Republic of the Philippines Department of Environment and Natural Resources Visayas Avenue, Diliman, Quezon City Tel Nos. 929-6626 to 29; 929-6633 to 35 929-7041 to 43; 929-6252; 929-1669 Website: http/www.denr.gov.ph E-mail: web@denrgov.ph Wy MAY 2.9 2014 MEMORANDUM CIRCULAR NO. 2014 - 05. SUBJECT : PROCESSING OF ECC APPLICATIONS OF PROJECTS DIRECTLY RELATED TO THE REHABILITATION EFFORTS OF THE GOVERNMENT TO BENEFIT YOLANDA VICTIMS In line with objective of the DENR to assist the Government in its effort to immediately rehabilitate areas hit by tropical storm “Yolanda”, as well as to provide victims with living and other support structures to help them rebuild their lives, all applications for housing, non-environmentally critical infrastructure and other projects directly related to rehabilitation efforts of the Government shall be processed and decided upon within a period of ten (10) working days. ‘The proponent shall be advised to use the Checklist Report Forms established under EMB Memorandum Circular No. 005-2011'. Likewise, all applications shall include among others information on climate considerations as well as disaster risk reduction programs. Should the threshold established therein require an Environmental Impact Statement (EIS), an internal review pool within the DENR shall be created to evaluate and process the application within the ten (10) working day period. ‘This Memorandum Circular shall take effect immediately, and its status of implementation shall be regularly reported to the undersigned for monitoring, information and reference. Tn a SENPOSTIC il * Incorporating Disaster Risk Reduction (ORR) and Climate Change Adaptation (CCA) Concerns in the Philippine E1S System Let’s Go Green !!!Annex 2-N GENERIC INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORM This Generic IEE Checklist Report Form shall be used as the interim pro-forma EIA Report requirement for projects required an IEE Report / IEE Checklist for ECC Application and where a customized IEE Checklist Report Form has not yet been developed. This IEE Checklist Report Form shall be submitted along with the following documents: « Proof of Compatibility with the existing Land Use Plan « Proof of Authority over the Project Site « Accountability Statements of Proponent (see attached form) and the Preparer (if any, following ‘Annexes 2-22 of Revised Procedural Manual for DAO 2003-30) + Photographs or plates/vicinity map of the project site showing impact areas and affected areas and communities «Duly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS) Questionnaire (see Annex 2-74 of Revised Procedural Manual for DAO 2003-30) (No other documents shall be required as pre-requisite to ECC epplications per DENR MC 2010-14.) Read the questions carefully and write the required information on the spaces provided or otherwise check (¥) the appropriate boxes []. Boxes with check marks M@ are mandatory requirements. Use additional sheets if necessary and indicate this in the appropriate space. Project proponents are strongly discouraged from engaging the services of consultants/faciltators/preparers to accompl'shifil-up the IEE Checklist Report Form, ‘The Report Forms have been designed to be user-friendly. Furthermore, the EMB Regional Office is required to complete the processing of an ECC application using the IEE Checklist Report within twenty (20) working days upon | receipt of duly-accomplished forms with complete attachments, Misleading or erroneous answers are grounds for legal action and/or denial of ECC issuance.