SKETCH MAP OF ESTABLISHMENT

REPUBLIC OF THE PHILIPPINES

CITY OF CEBU
CEBU CITY ENVIRONMENT AND NATURAL RESOURCES OFFICE

ENVIRONMENTAL SUSTAINABILITY ACTION PLAN

DATE OF APPLICATION: _______________

BARANGAY: TYPE OF APPLICATION: PERMIT NO.:

NEW

NORTH SOUTH RENEWAL OFFICIAL RECEIPT NO.:

__________________________

BUSINESS NAME: ________________________________________ CELL NO. __________________

BUSINESS ADDRESS: ______________________________________
_______________________________________________________ NO. OF EMPLOYEES: _________
OWNER’S NAME: ________________________________________
OPERATING HOURS: _________

TYPE OF BUSINESS:

MANUFACTURING _____________________________ SERVICE _______________________________

TRADING (RETAIL/WHOLESALE)___________________ SPECIAL _______________________________

I. MANDATORY COMPLIANCE: FIELD INSPECTOR FINDINGS/

REMARKS
1. NO SMOKING SIGNAGE (C.O. NO. 2241, SEC. 11.9)
2. WASTE SEGREGATION (C.O. NO. 2031)
3. NO PLASTIC ON WEDNESDAY, FRIDAY, AND SATURDAY (C.O. 2343)
4. PROVIDE WASTE RECEPTACLE OUTSIDE OF PLACE OF BUSINESS (C.O. NO. 1361)
5. USE OF LIGHT EMITTING DIODE (LED) LIGHTS (C.O. NO. 2243)
6. OTHERS: __________________________ _______________________________

II. CORPORATE SOCIAL RESPONSIBILITY: III. HAZARDOUS WASTE GENERATION

YES NO N/A YES NO N/A

TREE PLANTING WASTE WATER TREATMENT
COASTAL CLEANUP MATERIAL RECOVERY FACILITY
ADOPT-A-RIVER PROGRAM

PERMITS/CLEARANCES/CERTIFICATIONS PRESENTED:
DISCHARGE PERMIT ENVIRONMENTAL SANITATON CLEARANCE
ECC/CNC SANITARY PERMIT
SPECIAL HAULING PERMIT OTHERS ___________________________________
CONTRACT WITH PRIVATE HAULERS OF INFECTIOUS WASTE

I hereby certify that the information provided above are true and correct to the best of my knowledge. I further certify that
our business establishment is compliant with all environmental standards, rules, regulations and policies of the Local Government
Unit of Cebu City. I agree that any person, business, corporation who willfully certifies an incomplete, inaccurate, false or
misleading statement shall not be issued a Certificate of Compliance.

_________________________________________
BUSINESS OWNER/AUTHORIZED REPRESENTATIVE

SUBSCRIBED AND SWORN TO before me this ____ day of ______________, 20___, at __________________,
With affiants showing to me his Community Tax Certificate and valid I.D. with picture and signature as competent evidence of
identity under the 2004 RULES OF NOTARIAL SERVICE.

Doc. No. _______

Page No. ______
Book No. ______
Series of: ______