Batch Plant Project Report

BATCHING AND CRUSHING PLANT PROJECT

INITIAL ENVIRONMENTAL EXAMINATION ( IEE ) CHECKLIST REPORT for

Project name or Title

Below is the IEE Report Checklist for Batching and Crushing Plant Project:

Industry Parameter Threshold

Batching Plant (with or without crushing) All Batching Plants

Metallic Mineral or Ore Processing (e.g. copper, lead, nickel, cobalt, zinc, silver,

magnesium, and manganese, gold, placer with metal content) with Physical or

Mechanical Processing

Annual processing (inputs)

>200.0 MT annually but <70,000 MT

Read the questions carefully before answering the space provided. Uses additional sheets if necessary and indicate this in the appropriate space.

Misleading or erroneous answers are basic for legal actions and/or ECC.

EXECUTIVE SUMMARY

PROJECT FACT SHEET PD SUMMARY

Project Name: _________________________________________________________________

Project Site Location: __________________________________________________________

Nature of Project: ______________________________________________________________

Production Capacity: ___________________________________________________________

Total Land Area: ______________________________________________________________

Project Components: __________________________________________________________

Manpower Requirement: _______________________________________________________

Project Cost: _________________________________________________________________

PROCESS DOCUMENTATION

EIA Team:

Consultant Areas of Expertise

EIA Study Schedule (for primary data):

Activity Date Season

EIA Study Area:

Direct Impact Areas: (Complete Barangay, and Municipality/City) ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Indirect Impact Areas: (Complete Barangay, and Municipality/City) ____________________________________________________________________ ____________________________________________________________________ ___________________________________________________________________________

EIA Methodology:

EIA Study Module

METHODOLOGY

Type of Data (please

check)

Source of Data/Remarks (e.g.

LGU )

Primary Secondary

Land

Land Use Classification

Geology/Geomorphology

Pedology

Terrestrial Biology

Water

Hydrology/Hydrogeology

Oceanography

Water Quality

Freshwater or Marine Ecology

Air

Meteorology/Climatology

Air Quality and Noise

People

* Section or page number where the primary data can be found

I. PROJECT DESCRIPTION 1.1 PROJECT LOCATION: Street Name, Barangay, and Municipality/City (Vicinity Map showing sitio, barangay, municipality, province and region boundaries. Attach location and vicinity maps and photographs of the project site as ANNEX 1.)

_____________________________________________________________________________________________________________________________________________________________________________________________________________________

Geographic coordinates of project area: _________________ 1.2 PROJECT RATIONALE: Cite and focus on the need for the project based on national and local economic development and in terms of contribution to sustainable development agenda and current development thrusts of the Philippines.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________

1.3 PROJECT ALTERNATIVES: Reasons for selection of preferred option (please check): Technology Commercial Environmental Others

Facility Siting

Development Design

Process/Technology Selection

Resource Utilization

Others1

1 indicate a “no project” option in the comparative analysis at it still account for growth and

development even if the project were not approved. 1.4 PROJECT COMPONENTS Batching Plant

No. of Units Machinery/Equipment Specification

Cement Silos

Aggregate Hopper

Belt Conveyor

Transit Mixers

Payload

Generator Set

Fuel Storage Tank

Others:__________________________

(Use additional sheet, if necessary.) Crushing Plant

No. of Units Machinery/Equipment Specification

Steel Hopper Feeder

Vibrating Grizzly Feeder

Primary Jaw Crusher

Cone Crusher

Scalper Screen

Vibrating Screen

Sand Screw Classifier

Belt Conveyor

Water Pump

Others:___________________________

(Use additional sheet, if necessary.) Pollution Control Devices

No. of Units Pollution Control Device Facilities Being Served

Silencer/Muffler

Water Sprinkler

Dust Collector

Settling Pond

Silt/sediment traps

Septic Tank/Sewage Treatment Plant

Others: _________________________

(Use additional sheet, if necessary.)