‘Generic Initial Environmental Examination (IEE) Checklist Report Form PROJECT FACT SHEET Name of the Project Proponent Name Proponent Address Proponent Means of | Name: Designation: - Contact Landline No. Fax No, —_ ~ Email: a L |. PROJECT DESCRIPTION 1 PROJECT LOCATION AND AREA: Street/Sitio/Barangay ~ Cityimunicipalty ZonelCiassification (ie., industrial, residential) | ~ | Province Region | Total Project Lana Area Total Building Footprint Area Soe altasiod vicinity map/s and photographs ofthe project sie and sie dovelopmentTayout plan Geographic coordinates of the project area (Preferably use PRS 92 datum: otherwise, specity datum used) | Perimeter/Boundary points (based | ‘on OCTITCTIete) Longitude Latitude Other Description Details: eeGeneric intial Environmental Examination (IEE) Checklist Report Form — BEE* 1.2 PROJECT COMPONENTS __ No.of | Area (sq/M)/ Specifications/Description! |] Facilities units | Capacity Remarks Material storage facility Raw, chemical and process materials | Fuel, lubricants and similar materials Finished product (e.9, equipment facilities, silo, hopper, 2. Processing facil Material preparation and handling (eg , screening, sorting, conveyor belt, ete.) Material size reduction/agglomeration Heating/Drying (direct “heatlenergy application) Processing (e.g., mixing, | _ blending, refining, milling, ete.) Finishing (e.g., sorting, filing, packaging, etc.) Others, specify | ipport Faciities (e-9., | emergency generators, boilers, | __ steam generators, etc.) | 4 Admin support (e.g., canteen, office, clinic, quarters, etc.) 5. Water source / supply | 6 Waste water management facility | 7. Solid waste management facility : | 8 Drainage system | 9 Others, specify [Please list facilities By module/grouping. Use additional sheets if needed)snerc Initial Environmental Examination (IEE) Checklist Report Form — BAe 1.3 UTILITIESIREQUIREMENTS (Operation Phase) a Utilities: ‘Source Estimated Demand/Consumption 7] PowerlElectricity (Total) kwh PowerlElectricity KWn (From Renewable Energy Sources) | Water (Total) ” miiday (Fillup table below if water is not obtained from the local water utlity) Water miiday (Rainwater Collection System) Water Source groundwater Cl well =) spring others: (surface water (river = lake © others: Location of water source (Sitio/Zone, Barangay, Municipality/City, Province, Region) Energy/Water Efficiency - Proposed Efficiency/Conservation Usitiies Estimated Savings Mestnas Power/Electrcity KWh Water midayGeneric initial Environmental Examination IEE} Checklist Report Fom — EE 1.4 MANPOWER a. Construction Phase ‘Manpower Requirement Expertise/Skills I Total Expertise/Skills Total 1.5 INDICATIVE PROJECT COST Project Cost (PhP)Generic Initial Environmental Examination (IEE) Checklist Report Form BUETaAA, paureiad 2g 1m Jeu) UONEIaBan eee 40) Buroua) Areiodwwe) BpInold FA} j aiqissod puelsseg se yon se Suvesj9 pue} Vu pueUs!eW [| 3809 uonevado wWuHad VOd MOH "Wued Puensoioy — Buvesio juonionsisuco ai paiereBan-a jpayueidas Bung aaiy ‘gs NOVYNAG aa uoneis6an 01 anp ui payesBaquiiso9 fq | eave yo woqoadsul jenuuy py Jo suoRIpUOD Yuva AidWO || ayy ui uoNeraBan BunsHxy imo} soueGIMISIG [7] Ayoads 's1N0 seauy pajoaiod () reuonesioey seanynouBy rewsnpul 5) reuognsuy jerorewwo lequapisey [ ‘snipes bi, ulm sasn puel enjoy Ayjoads ‘S180 Seay PaIOeOId [| evonesisey nesnynouBy levisnpul (>) Jevoanyasit jetiauiweg ©) lenuapisey | (eoueuipio sn pule| yak Buuoz Jad se) snipes asn | Aanaedwioo yo joosd paygene 225 | | ums uyme asa pueluasing | PUEI Mim fouBIsisUCD [A ONY) | —— ] - ] ‘Speduiy Buyomuoy uonequawe/duy UONUOW Frceneia Buono ‘saunseaw BuneSnin /eAnuanaid quauluoIAU ouljaseg, JeIsog/1euoWUOMAUR NWid LNSWSOVNWI ONY LOVdIN TWINSWNOBIANS tTae. 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UIWIIM pue aus S| | juononsysucs eu J0 souesqe/soueseid seBeyoed uojesuadwod KeBuereq | aloud 21g ul sjuapisa: a payesBaqu! 1809 Py 30) Buuioyuow seinBay [a] aoueqimsipruoyenojai apinold | ysoy jo uoNeindod Jo azig Jo quawace|dsig (>) | a31d03d qi : Ayoods 's#8410 () 8 sean jo Buguerd 2 Jojpue Jeyng ayenbape apinoid (] 3 ssinoy a Sunesodo ayeudodde yuswaldu) [~] s (218 ‘seweq 3 punos eoue}is ‘sieyjnw “B'a) 3 souoz ‘s/@0inap j01U09 asiou ejelsdosdde up L UeUL HOW Jey jo Buuoyuow seynBay ¢} 24) ‘2igeondde vay jeisut (7) wy L500 3809 uoneiado syueidwoo (049 ‘soyeieue6 ‘sdwind wy ¢'0 UeW $2] 01 0 uonjonijsuoo oun 10 souasge/souaseid ‘sejayan ‘6'2) saounos asiou ‘Ayunwwoo uowersuab ur paresBauur is09 py JoUoW KueinGoy | | He wlewIeW pue ayes0do Auadoug (-) ysoieau o| goueisiq | 98!0U 0} en eouestN (7) ~ Sauanyep BuUNp Jano Yoni Jo