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Road Clearing Form Short

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Annex “A”

Monthly Cumulative Monitoring Report on Road Clearing Operations


Pursuant to PRRD’s Directive and DILG Memorandum Circular No. 2019-121 dated 29July2019 and DILG MC No. 2019-167 dated 4October 2019)

Region 1
Province of Pangasinan
City/Municipality of Bautista
Barangay Sinabaan
(for the month of March CY 2021)

Conducted Road
Clearing Operations
Location of Road Clearing Operations
[Check appropriate Date of Operation Action Taken Remarks
[Street Name/Address]
column]
YES NO
Sinabaan Barangay Road
√ (Chapel-Mangampat-Ferrer) --- --- No Road Obstructions
PNR Road Sinabaan-Pob. West
√ (Oswald Osmeña-Ong Game Farm) --- --- No Road Obstructions
Paz Street
√ (PNR-Old Cemetery) --- --- No Road Obstructions

Prepared by: Attested by:

_______________________________ _______________________________
Punong Barangay City/Municipal Mayor

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