1.5 PROCESS/ TECHNOLOGY OPTIONS Type of batching Process: Dry-type Wet-type (Provide a process flow diagram) Raw Materials No RAW MATERIALS CONSUMPTION /DAY

1 Cement

2 Gravel

3 Sand

4 Water

5 Admixture

(Use additional sheet, if necessary.) Water Supply

Community Water Demand : [ ] dry season ____ m3/sec [ ] rainy season ______ m

3/sec [ ] annual

_____ m3/sec

Water Source

[ ] surface water S/W Type : [ ] river (Name: _____________) [ ] rainwater collector

[ ] ground water G/W Type: [ ] well [ ] spring [ ] others: ____________________________

Location of water source ____________________________________________________________________________

(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Water source flow: a) dry season flow: _______ m3/sec b) rainy season: _______ m

3/sec

Percent & Flow of water source to be tapped:

a) dry season: ___ % (_____ m3/sec) b) rainy season: ___% (___ m

3/sec) c) annual: ___%

(___ m3/sec)

Location of communal water box/faucet area: ____________________________________________________________

(If water box/faucet area is to be provided) (Lot Number, Street, Sitio/Zone, Barangay, Municipality/City, Province, Region)

Communal box/faucet surface area: _____ m2 Volume :_______ m

3 Distance of box from

source: ______ m

Pipe length from source to water box: _____ m Pipe Material: [ ] GI pipes [ ] PVC

[ ] bamboo___________

Overflow of Concrete Water Box: ____ m (height) Target overflow: dry season____ m3/sec;

rainy season ____m3/sec

Power Supply

Sources of Power Supply

Yes No Estimated Daily Kilowatt consumed:

Local Electric Utility

Generator

Others, please specify

(Use additional sheet, if necessary)

Waste Management System Type of Waste

Source of Waste Volume Per Day Mode of Treatment2

Liquid

Air

Dust

Noise

Solid

(Use additional sheet, if necessary.) Include in the discussion how waste will be properly discharge/disposed-off during project pre-construction, construction and operation, as necessary. 1.6 PROJECT SIZE Total Land Area, sq.m _______ Land Area to be occupied, sq.m ________ Is the area owned or leased ___________ If leased, period covered ________________ (Attach document, TCT, as ANNEX 3) Production Rate

RAW MATERIALS CONSUMPTION (MT)/DAY

Cement

Gravel

Sand

Water

Admixture

Others_______________ Total

1.7 DEVELOPMENT PLAN, DESCRIPTION OF PROJECT PHASES AND CORRESPONDING TIMEFRAMES Pre-Operation/ Construction phase

3

Construction Schedule

ACTIVITY TIMEFRAME (no. of days)

Plans/Design

Permits/ Clearances

Site Preparation & Clearing

Excavation

Civil Works

Finishing Site Clearance

Installation of Equipment

Commissioning & Start-up Operation

(Use additional sheet if necessary. Include civil works undertaken as part of the project, e.g., Construction of office for operation, administration, canteen, and other amenities.

Operation Phase Provide brief discussion on the process: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Process Flowchart Abandonment Phase and schedule

Decommissioning Activities

Waste Generated Mode of Disposal Restoration Plan

□ Removal wastes

□ Dismantling of

plant structures and equipment

□ Retrenchment

package and labor support program

□ Used oil

□ Aggregates

stockpiles □ Others, please

specify_____

□ Used oil

□ Used pipes □ Used cables □ Concrete masonry □ Broken

equipments

□ Others, please

specify_____

□ EMB authorized

recyclers □ Landfill □ Others, please

specify_____

□ EMB authorized

recyclers

□ Landfill

□ To be donated

□ Others, please

specify_____

□ Revegetation

□ Leveling and

backfilling of settling ponds and non-usable drainage channels □ Repair of road

networks

□ Others, please

specify_____

□ Employee re-

training

□ Entrepreneurial

skills development

□ Others, please

specify_____

(Use additional sheet, if necessary.)