eauesad [] Jojes0U26 pue yweudinba Aneay‘sajaiyan Woy ay0WUs 240k} 40 By)yia Jo eoUasaY [| fygeds ‘seo | J© wondedsui (12In90) JeINB2Y | snp syesoues few yeu sevarew | ay ne jenwue-sweg — Janlap 0} Sejoiyen pasenoa asn [- 5 swepsas | | | renuy 5) Aqueau 0} yojwoosip aziuiuiws | fouanbass ppue seosnos isnp ssaiddns j Beda | uonequawoyduy jsrojeutoreg GunoTuOW, sounseaw BuneBnin /ennuensig —-uauONAUA eUaSea | [e!D0SMENEWONAUS | moneBmw yo y809, Ioe Generic Initial Environmental Examination (SEE) Checklist Report Form Ayoads 's:0Ni0, 6969 WH JO | squowounbos wm fyditosAYBIAS stuawaunbas Auojein6a1 sens ue Arajes “ouy ual Ald\OD ANDLAS ER] sio;jiom ue Ajunuwos \Yoq 04 swesBosd | ‘hayes ayeudosdde yuaweduu ‘ayes ue yijeay uo swesBoud Ayoads ‘su8u10 [ 1 | Kouabe paussouco o} sodas | Jouosssiugns seinGay py | SSOUSHEME DHA Ut aledionsed (7) sevseu | fon fouaBsowe Aue 405 21K0} Jo ase9I0Y [ | Waym uoneuipioos seinBay pa] | S99"V9S IPOIPSU aUS-UO SpInodd Ayoeds ‘1040 7] uorsojdx3, | ae Buidseyesnoy sadoud ansesqo A] : M0 alo rye a ‘Se0UEISQNS OKO ung Jo Buuoyuous seInB Oy [ aigeonsesd 1 Ness yoo uopeieco | sjurejdwoo | J®X@UauM 'sepeoueg pue Buny| | seoueisans ejqeueld juonjonsuos au Jo souasqeyaouesasd | ‘SUbis Buruem ajeudosdde apinosg (] sonisoidxa 5] ayes ove wiesy | ut payesBaqul is00 [A 2} Suuoyuows renew Py | NO UNM eIeUIpL0c» AuEINBOM sysu yo soinog | AYUNuMeD Uo Sedu] | | . mou ‘Ayoads ‘s10NO o1yesy yo Buluasiom pue | samsey | auunjon owes ul esearout ( suods pue uojeascoy (aie “iepi0 | (279 ‘pours pue eoead ‘uonesnpe | {Big ysod}no soyod 6) seomes ayand | 6'2) Japi0 pue eoeed Jo anirap peouewa [ | (249 ‘sjeydsoy ‘sor (eso | | 8:2) somioey uesH ue sogad ‘uoyesnpa Ayoads‘sieui0 (26.09 Yoouos ‘Sa)ssonnes | ySiy ‘Aeuewels land 46 P j o}8 ‘Bunusi ‘subs 6:9) o0y9g (9 | Ui woMadwegwondnisig Suwiemoyyen areudoidde epinoies | ‘AeBu 91 senGojeip pue suoyeinsuco | fsorfointicel 404 sonuanes pasea.ou| u! Sqj Jo uonedioned ensuZ ‘SeOINIaS SIGeIIENY seniunyoddo ai T een ‘spedui, on uoneweweydus, soinseow BuneBnIW joanuonsig | quawUOIIAUR euI]aSeg | jeID0S;e}UAUIUOAIAUR moneBnwy Jo 1s09, jsisjoureseg BuoHuoYGener Initial Environmental Examination (IEE) Chooklist Repost Form — AE% Il, ABANDONMENT / DECOMMISSIONING / REHABILITATION POLICIES AND GENERIC GUIDELINES (i Applicable) Project Life or Service years Provide description of the Abandonment activities, such as, dismantling and waste disposal IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATION Organization ChartGeneric Initial Environmental Examination (IEE) Checklist Report Form Attach drawing/plan of waste water treatment facility (with dimensions and descriptions)Genenc Initial Environmental Examination (IEE) Checklist Report. ia | Attach drawing/plan of air pollution source and control installations (with dimensions and descriptions)Generic initial Environmental Examination (IEE) Checklist Report Fon RE SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENT This is to certify that all the information and commitments in this Initial Environmental Examination (IEE) Checklist Report are accurate and complete to the best of my knowledge. By the authority vested in me by the as hereby commit fo ensure implementation of all commitments, mitigating measures and monitoring requirements indicated in this IEE Checklist Report as well as the following * Conform to pertinent provisions of applicable environmental laws e.g., RA. No 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Act of 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000), RA No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749 (Philippine Clean Air Act of 1999), ‘+ Abide and conform to LGU development plan and guidelines. + Promptly pay local taxes and other financial obligations, + Regularly submit reports to concerned agencies. hereby bind myself to answer any penalty that may be imposed arising from any misrepresentation or failure to state material information in this IEE Checklist In witness whereof, | hereby set my hand this day of at SUBSCRIBED AND SWORN TO before me this day of 201__. affiant