Department of Environment and Natural Resources Environmental Management Bureau LEGEN' ALL CAPS BOLD TEXT - Notes Ialcizod toxt- Example Reference No: (tobe filed up by DENR only) GENERAL INFORMATION SHEET Name of the Establishment/Facilily ‘Sugbo Corporation Address Establishment/Facility (NOT the company of Street # & Street Name: Kaoshiung St. Barangay: North Reclamation Area City/Municipality: Mandaue City address) head office) Province: Cebu Name of “Sugbo Corporat Owner!Company jugbo Corporation Address Street # & Street Name: Kaoshiung St (address is not the same as previous Barangay: North Reclamation Area City/Municipality: Mandaue City Provinee: Cebu Phone Number (032) 234-5678 Fax Number (032) 245-6789 e-mail address. DOWNLOAD THE PHILIPPINE STANDARD INDUSTRIAL [email protected] CLASSIFICATION EBOOK BY NCA FOR THIS SECTION Industry Classification Type of Business! Philippine Standard Industry Classification Code No. 31010 Philippine Standard Industry Descriptor: Manufacture of Wood Furniture Responsible Officerls: CEO/President. Juan de la Cruz Tel #: (032) 333-4444 Fax#: (032) 333-4444 e-mail address: [email protected] THIS SHALL BE THE MANAGING HEAD TO SIGN THE AFFIDAVIT OF Plant Manager: Jose Santiago <——— JOINT UNDERTAKING WITH PCO Tel #: (032) 245-6789 Fax #: (032) 245-6789 email address: [[email protected] Pollution Control Name, Meg Modequillo Tel #: (032) 333-8888 Fax #: (032) 333-8888 Officer e-mailaddress: [email protected] © single proprietorship partnership Legal Classication | © private domestic corporation © government corporation 1 Multinational a We hereby certty thatthe above information are true and correct. ACCREDITATION MANAGING HEAD IF CEO! PRES CANNOT SIGN NO. HERE (Mee MopEquuLo— Name/Signaturé of CEO/President ‘Name/Signature of PCOProcedural and Reference Manual for DAO 2003-27 Department of Environment and Natural Resources Environmental Management Bureau 2016 1** QUARTER SELF-MONITORING REPORT MODULE 1: GENERAL INFORMATION Name ofthe Plant | SUGBO CORPORATION YOU CAN PROVIDE ALL DETAILS NOT MENTIONED IN THE REST OF THE SMR IN THIS SECTION (INCLUDING INFORMATION ON WTFIAPCD BREAKDOWNS, UPDATES ON STATUS OF EXPIRED PERMITS, ETC.) ‘Sugbo Corporation was established in January 1990 with a land area of 10,267 m? 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 Environment Permits Dateoftesue | Expiry Date AIC No, NA N/A NA P.988 SONS RA 9275 DISCHARGE DP/12/074623-001 10/20/2012 11/20/2015 PERMIT NO. PO 1585 ECC CNECER-T009-07-20-"20 | _ieno1e | _WA DENR Registy iD ©, R-19-76-0048 NA NA GENERATOR'S 0 RA 6969 CCO Registry N/A N/A NA importer Clearance No NA NA NA Permit to Femi NA NA NA AIC No WA WA WA RAaTED PO No. poararoreeson | rorozor | 11202015 NNO FIELD IN THE TABLE ABOVE SHOULD BE LEFT BLANK. PUT “NIA” IF NOT APPLICABLE Operation Operating hoursiday | Operating daysiveek # of shifiday 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/lUPACICAS Index Name. CAS No: Trade Name: For importers only: Quanity | giMPO T Dateot | Guanity | Porot | Countryof | County of Requested a Arival | Received’ | — Entry Origin | Manufacture Total Quantity Total Quantity Requested (annual) Received (annual) * attach copyis of BIT of Lading For distributors (importers/non- importers) Name of Client License No. Quantity Date of Distribution Total Quantity Distributed 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 