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Republic of the Philippines

Department of Environmental and Natural Resources App No
Environmental Management Bureau 251459
Region VI

APPLICATION FOR DISCHARGE PERMIT

BOX A: General Information

Type: Renewal
Name of Owner: Joseph Francis H. Chua (djp Opc)
Jp&d Bldg., Hervias Heritage Sq., Burgos St., Villamonte, Bacolod City (Capital),
Office Address: Negros Occidental

Name of Permittee: Djp Opc TIN: 761-363-830-000

PSIC Code: 681 Year Est.: 2000
Jp&d Bldg., Hervias Heritage Sq.,
Plant Address No & Street Name: Barangay: Villamonte
Burgos St.
City or Municipality: BACOLOD CITY (Capital) Region: Region VI
Type of Industry: Real estate activities with own or leased property
Name of PCO: Joseph Francis H. Chua Accreditation Date: Sept. 15, 2015
Tel. No. & Cel. No: 09302723569 Fax No: N/A

Legal Classification Private Corp

Ownership forms Private 100.0 % Foreign 0.0 % Government 0.0 %

BOX B: Employment and Operation Information

Total employment (number of workers) in the factory: Production: 0 Non Production: 2

Production Time: No of hours/day: 8 No of days/mo: 26

No of months/year: 12 No of days with discharge/mo: 30

BOX C: Sources of Water Supply and Wasterwater Generation

Monthly Daily Estimated

Sources of Water Supply ave vol. ave vol. Generating Process Flow
(m3) (m3) (m3/day)

MWSS (please attach water bills) 0.0 0.0 Process Wastewater 0.0

Local Water District (please attach water Washing/Cleaning of Process

0.0 0.0 0.0
bills) Eqpt.

Deep Well 97.0 3.2 Cooling 0.0

Surface water (lake, river, creek, etc.) 0.0 0.0 Domestic 2.6

Others 0.0 0.0 Recycled/Reuse 0.0

Others (drinking water, gardening,

evaporation, leaks, product 0.6
components, etc.)

Total Volume of Discharge

Total Water Consumption 97.0 3.2 3.2
Wastewater

BOX D: Dwelling Units Information (hotels, condominium, restaurants, malls, etc.)

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Total Floor Area (m2): 306.0 No of Bedrooms: 19 No of Guests/year: 12

Total Area for Dining Units: 0.0 No of Restaurants/Dining Units: 0

BOX E: Product Information

Annual Annual
Product Name Production Production in the Type of Process
Capacity previous year

BOX F: Water Pollution Information

Ave. Rate of
Outlet Location and Description of the Name of the Receiving Ave. BOD, Ave. BOD
Discharge,
Number Outlet Body of Water mg/L Load, kg/day
m3/day

Outlet#1&2: 3m behind main

bldg/4m left of main bldg - septic
1 None 6.0 3.2 0.0
tank effluent discharge pipe (4"
pvc) with sample port

Total 6.0 3.2 0.0

BOX G: Flow Meter Information

Flow meter is installed at: Effluent

visual count and timing (4L

Type of flow meter and method used at (effluent side):
bucket/stopwatch) septic tank effluent pipe

BOX H: Information on the Wastewater Treatment System

Wastewater treatment system existing?: ✔ Yes No If YES, what is the capacity: 18.2m3/day

Value of capital investent in the wastewater treatment plant: Php 47000.0

Is there a primary treatment system?: ✔ Yes No Date primary system installed: Month: 11 Year: 1999

If Yes, what is the composition of the physical treatment system:

Screening Equalization Grit Removal

If others, please specify:

Oil-Water separation (Floatation) Sedimentation (Primary Setting) Anaerobic Digestion (Septic
Tanks)

Is there a chemical treatment?: Yes ✔ No Date primary system installed:

If Yes, what is the composition of the chemical treatment system:

Absorption Disinfection Flocculation/coagulation

pH Adjustment If others, specify: N/A

Is there a secondary treatment

✔ Yes No Date primary system installed: Month: 2 Year: 2021
system?:

Activated Sludge Single Batch Reaction Anaerobic Digestion Oxidation/Stabilization (Pond)

If others, specify: Aerobic

Tricking Filtration Rotating Biological Contract
Digestion (Reed Bed)
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Note: **Please use generic name. Not brand names, in metric tons of products except for the following subsectors:
hog raising (heads), carbonated drinks and beers (m3), slaughtering/preserving meat (ton LWK, electroplating (m2)).

NOTARIZED CERTIFICATION

We hereby certify that the above information and attached documents are true and correct to the best of my
knowledge. Done this _________________________ day of ________________________,
__________________.

Name and Signature of the Pollution Control Chief Executive Officer

Officer (Name, Signature and Position)

SUBSCRIBED AND SWORN to before me a Notary Public. This __________ day of ______________________,
affliant exhibiting to me his/her _________________________________________________________________,
issued at ___________________________________________________________________________________
on ______________________________________________________________.

(Notary Public)