exhibiting his/her Community Tax Certificate No. Doc No Page No| Book No Series of — NAME OF PROPONENT HEAD Signature Position Company Name issued at onAnnex 2 INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORM for SUBDIVISIONS AND HOUSING PROJECTS ‘This IEE Checklist Report Form shall be used for proposed SUBDIVISIONS AND HOUSING PROJECTS required an IEE Report / IEE Checklist for ECC Application This IEE Checklist Report Form shall be submitted along with the following documents: + Proof of Compatibility with the existing Land Use Plan | + Proof of Authority over the Project Site | « Accountability Statements of Proponent (see attached form) and the Preparer (if any, following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30) + Photographs or plates/vicinity map of the project site showing impact areas and affected areas | and communities * Duly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS) Questionnaire (see Annex 2-74 of Revised Procedural Manual for DAO 2003-30) | (No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14) | Read the questions carefully and write the required information on the spaces provided or | otherwise check (¥) the appropriate boxes [] Boxes with check marks fare mandatory | | requirements. Use additional sheets if necessary and indicate this in the appropriate space | { Project proponents are strongly discouraged from engaging the services of consuitants/facilitators/preparers to accomplishifil-up the IEE Checklist Report Form. The Report Forms have been designed to be user-friendly | | | Furthermore, the EMB Regional Office is required to complete the processing of an ECC application using the IEE Checkiist Report within twenty (20) working | | days upon receipt of duly-accomplished forms with complete attachments Misleading or erroneous answers are grounds for legal action and/or denial of ECC | issuance.Jntia! Environmental Exan ft dist Report Form for Subdivision and Housing Projects PROJECT FACT SHEET Name of the Project Proponent Name | Proponent Address Proponent Means of | Name: Designation: - 1 Contact | Landline No. Fax No. - Mobile No. Email: ~ j, PROJECT DESCRIPTION _ _ _ _ Please Check Project Type (indicate fofal land area below) Low Cost Subdivision or Resettlement Housing I Economic & Socialized Housing 1 ‘Open Market Housing Other similar Horizontal Land Development eee i iv | | | | ' [ Total land area, including all common, open and other areas Other Description Details: l4_ PROJECT LOCATION AND AREA: treet/Sitio/Barangay ZonelCiassification (\e , industrial, residential) CCityiMunicipalty Province Region ‘otal Project Land Area Total Building Footprint Area "See attached visnly mag/s and photographs OF the project Ste and Sie developmertiayout plan.Initial Environmental Examination (JEE) Checklist Report Form for Subdivision and Housing Projects Geographic coordinates of the project area (Preferably use PRS 92 datum: otherwise, specify datum used) Perimeter/Boundary points (based Longitude Latitude ‘on OCTITCTiete.) .2 PROJECT COMPONENTS: Facilities No. of | Area(sq/M) | — Specifications/Description/ Units | Capacity Remarks | [7 Residentar ots \ 2. Commercial Area (@ 6, banks, |” “restaurants, outlets, stores, etc 3. Institutional Area (e.g.. swimming 1 pools, gym, chapel, club house, etc) 4. Open/Gommon Spaces (e.g. reception area, garden, parks, | | __ete) | 5 Road system | |__PrimaryiMiain Road | Secondary Road | ale 8 Common Parking Area | 7 Water supply system | 8. Drainage system | Waste water management facil 110 Support facilities (e-g., | emergency generators, guard _housesiposts, etc.) | _11. Waste water management facility 12. Solid waste management facil |43. Others, specify i tional sheels, ifnecessary fInitial Environmental Examination (IEE) Checklist Report Form for Subdivision and Housing Projects B= 1.3 UTILITIESIREQUIREMENTS (Operation Phase): Utilities ‘Source Estimated DemandiConsumption | PoweriElectricity (Total) PowerlElectricity | KWh (From Renewable Energy Sources) Water (Total) a miiday ‘Fil-up table below if water is not obtained