Guaniily 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: Manner ot handing | 7 storage on-site Cl Treatment on-site hazardous wastes | 1 storage off-site 1 Treatment off-site Ye Changes in Safety _ | 2 Y@s (Please attach copy of revised plan) Management System | 1. y, 1 Yes (please attach copy if not submittedincluded in previous reports or Chemical Substitute | had been revised) Plan 0 No B. Hazardous Wastes Generator opuLE 2.8 IS TO BE ACCOMPLISHED BY ALL GENERATORS OF HAZARDOUS WASTE (BASICALLY EVERYONE) HW Generation: Remaining HW from Previous Report bw Hw | Hw | HWGENERATED From | (_¢iWVGonerated HW) wetass | Natur | Cataloguin | "PREVIOUS aUARTER His au * go" | smut sToReD IN YOUR PLANT Quanity | Unit | Quantiy [Uni So | Empty paint 0 pos % pes 20) containers (s | sola | Toxic | (0) | fons) | (0.03) | tons) gallons siz J20 | Empty paint thinner 10 pes 20 pcs, 1 drums Solid Toxic (0.0001) (tons) (0.0002) (tons) ‘Contaminated rags Toxic, 50 pes. 50 pcs, nog] “Guth ot) | sora | Flammabs | (0.008) | dons) | (0.005) | (ons) ° Foq | Dred pantrostaval Tox | 7 7 3 % 7. | fromwater curtain | Solid | Flammabl | (0.011) (tons) (0.009) (tons) ° Dad} —BusteaTaMPS | Song | Tome | pe 3 Pes z (0.05) (tons) (0.05) (tons) FeO} Paint age fom | Side | pox 3 rg 5 9 1 WIF e (0.003) (tons) (0.015) (tons) Had} Grease] Sudg | 7a, | 80 1g 0 G 2 e (0.06) (tons) (0.06) (tons) UseroT Tox —|— 25 —|~lers J — 25 | — ers 1101 Liquid | Flammab! | (0.02) (tons) (0.02) (tons) ° Preparation and Submission of SMR 4Procedural and Reference Manual for DAO 2003-27 Waste Storage, Treatment and Disposal:(Please fil-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 Details HW No,: J201 (Empty Containers} Qty of HW Treated: 0.03 Unit: fons TSD Location: off-site Storage WHO AND HOW HW IS STORED FOR THIS QUARTER Name: Sugbo Corporation (HW storage shed) Method: collected in metal pail Transporter WHO TRANSPORTED ‘THE HW FROM YOUR FACILITY, ID: 93-14-0003 Name: Inchem Environmental inc Date: January 18, 2016 Treat aren vour | !O: 03:14:005 Name: Inchem Environmental nc HW FOR THIS Method: Physico-chemical treatment Date: 2/01/2016 QUARTER Disposal WHO DISPOSED THE ID: 93-14-07 Name: Inchem Environmental inc. TREATEDHWFOR | Method Date: THIS QUARTER —_— HWNo,: 201 (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 ret ID: 03-14-05 Name: Inchem Environmental inc. ‘eater Method: BLANK ENTRY MEANS NOT YET TREATED Date ID: 03-14-07 Name: Inchem Environmental inc. Disposal Method: BLANK ENTRY MEANS NOT YET Date On-Site Self Inspection of Storage Area: Date Conducted Premises/Area Fingings & Corrective Aation Inspected Observations Taken (itany) No adverse findings | | Arrange schedule with 1/15/2016 HW storage area aside from build-up of oe ntractor wastes oanore Tw slorage area Used lead-acid | Arrange schedule with batteries accumulating contractor ‘One of the steel drums 34/2016 HW storage area | used to store used oi! | Container replaced has leak MODULE 2.