Department of Environment and Natural Resources

Environmental Management Bureau

Reference No:

(to be filled up by DENR only)

GENERAL INFORMATION SHEET

Name of the
AG FOODS CORP
Establishment/Facility

Establishment/Facility Street # & Street Name: N/A ___

Address Barangay: Sta. Ana City/Municipality: Tagoloan___
(NOT the company of head
office) Province: Misamis Oriental
Name of
AG FOODS CORP
Owner/Company
Street # & Street Name: N/A ___
Address
(if address is not the same Barangay: Sta. Ana City/Municipality: Tagoloan___
as previous address)
Province: Misamis Oriental

Phone Number N/A Fax Number N/A

e-mail address N/A

Type of Business/ Philippine Standard Industry Classification Code No. 1079 ___
Industry Philippine Standard Industry Descriptor: Manufacture of other food
Classification products__

CEO/President. Arturo F. Gonzales ___

Tel #: N/A Fax #: N/A ___

Responsible e-mail address: N/A ___

Officer/s: Plant Manager: Jomar R. Santos ___
Tel #: N/A Fax #: N/A ___
e-mail address: N/A ___

Name. Engr. Joel T. Garcia ___

Pollution Control
Tel #: N/A Fax #: N/A ___
Officer
e-mail address: N/A ___

 single proprietorship  partnership

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

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

ARTURO F. GONZALES ENGR. JOEL T. GARCIA

Name/Signature of CEO/President Name/Signature of PCO
Name of Plant:
Reference No:

Department of Environment and Natural Resources

Environmental Management Bureau

QUARTERLY SELF-MONITORING REPORT

MODULE 1: GENERAL INFORMATION

Name of the Plant AG FOODS CORP
Please provide the necessary revised, corrected or updated information not contained in your
General Information Sheet

AG FOODS CORP employs some 80 personnel assigned in different areas inside his plant. His 3-
hectare compound which includes a 1,500 warehouse. The corporation also has its own fleet of
delivery trucks and maintains a motor pool and machine shop.

(use additional sheet/s if necessary)

DENR Permits/Licenses/Clearances
Environmental
Permits Date of Issue Expiry Date
Laws
A/C No.
P.D. 984
PO No. POW-1114-0774 Aug 15. 2019 Aug. 30, 2020
ECC 1 ECC-R10-1014-0557 Feb. 10, 2019
PD 1586 ECC 2
ECC 3
DENR
Registry ID
CCO Registry CCO-2019-0440 Aug. 22, 2019
RA 6969 Importer
Clearance No
Permit to
Transport
GR-R10-43-00006 Aug. 6, 2019
A/C No.
RA 8749 2019-POA-4560-3338 May 30, 2019 May 30, 2020
PO No.
2019-POA-5220-1178 Aug. 17, 2019 Aug. 30, 2019
DAO 2014-02 PCO No.

Operation
Operating hours/day Operating days/week # of shift/day
Average 16 4 2
Maximum 24 3 2

Module 1: General Information page ____ of ____

Name of Plant:
Reference No:

Operation/Production/Capacity:
Average Daily Total Output this
10.23 tons 941.16 tons
Production Output Quarter
Total Water Total Electric
Consumption this 243,530.60 Consumption this 4,750,689.20
Quarter (cubic meters) Quarter (KwH)
Please use additional sheet/s if necessary

Module 1: General Information page ____ of ____

Name of Plant:
Reference No:

MODULE 2: RA 6969

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

Common Name/IUPAC/CAS Index Name. Mercury (II) Sulfate ___

CAS No.: 888-77-7 ___
Trade Name: Mercury Sulfate ___

For importers only:n/a

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

Total Quantity Total Quantity

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

For distributors (importers/non-importers) n/a

Name of Client License No. Quantity Date of Distribution

Total Quantity Distributed

For non-importer users:

Name of Distributor Quantity Date of Purchase
YANA CHEMODITIES 3 BOTTLES/100GMS

Total Quantity Purchased from Distributor

For producers N/A

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

Name of Plant:
Reference No:

Average Daily Total Output this

Production Output Quarter
Quantity of Stock 300 grams Quantity of Stock 100 grams
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) N/A
Average Daily Total Output this
Production Output Quarter
Average Quantity Used Total Quantity Used
per month this Quarter
Describe any changes in Production/Process/Operations:

Stock Inventory/Waste Chemical Generated: N/A

Average Quantity of 10ml Total Quantity of Waste 3.50 liters
Waste Chemical Chemical Generated
Generated per month this Quarter
Quantity of Stock 0 Quantity of Stock
Inventory (Start of Inventory (End of
Quarter) Quarter)

Other Information:
Manner of handling ̷X 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 X No

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

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

Name of Plant:
Reference No:

B. Hazardous Wastes Treater/Recyler

HW Stored and/or Untreated as of End of Quarter: N/A

Type of
Transport Storage Time Table
HW Wastes Date of
Permit/Date Valid until Quantity Container/ for
Number Generator Transport
of Issue # of Treatment
containers

HW Treated and/or Recycled as of End of Quarter: N/A

Type of Type &
Transport Treatment Quantity of
Type of HW Wastes Date of
Permit/Date Quantity or Recycled
Wastes Number Generator Transport
of Issue Recycling or Treated
Process Product

Residual Wastes Generated from the Treatment and/or Recycling Operation:N/A

Type of
Process by
Storage
Type of which the Disposal Time Table
HW Number Quantity Container/
Wastes Wastes is Option for Disposal
# of
Generated
containers

Module 2B: RA 6969 (Hazardous Wastes Treater/Recycler) page ____ of ____

Name of Plant:
Reference No:

C. Hazardous Wastes Generator

HW Generation:
Remaining HW from
HW HW HW Generated
HW No. HW Class Previous Report
Nature Cataloguing
Quantity Unit Quantity Unit
B201 Sulfuric Acid Toxic
B202 Hydrocholoric Toxic
Acid
B204 Acid Wastes Toxic
C301 Alkali Wastes Toxic 2713.78 cu.m./day
D406 Lead acid Toxic 71 pcs
batteries
D407 Busted Solid Toxic 196 pcs
Lamps
I101 Used oil Liquid Toxic, 2,450 liters
flammable

Waste Storage, Treatment and Disposal:(Please fill-up one table per HW)
HW No,: B208 & C301 ___
HW Details Qty of HW Treated: 2,713.78 Unit: cu.m/day__
TSD Location: on-site ___

Name: ___
Storage
Method: ___

ID: Name: ___

Transporter
Date: ___

ID: Name: ___

Treater
Method: Date: ___

ID: Name: ___

Disposal
Date: Date: ___

HW No,: I 101 ___

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

Name: materials warehouse- hazardwaste section

Storage ___
Method: stockpile / scrap ___

ID: Name: ___

Transporter
Date: ___

Module 2C: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:
Reference No:

ID: Name: ___

Treater
Method: Date: ___

ID: Name: ___

Disposal
Date: Date: ___

On-Site Self Inspection of Storage Area:

Premises/Area Findings & Corrective Action
Date Conducted
Inspected Observations Taken (if any)
daily Normal operation Monitoring/ inventory

Module 2C: RA 6969 (Hazardous Wastes Generator) page ____ of ____

Name of Plant:
Reference No:

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

Water Pollution Data

Domestic wastewater Process wastewater
128.6 473.36
(cubic meters/day) (cubic meters/day)
Cooling water Others: ___________
381.11
(cubic meters/day) (cubic meters/day)
Wash water, Wash water, floor
1272 172.35
equipment (m3/day) (cubic meters/day)

Record of Cost of Treatment n/a

Month 1 Month 2 Month 3

New/Additional
Investments in WTP
(Description)