from the local water utility) | Water ividay | (Rainwater Collection System) Water Source “groundwater well Cl spring others: Cl surface water = river «= lake others: Location of water source (Sitio/Zone, Barangay, Municipality/City, Province, Region) |Jnitiel Environmental Examination (IEE) Energy/Water Efficiency list Report Form for Subdivi and Housing Projects Utilities Estimated Savings Ce ee PowerfEiearieny ‘Rh Water mifday ~ a 14 MANPOWER 4, Construction Phase | Manpower Requirement _ Expertise/Skills - Total — b, Operation Phase (__“Manpower Requirement _ Expertise/Skills Total | 1.5 INDICATIVE PROJECT COST Project Cost (PhP):BA {nitial Environments! 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INSTITUTIONAL PLAN FOR EMP IMPLEMENTATION Organization ChartInitial Environmental Examination (IEE) Checklist Report Form for Subdivision and Housing Projects RES | Attach drawingiplan of sewerage treatment fac ies (with dimensions and descriptions)Initial Environmental Examination (IEE) Checklist Report For for Subdivision and Housing Projects EEL ‘SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENT This is to certify that all the information and commitments in this Initial Environmental Examination (IEE) Checklist Report are accurate and complete to the best of my knowledge. By the authority vested in me by the as I hereby commit to ensure implementation of all commitments, mitigating measures and monitoring requirements indicated in this IEE Checklist Report as well as the following ‘= Conform to pertinent provisions of applicable environmental laws e.g., R.A. No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Act of 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000), R.A No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749 (Philippine Clean Air Act of 1999) ‘+ Abide and conform to LGU development plan and guidelines. ‘+ Promptly pay local taxes and other financial obligations. + Reguiarly submit reports to concerned agencies. I hereby bind myself to answer any penalty that may be imposed arising from any misrepresentation or failure to state material information in this IEE Checklist In witness whereof, | hereby set my hand this day of at NAME OF PROPONENT HEA ‘Signature Position Company Name SUBSCRIBED AND SWORN TO before me this_day of. 201_, affiant exhibiting hisiher Community Tax Certificate No. issued at on Doc No. Page No| Book No. Series ofAnnex 2-J INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT FORM for ROAD AND BRIDGE PROJECTS This IEE Checklist Report Form shall be used for proposed ROAD AND BRIDGE PROJECTS, required an IEE Report / IEE Checklist for ECC Application This IEE Checklist Report Form shall be submitted along with the following documents: + Proof of Compatibility with the existing Land Use Plan. + Proof of Authority over the Project Site ‘+ Accountability Statements of Proponent (see attached form) and the Preparer (if any, following ‘Annexes 2-22 of Revised Procedural Manual for DAO 2003-30) + Photographs or platesivicinity map of the project site showing impact areas and affected areas and communities + Duly Accomplished Project Environmental Monitoring & Audit Prioritization Scheme (PEMAPS) Questionnaire (see Annex 2-74 of Revised Procedural Manual for DAO 2003-30) {No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14) | Read the questions carefully and write the required information on the spaces provided or | otherwise check (¥) the appropriate boxes [1] Boxes with check marks [7 are mandatory requirements. Use additional sheets if necessary and indicate this in the appropriate space. ‘Project proponents are strongly discouraged from engaging the services of | consuitants/facilitators/preparers to accomplishifiltup the IEE Checklist Report | Form. The Report Forms have been designed to be user-friendly. Furthermore, the EMB Regional Office is required to complete the processing of an ECC application using the IEE Checklist Report within twenty (20) working days upon receipt of duly-accomplished forms with complete attachments ‘Misleading or erroneous