NAME OF ESTABLISHMENT: ______________________________ OWNER: ________________________

LOCATION: ___________________________________________ DATE OF INSPECTION: _____________

GENERAL INSPECTION CHECKLIST

NATURE OF BUSINESS:
Manufacturing. Specify: Product(s)________________ Volume ___________________
Wholesale/Trade. Specify: Product(s) ______________ Volume ___________________
Service. Specify: Service rendered: ________________ Product(s) _________________
WATER SUPPLY
Sources of Water Supply
Metro Lipa Water District. Volume of consumption in cubic meters/day ______________
Surface water. Volume of consumption in cubic meters/day _______________________
Deepwell. Volume of consumption in cubic meters/day ___________________________
Others, please specify _______________. Volume of consumption _____________________

DRAINAGE SYSTEM
Open canal Close/underground drainage None
POWER SUPPLY
Batelec II Generator. Specify capacity/no. _________ Others, specify___________
WASTEWATER TREATMENT/DISPOSAL SYSTEM
Sewage System
Individual septic tank Centralized septic tank
Communal septic tank Others, pls. specify ________________________
Sewage Disposal
Discharge to an existing public sewerage system
Treated in a community disposal plant or communal septic tank
Treatment in individual septic tank with disposal by absorption field or leaching pH
Others, please specify __________________________________
Is there wastewater treatment facility? If yes, please specify ____________________________________
Is there air pollution facility? If yes, please specify ____________________________________________
SOLID WASTE DISPOSAL SYSTEM
Type of Waste Volume, kg/day Mode of Collection Mode of disposal

Location of waste disposal site ___________________________________________________

PERMITTING SYSTEM
Environmental Compliance Certificate (ECC) No. ______________ Date Issued: _________________
Discharge Permit No. ___________ Date Issued: ____________________
Permit to Operate No. _________ Date Issued _____________________

Inspected by:

___________________________________ _________________________________
(Printed name above signature) Printed name above signature)
___________________________________ _________________________________
(Designation) (Designation)

Confirmation:

___________________________________
(Printed name above signature of owner/manager/caretaker)