Department of Environment and Natural Resources

Environmental Management Bureau

Reference No:
(to be filled up by DENR only)

GENERAL INFORMATION SHEET

Name of the
RSCalagui Real Estate Property Leasing
Establishment/Facility

Establishment/Facility Street # & Street Name: BLk 7, Lot 19 Golden Harvest Subdivision
Address Barangay: Caggay City/Municipality: Tuguegarao City
(NOT the company of head
office) Province: Cagayan
Name of
Rosario Soriano Calagui
Owner/Company
Street # & Street Name: Same as above
Address
(if address is not the same as Barangay: City/Municipality: ___
previous address)
Province:

Phone Number 099552724861 Fax Number

e-mail address

Philippine Standard Industry Classification Code No. 55

Type of Business/
Philippine Standard Industry Descriptor: Accomodation
Industry Classification
___

CEO/President. Rosario Soriano Calagui

Tel #: Same as above Fax #: ___
e-mail address: ___
Responsible Officer/s:
Plant Manager: N/A
Tel #: Fax #: ___
e-mail address: ___

Name. RACQUEL CALAGUI VERA CRUZ

Pollution Control
Tel #: 09153070504 Fax #: ___
Officer
e-mail address: ___

X single proprietorship  partnership

Legal Classification  private domestic corporation  government corporation
 Multi-national  ___

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

ROSARIO SORIANO CALAGUI RACQUEL CALAGUI VERA CRUZ

Name/Signature of CEO/President Name/Signature of PCO
Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

Department of Environment and Natural Resources

Environmental Management Bureau

QUARTERLY SELF-MONITORING REPORT

MODULE 1: GENERAL INFORMATION

Name of the Plant RSCalagui Real Estate Property Leasing
Please provide the necessary revised, corrected or updated information not contained in your General
Information Sheet

NOTE:
The digestive and loading chambers of the septic tank was fully cemented at the area base, as informed
and certified by the civil engineer of our project Engr. Babileo Te.
It is a water tight septic tank.

(use additional sheet/s if necessary)

DENR Permits/Licenses/Clearances
Environmental
Permits Date of Issue Expiry Date
Laws
P.D. 984
A/C No. 2019-OP-E-0215 CC0736 March 18, 2019 March 28, 2020
(RA 9275) PO No. (DP
No.)
ECC 1

PD 1586 ECC 2

ECC 3
DENR
Registry ID
CCO Registry
RA 6969 Importer
Clearance No
Permit to
Transport
A/C No.
RA 8749
PO No.

Module 1: General Information page ___ of 12

Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

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

Operation/Production/Capacity:
Average Daily Capacity 8 persons Total Output this Quarter 8 persons
Total Water Consumption Total Electric
this Quarter (cubic 150 Consumption this Quarter 1076
meters) (KwH)
Please use additional sheet/s if necessary

Module 1: General Information page ___ of 12

Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

MODULE 2: RA 6969

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

Common Name/IUPAC/CAS Index Name. ___

CAS No.: ___
Trade Name: ___

For importers only:

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

Not NONE
Applicable

Total Quantity Requested Total Quantity Received

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

For distributors (importers/non-importers)

Name of Client License No. Quantity Date of Distribution

Not Applicable NONE

Total Quantity Distributed

For non-importer users:

Name of Distributor Quantity Date of Purchase

Not Applicable

Total Quantity Purchased from Distributor

For producers

Module 2A: RA 6969 (CCO Report) page ___ of 12

Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

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

Not Applicable

Total Quantity Sold

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

Average Daily
Total Output this Quarter
Production Output
Average Quantity Used Total Quantity Used this
per month Quarter
Describe any changes in Production/Process/Operations:

NONE

Stock Inventory/Waste Chemical Generated:

Average Quantity of Total Quantity of Waste
Waste Chemical Not Applicable Chemical Generated this
Generated per month Quarter
Quantity of Stock Quantity of Stock
Inventory (Start of Inventory (End of
Quarter) Quarter)

Other Information:
Manner of handling  storage on-site  Treatment on-site
hazardous wastes  storage off-site  Treatment off-site

Changes in Safety  Yes (please attach copy of revised plan)

Management System  No

Chemical Substitute  Yes (please attach copy if not submitted/included in previous report/s or had been revised)
Plan  No

B. Hazardous Wastes Generator

Module 2A: RA 6969 (CCO Report) page ___ of 12

Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

HW Generation:
Remaining HW from
HW HW Generated
HW No. HW Class HW Nature Previous Report
Cataloguing
Quantity Unit Quantity Unit

N/A

Waste Storage, Treatment and Disposal:(Please fill-up one table per HW)
HW No,: NOT APPLICABLE
HW Details Qty of HW Treated: Unit: ___
TSD Location: ___