¢ 1S 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 ©. Hazardous Wastes TrestermRecycler HW Stored and/or Untreated as of End of Quarter: Typeor sw Transport Storege | _ time Numbo | Wastes | Bate ot | Bormivoat | Vaid unt | quantity | Container | Tato for r pe e of Issue Hof Treatment aE OF company wien GENERATED HW TOBE TREATED HW Treatod andlor Recyciod as of End of Quarter: Type of ae typeot | Hw | wastes | Date ot | Jansport Treatment | OMGf Wastes Number | Generator | Transport ‘ermit/Dat | Quantity or Recycled otlssue Recyeing | Reeveled Process Product Residual Wastes Generated from the Treatment and/or Recycling Operation: rcs pee Type of which te Dispos! | Time Table Wastes | Number] Wostosis | Gvantty | Container | OPton! | srplpose 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 waslewater (cubic metersida 2.61 (cubic metersiday) 0.1 (recycled) Cooling water Others: (cubic metersida WA (cubic matersiday) WA Wash water, WA Wash water, floor WA ‘equipment (m*/day (cubic metersiday) Record of Cost of Treatment (Separate entries for separate facilities) Month 1 Month 2 Month 3. Person employed, (F of employees) 6 5 6 Person employed, (cost) P 115,000 P 115,000 P115,000 Cost of Chemicals costo ee Incorporated with the contractors/third party feos Utility Costs of WTP (clectricity & water) P 12,200 P 12,200 P 12,200 ‘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- house laboratory Incorporated with the contractors/third party fees New/Additional Investments in WTP none none none (Description) Cost of New/Add Investments P.45,000 none none WTP Discharge Location PLANT'S RECEIVING WATERBODY IS FOUND IN THE DISCHARGE PERMIT poate Location of the Outlet Name of Receiving Water Body 1 Bohind plant parking lot Mactan Channel (Glass SO) 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 pare | Few | BOD | TSS | cor | ph | croaso | iso | (me) Rate (mgt) | (mgiL) el (mgt) ce) mg (m*day) ‘3 (unit wee | 36 14 24 82 1 2 atsi6 [36 20 13 69 <1.0 3 areté [3.8 21 67 70 2 1 Please fill-uplaccomplish separate formls for other outlets. Detailed Report of Wastewater Characteristics for Other Pollutants Oullet No. 1 ettuent | 200 Flow. | (name) | j= zs a i i pare | om | (name) | (name) | (name) | (name) | (nme) | (name | (name) (miday) | (ent) | Fan | Ten | Toni | Toni | To | to 1616 | 3.5 90 2616 | 36 80 wnsi6 | 38 92 Please fil-uplaccomplish separate formis for other outlets. Please use additional sheet/s if necessary. 7 Preparation and Submission of SMRProcedural and Reference Manual for DAO 2003-27 MODULE 4: R.A. 8749 (Air Pollution) Summary of APSEIAPCE __cyuMEqATe THE APSES/APCEs LISTED IN YOUR PERMIT 10 OPERATE Process Equipment Location # of hrs of operations au (FOR THIS QTR) Two (2) units 5 KW Band Saw Production area 71440 Two (2) units 5.5 KW Panel Saw Production area 1440 Two (2) units 5 kW Planer Production area 1,440 One (7) unit 4 RW Boll Sander Production area 1440 Two (2) units 1 KW Jigsaw Machine Production area 1440 Tho ants TRW Malle Boing Produclon ara aa ‘One (1) unit 25 KW Carving Machine Production area 1,440 ‘One (1) unit 3 RW Edge Banding Machine Production area 1,440 One (1) unt 2.5 kW Edge Sander Production area 1440 ‘One (1) unit kW Edge Trimmer voduction are One (1) 4 Production area 1440 Four (4) units Spray Gun Production area 1440 Quantity # of hrs of Fuel Burning Equipment | Location | FuelUsed | — Consumed operations (FOR THIS GTR) | (FOR THIS QTR) One (1) unit 626 kVA Powerhouse | Diese! 