ANNEX C.

Pro-forma Project Description for Certificate of Non-Coverage (CNC) Applications

Please Check Purpose: for CNC Application (Prior to 1982? yes/no)  for Category C Project Evaluation
PART I. FOR CNC APPLICATIONS (CATEGORY D & PROJECTS IMPLEMENTED PRIOR TO 1982) AND EVALUATION OF CATEGORY C
PROJECTS
1. Name of the Construction/Upgrading/Rehabilitation of Drainage along National Road –
Project
Secondary Road- San Fernando Port Road- K0267+-393-K0267+607
2. Project Street/Sitio/Barangay: Brgy. Madayegdeg Zone/Classification:
Location commercial/residential/ agricultural/

City/Municipality: San Fernando Province: Pangasinan Region: 1

3. Proponent Department of Public Works and Highways- Regional Office 1

Name
4. Proponent Aguila Road, Sevilla, City of San Fernando, La Union
Address
5. Contact Name: ENGR. RONNEL M. TAN, CESO IV Designation: Regional Director
Person
6. Proponent Landline No.: (072) 242-9350 Fax No.: (072) 242-9353
Means of Mobile No. E-mail: villanueva.jeslyn@dpwh.gov.ph
Contact
7. Project Type Construction of drainage canal on both sides
/
Undertaking
8. Project Size Fill up only relevant parameters.
Capacity/Others Space Allocation/Area
(i.e. MW, m3, heads) (i.e. km, ha, sq. m.) 1.0 kilometers

Quantity to be Processed Others:

(i.e. MT of raw material)
Production Rate
(i.e. MT/year)

9. Description Pre-Construction Phase:

of Project -detailed engineering survey, design and preparation of construction plans and drawing and bidding
Activities Construction Phase:
(i.e. during - Construction of Drainage
pre- Operation and Abandonment:
construction, -Turn over to the DPWH District Engineering Office for the continuous operation and maintenance
construction, -Waste management scheme
operation
and
abandonmen
t)
Prepared/Submitted by: Concurred/Approved by:

JESLYN D. VILLANUEVA RONNEL M. TAN, CESO IV

Environmental Management Specialist-II Regional Director
Signature over Printed Name Owner’s/Proponent’s Signature over Printed Name
*The only requirement for CNC Applications is to fill-up this form. No attachments are necessary. If additional space is needed for the “Description of Project
Activities”, a maximum of 1 page may be attached.
** As a general rule, DENR-EMB will process CNC Applications within the same day of receipt at the designated office.
*** Be sure to secure the computer-generated tracking code assigned to your application to be provided upon submission of this application. It will serve as an
assurance that your application has already been inputted into the DENR-EMB’s CNC Automated Processing System.