Republic of the Philippines

Department of Environment and Natural Resources

MINES AND GEOSCIENCES BUREAU
Regional Office No. IV (CALABARZON)
th
8 Floor, DENR by the Bay, 1515 Roxas Blvd., Ermita, Manila, Philippines

ANNUAL LAND USE REPORT (CY ___)

1. BACKGROUND INFORMATION

Mining Tenement :
Tenement Holder :
Authorized Operator,
if any :
Date of Approved: :
Commodity :
Tenement Area :
Location :
Period Covered :

2. STATUS OF MINING OPERATIONS

Briefly discuss the following:

(a) Status of mining operations and/or other facilities, which has significant impact
within the specific mining tenement.
(b) The use of areas outside the mining tenement, if any

3. TABLE SHOWING THE UPDATED LAND USE WITHIN THE APPROVED

TENEMENT

Area
covered in Technical
Particular/s Brief Description/s
hectares Description
(has.)
A. Total Land Disturbed
B. Area per Classification:
1. Active Mining Areas
2. Ancillary Facilities
2.1. Mine
Camp/Facilities
(Vertical
Structures)
2.2. Others (if any)
3. Stockyards/ Stockpile
Area
3.1. Ore Stockyards
3.2. Waste
Stockyards
3.3. Topsoil
Stockyards
4. Environmental
Structures
 4.1. Silt Pond
4.2. Tailings Pond
4.3. Nursery
4.4. Buffer Zone
areas
4.5. Others, if any
5. Causeways
6. Pier yards
7. Mineral Processing
plant (if applicable)
8. Road Networks (e.g.
Access and Hauling
Roads)
9. Exploration Area (if
applicable)
10. Idle/Unused areas
C. Mined-out Areas
D. Rehabilitated Areas
(under Progressive
Rehabilitation)
E. Areas under temporary
Rehabilitation/re-
vegetation
F. Others (Please specify)

4. PROVIDE LOCATION MAP SHOWING EACH OF THE DISCUSSED LAND USE

PER CLASSIFICATION

(Use a scale of 1:20,000 and paper size of A2 or 42mm x 59.4 mm)

5. SIGN AND SEAL OF THE PREPARER

Must show the Signature of the Person who prepared the Report, specify PRC
License Number and the PTR Number, and duly conform by the highest official of the
mine site.

Attachments:

1. Photos/Maps/Mine Plan or Layout

 SUBSCRIBED AND SWORN to before me at the place aforesaid, on this
__________ day of ____________________, 20___. The affiant exhibited to me his/her
Community Tax Certificate No. ____________ issued in _____________________ on the
_________ day of _______________, 20__.

___________________________
NOTARY PUBLIC

Doc. No. _______

Page No. _______
Book No. _______
Series of _______