Republic of the Philippines

Department of Environment and Natural Resources ENVIRONMENTAL MANAGEMENT BUREAU REGION IV CALABARZON
6th Floor, DENR By the Bay Building, 1515 Roxas Boulevard, Ermita, Manila

APPLICATION FOR PERMIT TO OPERATE AIR POLLUTION SOURCE AND CONTROL FACILITIES
Type
( X ). ( ). ( ). ( ). New Renewal Additional Change of Ownership/Name

NAME OF FIRM/ESTABLISHMENT PLANT LOCATION/ADDRESS MAILING ADDRESS TELEPHONE & CELL NO. NATURE OF BUSINESS ENVIRONMENTAL COMPLIANCE CERTIFICATE (ECC) NUMBER AUTHORIZED CAPITAL

: : : : : : :

List of Air Pollution Source Equipment (APSE) and Corresponding Air Pollution Control Facilities (APCF) covered by Permit Application.

a. One (1) unit 300 Hp, 150 kVA, 220V, 60 Hz, 8 Cycle Isuzu Biogas-fired electric generator provided with muffler.

CERTIFIED CORRECT

__________________________
Farm Consultant Signature of Applicant

O.R. NO. : __________ O.R. NO. : __________ O.R. NO. : __________ O.R. NO. : __________

Permit Fee : __________ Filing Fee : __________ P.D. 1856 : __________ Penalty : __________

Date:__________ Date:__________ Date:__________ Date:__________

SUBSCRIBED AND SWORN to before me this day of at affiant exhibiting to me her CTC No. issued on at .

, ,

Doc. No. Page No. Book No. Series of

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