Cost of New/Add
Investments
Person employed, (# of
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

WTP Discharge Location n/a

Outlet
Location of the Outlet Name of Receiving Water Body
Number
1
2
3
4
5

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:
Reference No:

Detailed Report of Wastewater Characteristics for Conventional Pollutants

Outlet No.
Effluent ___DO___
Oil &
Flow BOD TSS Temp rise (name)
DATE Color pH Grease
Rate (mg/L) (mg/L) (ºC)
(mg/L)
(m3/day) (unit)

8/3/19 1814 7 20 7.59 -2 7.0

8/5/19 1335 7 20 7.76 -3 7.8
8/7/19 2431 5 35 8.31 -0.5 5.4
9/5/19 2144 3 20 7.91 0.0022 -1 6.2
9/6/19 3418 8 25 8.04 -1 5.7

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

Detailed Report of Wastewater Characteristics for Other Pollutants

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:
Reference No:

Outlet No.

Effluent _COD_ ________ ________ ________ ________ ________ ________

(name) (name) (name) (name) (name) (name) (name)
DATE Flow Rate
(m3/day)
(unit) (unit) (unit) (unit) (unit) (unit) (unit)

8/3/19 1814 37
8/5/19 1335 103
8/7/19 2431 85
9/5/19 2144 46
9/6/19 3418 16

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

Please use additional sheet/s if necessary.

Module 3: P.D. 984 (Water Pollution) page ____ of ____

Name of Plant:
Reference No:

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

Summary of APSE/APCF
# of hrs of
Process Equipment Location
operations
1.
2.
3.
4.
Quantity # of hrs of
Fuel Burning Equipment Location Fuel Used
Consumed operations
1. Fired boiler Coal 1,494,884 kgs 1,852
2. Generator Sets Diesel 8,290 liters 44.57
3.
4.
5.
6.
# of hrs of
Pollution Control Facility Location
operations
1.
2.
3.
4.

Cost of Treatment
Month 1 Month 2 Month 3

Improvement or
modification, if any.
(Description)

Cost of improvement of
modification
Cost of Person
employed, (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

Module 4: RA 8749 (Air Pollution) page ____ of ____

Name of Plant:
Reference No:

Detailed Report of Air Emission Characteristics

Description/Location
of PCF
_______ _______
________ ________
Flow Rate CO NOx Particulates (name) _ _ (name)
DATE (name) (name)
(Ncm/day) (mg/Ncm) (mg/Ncm) (mg/Ncm)
(mg/Ncm) (mg/Ncm)
(mg/Ncm) (mg/Ncm)

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

Please use additional sheet/s if necessary.

Module 4: RA 8749 (Air Pollution) page ____ of ____

Name of Plant:
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)
DATE (name) (name)
Level (dB) (mg/Ncm) (mg/Ncm) (mg/Ncm)
(mg/Ncm) (mg/Ncm)
(mg/Ncm) (mg/Ncm)

(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)

(Please accomplish one table per sampling station.)

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

Name of Plant:
Reference No:

Other ECC Conditions

Status of Compliance
ECC Condition/s Actions Taken
Yes No

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Please use additional sheet/s if necessary.

Environmental Management Plan/Program

Status of
Enhancement/Mitigation Measures Implementation Actions Taken
Yes No

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Please use additional sheet/s if necessary.

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

 Procedural and Reference Manual for DAO 2003-27

MODULE 6: OTHERS

Accidents & Emergency Records

Findings and
Date Area/Location Actions Taken Remarks
Observation

Personnel/Staff Training
# of Personnel
Date Conducted Course/Training Description
Trained

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

Done this 6th of May, 2020, in Misamis Oriental.

Engr. Joel T. Garcia

Name/Signature of PCO
Arturo F. Gonzales
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

_____________________ _____________ _______________ ______________
_____________________ _____________ _______________ ______________

Preparation and Submission of SMR 16