Name: ___
Storage
Method: ___

ID: Name: ___

Transporter
Date: ___

ID: Name: ___

Treater
Method: Date: ___

ID: Name: ___

Disposal
Date: Date: ___

HW No,: NOT APPLICABLE

HW Details Qty of HW Treated: Unit: ___
TSD Location: ___

Name: ___
Storage
Method: ___

ID: Name: ___

Transporter
Date: ___

ID: Name: ___

Treater
Method: Date: ___

ID: Name: ___

Disposal
Date: Date: ___

Module 2A: RA 6969 (CCO Report) page ___ of 12

Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

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

Water Pollution Data

Domestic wastewater Process wastewater
1-2
(cubic meters/day) (cubic meters/day)
Cooling water Others: ___________
(cubic meters/day) (cubic meters/day)
Wash water, equipment Wash water, floor
.12
(m3/day) (cubic meters/day)

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

Month 1 Month 2 Month 3
Person employed, (# of
Not Applicable
employees)
Person employed, (cost)
Cost of Chemicals used
by WTP
Utility Costs of WTP
(electricity & water)
Administrative and
Overhead Costs
Cost of operating in-
house laboratory

New/Additional
Investments in WTP
(Description)

Cost of New/Add
Investments

WTP Discharge Location

Outlet
Location of the Outlet Name of Receiving Water Body
Number

Septic Tank Cagayan River

Module 5: P.D. 1586 (EIS System) page ____ of ____

Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

Detailed Report of Wastewater Characteristics for Conventional Pollutants

Outlet No.

Effluent Oil & ________

BOD TSS Temp rise (name)
DATE Flow Rate Color pH Grease
(mg/L) (mg/L) (ºC)
(m3/day) (mg/L)
(unit)

N/A

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

Module 5: P.D. 1586 (EIS System) page ____ of ____

Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

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

Summary of APSE/APCF
Process Equipment Location # of hrs of operations
1. NONE
2.
3.
4.
Fuel Burning Quantity # of hrs of
Location Fuel Used
Equipment Consumed operations
1. NONE
2.
3.
4.
5.
6.
Pollution Control Facility Location # of hrs of operations
1.
2.
3.
4.

Cost of Treatment
Month 1 Month 2 Month 3
Cost of Person employed,
NOT APPLICABLE
(salary)
Total Consumption of
Water (cubic meters)
Total Cost of chemicals
used (e.g., activated
carbon, KMnO4)
Total Consumption of
Electricity (KwH)
Administrative and
Overhead Costs
Cost of operating in-
house laboratory, if any

Improvement or
modification, if any.
(Description)

Cost of improvement of
modification

Module 5: P.D. 1586 (EIS System) page ____ of ____

Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

MODULE 5: P.D. 1586

Ambient Air Quality Monitoring (if required as part of ECC conditions)
Description/Location
of Monitoring
Station
Noise ________ ________ ________ ________
CO NOx Particulates (name) (name) (name) (name)
DATE Level
(mg/Ncm) (mg/Ncm) (mg/Ncm)
(dB) (mg/Ncm) (mg/Ncm) (mg/Ncm) (mg/Ncm)

N/A

(Please accomplish one table per monitoring station.)

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

Description/Location
of Sampling Station
________ ________ ________ ________ ________ ________ ________ ________
(name) (name) (name) (name) (name) (name) (name) (name)
DATE
(unit) (unit) (unit) (unit) (unit) (unit) (unit) (unit)

N/A

(Please accomplish one table per sampling station.)

Module 5: P.D. 1586 (EIS System) page ____ of ____

Name of Plant:

RSCalagui Real Estate Property Leasing

Reference No:

Other ECC Conditions

Status of Compliance
ECC Condition/s Actions Taken
Yes No

1. NOT APPLICABLE
2.
3.
4.
5.
6.
Please use additional sheet/s if necessary.

Environmental Management Plan/Program

Status of
Enhancement/Mitigation Measures Implementation Actions Taken
Yes No

1.NOT APPLICABLE
2.
3.
4.
5.
6.
Please use additional sheet/s if necessary.

Solid Waste Characterization/Information:

Average Quantity of Total Quantity of Solid
Solid Wastes Generated 20 kgs. Wastes Generated this 60 kgs.
per month Quarter
Average Quantity of Total Quantity of Solid
Solid Wastes Collected 15 kgs. Wastes Collected this 45 kgs.
per month Quarter
Entity in charge of
Tuguegarao City Govt’s Garbage and Solid Waste Collection Facility
collecting solid wastes

Brief Description of
Practice Waste Reduction, Segregation and Recycling
Solid Waste
Management Plan (e.g.,
waste reduction,
segregation, recycling)

Module 5: P.D. 1586 (EIS System) page ____ of ____