1,500 L 12.4 Cummins" Generator Set # of hs of operations Pollution Control Facility Location oftas of operator ‘One (1) units Critical Muffier with jon insulation and aluminum/cladding Production area 1,440 Five (uns 4 HP pole Bag Fouluchon awe Tam ‘One (1) ani contalzed dust colector system ( size: 2.5m x 2.5mx 4m) consisting of two lines ducting system Production area 1,440 equipped with 22 HP suction fan in each fine Two (2) uns spray booth equipped with water curtain and exhaust fan Production area 1,440 Cost of Treatment Month 1 Month 2 Month 3 Cost of Person 7 7 7 employed, (salary) Total Consumption of Water (cubic meters) 20 20 20 Total Cost of chemicals used (@.g., activated NA NA N/A carbon, Kin.) Total Consumption of Tal Consume 13,000 13,000 13,000 ‘Administrative and Administrative ar 20,000.00 20,000.00 20,000.00 Cost of operating in- WA WA WA Preparation and Submission of SMR 8Procedural and Reference Manual for DAO 2003-27 house laboratory, irany Improvement or Regular Cleaning of modification, if any None None (Description) ‘smoke stacks Gost of improvement of modification NA NA NA 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. DescHaTAT smoke Stack of One (1) unt 626 KVA "Cummins” Generator Set located in cece Powerhouse SOs —__ Roe co NOx | Particulat | (name) | (name) | (name) | “(name DATE | ysevda | (maiNe | (mgNe | es | ™ m) | (mg/cm) | (mgiNc | (mgiNc | (mgiNe | (mg/Ne m m) m) m) was | 30 = 400 50 150 Ambient Air Quality Monit. Please fill-up/accomplish separate formls for other PCFIs. Please use additional sheet/s if necessary. MODULE 5: PD, 1586 THIS MODULE IS TO BE ACCOMPLISHED BY ECC HOLDERS ing (if required as part of ECC conditions) Description/Location of Monitoring Station co | No: | Partculat | = = = = pare 08, | name | enanic | “ae | tosve) | (rane) | (se) | ene) ™ m) | (maNem) | Gmginc | (mgiNc | (mgiNc | (mgiNe 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) (nae) (name) | (name) (uni (unit) |" (unit) (unit) (unit) (unity unit) | (unit (Please accomplish one table par sampling station.) Preparation and Submission of SMRProcedural and Reference Manual for DAO 2003-27 Other ECC Conditions ‘Status of Compliance ECC Condition/s Actions Taken Yes No 7 2 3, Please use additional sheet/s if necessary. Environmental Management Plan/Program ‘Status of Enhancement/Mitigation Measures Implementation Actions Taken Yes No 7 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 ‘erage Quanta ta Gusnty of Ses Sot Hastes Recylbles- 3009 | Waaten Gonealeaina | Roeebes 600 kg Generated per month vesidual g Quarter si 9 frerage Quay o etal ety of Sea Solid Wastes Collected | Residual - 300 kg Wastes Collected this Residual - 900 kg pormanth uate Enfity in charge oF collecting solid wastes Brief Description of Solid Waste Management Plan (e.g., waste reduction, segregation, recycling) Mandaue City Waste Management 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 Dato | ArealLocation | aM9SANG | Actions Taken | Remarks Clean-up and vaozore | Seneratorset | Spi ofstored | instalment of area used of secondary containment Personnel/Staf Training (91 ATED 10 THE ENVIRONMENT) Date Conducted CourseTraining Description | ~#ofPersonnel Fabriany 15-19, 2076 ‘Whours PCO Training 2 [ February 20, 2016 [PCO Training for Managing Heads | 7 1 hereby certify that the above information are true and correct. Done this 4” day of April, 2016, in Cobu City. PUT_YOUR co ‘ACCREDITATION NO. HERE 5 4 oinee monequiio— Seba Wo. 015-807-1234 Name/Signature of PCO MANAGING HEAD IF CEO PRES CANNOT SIGN JUAN/DE LA GRUZ ‘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 Cily May 5, 2014 Preparation and Submission of SMR 4