answers are grounds for legal action and/or denial of ECC | issuance.Initial Environmental i *hecklist Report Form for Road and Bridge Projects PROJECT FACT SHEET Name of the Project » Proponent Name Proponent Address Proponent Means of | Name: Contact Tandline Wo. | Mobile No. Designation: Fax No, Email 1 PROJECT DESCRIPTION Please check project type and indicate size v — Project Type Project Size_| Project Size ~ Parameter . Bridges and viaducts, new construction Length | Tength with no entical Roads, new construction, widening slope, OR (including RO-RO facilities) length with eritical slope Elevated roads, fiyovericioverleal/ interchanges, Tunnels and sub-grade roads and railways Length “Pedestian passages ther Description Details: |. PROJECT LOCATION AND AREA: | StreeuSitio/Barangay ZonelClassification (ie, industrial, residential) | CityiMunicipalty Province Region Total Project Land Area Total Building Footprint Are See aitached vieinly map/@ and photegraphs oF the project sie and site developmentlayout plan. LeaInitial Environmental Examination (IEE) Checklist Report Fonn for Road and Bridge Projects Geographic coordinates of the project area (Preferably use PRS 92 datum: otherwise, specily datum used). | PerimeteriBoundary points (based | ‘on OCTTCTiete.) Longitude Latitude Facilities No. of Units Area (sq/M)/ Capacity Specifications/Description! | Remarks \ 11 Road 12 Intersections | 3 Bagels 4 Recess roads/Ramp 5. Drainage facilities | (ie Reinforced Concrete Box | Culverts (RCBC);Reinforced Concrete Pipe Culverts (RCPC), | __ others) 6. Associated facilities (Ie. 1” “Guardrails, Traffic signs, etc.) | 7. Solid waste management facility 8 Others, specify “Use additional sheets, ifnecessary aeInitial Environmental Examination (JEE) Checklist Report Form for Road and Bridge Projects 13 UTILITIESIREQUIREMENTS (Operation Phase): Utilities ‘Source Estimated Demand/Consumption ] PowerlElectricity (Total) KWah PowerlElectrcity Wh (From Renewable Energy Sources) Water (Total) - mday (Fil-up table below if water is not obtained from the local water utility) Water “miday | (Rainwater Collection System) Water Source groundwater 1 well © spring others: ' surface water 1 river = lake ©. others: Location of water source (SitiorZone, Barangay, Municipalty/City, Province, Region)(nital Environmental Examination (EE dist Re for Road and Bridge Projects Energy/Water Efficiency Proposed Efficiency/Conservation Estimated Savings seats PowerlElectricity ~ KWwh : - Water mivday | | | - | 13 MANPOWER 4a. 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INSTITUTIONAL PLAN FOR EMP IMPLEMENTATION Organization ChartInitial Environmental Examination (JEE} Checklist Report Form for Road and Bridge Projects Rt ‘SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENT This is to certify that all the information and commitments in this Initial Environmental Examination (IEE) Checklist Report are accurate and complete to the best of my knowledge. By the authority vested in me by the I hereby commit to ensure implementation of all commitments, mitigating measures and monitoring requirements indicated in this IEE Checklist Report as well as the following as Conform to pertinent provisions of applicable environmental laws e.g., R.A. No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Act of 1990), R.A. No. 9003 (Ecological Solid Waste Management Act of 2000), R.A No. 9275 (Philippine Clean Water Act of 2004), and R.A. No. 8749 (Philippine Clean Air Act of 1999) Abide and conform to LGU development plan and guidelines. Promptiy pay local taxes and other financial obligations, Regularly submit reports to concemed agencies. { hereby bind myself to answer any penalty that may be imposed arising from any misrepresentation or failure to state material information in this {EE Checklist. in witness whereof, | hereby set my hand this day of at NAME OF PROPONENT HEAD Signature Position ‘Company Name SUBSCRIBED AND SWORN TO before me this day of 201__. affiant exhibiting his/her Community Tax Certificate No. issued at on Doc No Page No| Book No Series of,