTING OF STACK
EMISSIONS IS A MANDATORY REQUIREMENT. REPORT A SUMMARY OF YOUR LATEST SST RESULTS
(EVEN LAST TESTING OCCURRED LAST YEAR) IN THIS TABLE.

Description/
Smoke Stack of One (1) unit 625 kVA “Cummins” Generator Set located in
Location
Powerhouse
of PCF
SO3 _______ _______ _______
Flow
CO NOx Particulat (name) (name) (name) (name)
Rate
DATE (mg/Nc (mg/Nc es
(Ncm/da
m) m) (mg/Ncm) (mg/Nc (mg/Nc (mg/Nc (mg/Nc
y)
m) m) m) m)
9/2/15 30 -- 400 50 150

Please fill-up/accomplish separate form/s for other PCF/s.

Please use additional sheet/s if necessary.

MODULE 5: P.D. 1586 THIS MODULE IS TO BE ACCOMPLISHED BY ECC HOLDERS

Ambient Air Quality Monitoring (if required as part of ECC conditions)
Description/Location
of Monitoring Station
_______ _______ _______ _______
_ _ _ _
CO NOx Particulat
Noise (name) (name) (name) (name)
DATE (mg/Nc (mg/Nc es
Level (dB)
m) m) (mg/Ncm)
(mg/Nc (mg/Nc (mg/Nc (mg/Nc
m) m) m) m)

(Please accomplish one table per monitoring station.)

Ambient Water Quality Monitoring (if required as part of ECC conditions)

Description/Location
of Sampling Station
_______ _______ _______ _______ _______ _______ _______ _______
_ _ _ _ _ _ _ _
DATE (name) (name) (name) (name) (name) (name) (name) (name)

(unit) (unit) (unit) (unit) (unit) (unit) (unit) (unit)

(Please accomplish one table per sampling station.)

Preparation and Submission of SMR 9

 Procedural and Reference Manual for DAO 2003-27

Other ECC Conditions

Status of Compliance
ECC Condition/s Actions Taken
Yes No
1.
2.
3.
Please use additional sheet/s if necessary.

Environmental Management Plan/Program

Status of
Enhancement/Mitigation Measures Implementation Actions Taken
Yes No
1.
2.
3.
Please use additional sheet/s if necessary.

Solid Waste Characterization/Information:

ALL ESTABLISHMENTS ARE ENCOURAGED TO ACCOMPLISH THIS TABLE, WHETHER AN ECC HOLDER OR NOT
Average Quantity of Total Quantity of Solid
Recyclables - 300 kg Recyclables - 900 kg
Solid Wastes Wastes Generated this
Residual - 300 kg Residual - 900 kg
Generated per month Quarter
Average Quantity of Total Quantity of Solid
Solid Wastes Collected Residual - 300 kg Wastes Collected this Residual - 900 kg
per month Quarter
Entity in charge of
Mandaue City Waste Management
collecting solid wastes
Brief Description of
Solid Waste
Management Plan
(e.g., waste reduction,
segregation, recycling)

Preparation and Submission of SMR 10

 Procedural and Reference Manual for DAO 2003-27

MODULE 6: OTHERS

Accidents & Emergency Records (RELATED TO THE ENVIRONMENT)

Findings and
Date Area/Location Actions Taken Remarks
Observation
Clean-up and
Generator Set Spill of stored installment of
1/30/2016
area used oil secondary
containment

Personnel/Staff Training (RELATED TO THE ENVIRONMENT)

# of Personnel
Date Conducted Course/Training Description
Trained
February 15-19, 2016 40 hours PCO Training 2
February 20, 2016 PCO Training for Managing Heads 1

I hereby certify that the above information are true and correct.

Done this 4th day of April, 2016, in Cebu City.

PUT YOUR PCO
ACCREDITATION
NO. HERE
MEG MODEQUILLO
MANAGING HEAD IF CEO/
PRES CANNOT SIGN COA No. 2015-RO7-1234
Name/Signature of PCO
JUAN DE LA CRUZ
Name/Signature of CEO

SUBSCRIBED AND SWORN before me, a Notary Public, this ________ day of
______________________, affiants exhibiting to me their Community Tax Receipts:

Name CTR No. Issued at Issued on

JUAN DELA CRUZ Passport 12345 Cebu City March 25, 2014
MEG MODEQUILLO Passport 45678 Cebu City May 5, 2014

Preparation and Submission of SMR 11