Republic of the Philippines Republic of the Philippines

Province of Zamboanga del Norte Province of Zamboanga del Norte

Municipality of Polanco Municipality of Polanco
Office of the MPDC Office of the MPDC
SOLID WASTE MANAGEMENT UNIT SOLID WASTE MANAGEMENT UNIT

Violator’s Name: ______________________________________ Violator’s Name: ______________________________________

Address: ____________________________________________ Address: ____________________________________________

Sir/Madam: Sir/Madam:

You are hereby cited for violating the Municipal Ordinance 15-24 You are hereby cited for violating the Municipal Ordinance 15-24
or otherwise known as the Comprehensive Solid Waste or otherwise known as the Comprehensive Solid Waste
Management Ordinance of Polanco, listed hereunder: Management Ordinance of Polanco, listed hereunder:

VIOLATION VIOLATION

A. ( ) Non-segregation of solid waste A. ( ) Non-segregation of solid waste

B. ( ) Bringing out of waste out of scheduled collection day B. ( ) Bringing out of waste out of scheduled collection day
C. ( ) Littering in public places C. ( ) Littering in public places
D. ( ) Open and indiscriminate burning of residual/special waste D. ( ) Open and indiscriminate burning of residual/special waste
E. ( ) Non-provision of receptacles/containers for wastes E. ( ) Non-provision of receptacles/containers for wastes
F. ( ) F. ( )
G. ( ) G. ( )

CLASSIFICATION CLASSIFICATION

( ) Big business and commercial establishment, industrial & ( ) Big business and commercial establishment, industrial &
manufacturing plants manufacturing plants
( ) Small business establishments ( ) Small business establishments
( ) Institutional establishments ( ) Institutional establishments
( ) Residential/Household/Individual ( ) Residential/Household/Individual

PENALTY PENALTY

( ) First Offense ( ) Second Offense ( ) Third Offense
( ) Reprimand
( ) ₱50 ( ) ₱150 ( ) ₱250 ( ) ₱300 ( ) ₱500 ( ) ₱1000
Community Service
( ) 1 Day ( ) 3 Days ( ) 5 Days ( ) 6 Days ( ) 10 Days
( ) First Offense ( ) Second Offense ( ) Third Offense
( ) Reprimand
( ) ₱50 ( ) ₱150 ( ) ₱250 ( ) ₱300 ( ) ₱500 ( ) ₱1000
Community Service
( ) 1 Day ( ) 3 Days ( ) 5 Days ( ) 6 Days ( ) 10 Days

Time: _____________________________________________________ Time: _____________________________________________________

Date: _____________________________________________________ Date: _____________________________________________________
Place of Occurrence: _________________________________________ Place of Occurrence: _________________________________________

You are requested to appear to the Office of the Municipal You are requested to appear to the Office of the Municipal
Treasurer within 3 days from date of violation. Your failure to Treasurer within 3 days from date of violation. Your failure to
appear will compel this office to file legal action against you. appear will compel this office to file legal action against you.

________________________________________ ________________________________________
Apprehending Officer Apprehending Officer
(Signature over Printed Name) (Signature over Printed Name)

Citation Ticket Received by: Citation Ticket Received by:

________________________________________ ________________________________________
Signature over Printed Name Signature over Printed Name

Note: If violators refused to sign Note: If violators refused to sign

Witness: Witness:

1. _____________________________________ 1. _____________________________________

2. _____________________________________ 2. _____________________________________