Insert process flowchart

1.8 MANPOWER

Manpower Requirement

Expertise/Skills No. of Women

No. of Men No. of IP’s Total

1.9 INDICATIVE PROJECT COST Project Cost (PhP): ____________ LIST OF ACRONYMS dB – Decibel DENR – Department of Environment and Natural Resources ECA – Environmentally Critical Area ECC – Environmental Compliance Certificate EIA – Environmental Impact Assessment EIS – Environmental Impact Statement EMB – Environmental Management Bureau ESWMP – Ecological Solid Waste Management Plan FPIC – Free, Prior and Informed Consent GenSet – Generator Set IP – Indigenous People LGU – Local Government Unit NCIP – National Commission on Indigenous Peoples NHI – National Housing Institute NOx – Nitrogen Oxide PA – Protected Area PAMB – Protected Area Management Board PCA – Philippine Coconut Authority PPE – Protective Personal Equipment ROW – Right of Way SLUP – Special Land Use Plan SOx – Sulfur Oxide TCT – Transfer Certificate of Title TSP – Total Suspended Particulates TSS – Total Suspended Solid

http://www.ncip.gov.ph/

II. ENVIRONMENTAL IMPACT AND CLIMATE CHANGE RISK MANAGEMENT PLAN

Environmental Impact Management Plan

Project Phase / Activities

Possible Environmental/ Social Impacts

Baseline Data Parameter

Preventive/ Mitigating/Enhancement

Measures

Monitoring Parameters/

Implementation

Cost of Mitigation/ Monitoring (Assumed to be integrated in project cost per project phase)

Pre-construction Phase Site Selection and

Planning/ Design

Change/ Inconsistency in land use

Current land use:

Residential

Commercial/ Institutional

Industrial

Agricultural/ Recreational

Protected Ares History/record of hazard or damage to land and property

Infestation

Fire

Floods/drought

Typhoon

earthquake

Others, specify ____________ ____________

Consider alternative site

Secure LGU zoning clearance

Expand and strengthen data collection and monitoring in order to improve decision making;

Adopt short and long-term measures to increase resilience of resources;

Develop a comprehensive land use and management plan incorporating climate change concerns vis-à-vis vital requisites of project sustainability;

Others, specify: ____________ ____________ ____________

Presence of LGU zoning clearance

Comparative benefits and costs monitoring of applied land management schemes

Undertake monitoring systems for land use activities and related events to ensure trends can be detected

Others, specify ____________ ____________

Acquisition of Clearance integrated in Pre-construction Cost: ______

Design, construction, maintenance and monitoring of land management schemes

Others, specify ____________ ____________

Encroachment in Environmentally Critical Areas (ECAs)

Project is within an ECA:

All areas declared by law as national parks, watershed reserves, wildlife preserves, sanctuaries

Areas set aside as aesthetic potential tourist spots

Areas which constitute the habitat of any endangered or

Consider alternative site or design to be compatible with the PA zoning

Secure PAMB Resolution for PA

Consider alternative site to avoid/lessen construction impacts on IPs/IP areas unless the IPs are among the beneficiaries of the facility

Presence of PAMB Resolution

Proof of Completion of FBI

Presence of FPIC Document

Coordination with NCIP

Presence of NHI clearance

Proof of coordination arrangements or

Acquisition of Resolution integrated in Pre-construction Cost: _______

Survey Cost integrated in Pre-construction Cost: _____

Meetings Cost integrated in Pre-construction Cost: _____

Meetings on acquisition of clearance, clearance fees & coordination with NHI integrated in Pre-






Measures


Implementation


threatened species of Philippine wildlife (flora and fauna)

Areas of unique historic, archaeological, or scientific interests

Areas which are traditionally occupied by cultural communities or tribes

Areas frequently visited and/or hard-hit by natural calamities (geologic hazards, floods, typhoons, volcanic activity, etc.)

Areas with critical slopes

Areas classified as prime agricultural lands

Recharged areas of aquifers

Water bodies characterized by one or any combination of the following conditions: tapped for domestic purposes; within the controlled and/or protected areas declared by appropriate authorities; which support wildlife and fishery activities

Mangrove areas characterized by one or

Apply for FBI and secure FPIC from the IPs thru the NCIP

Consider alternative site or redesign to avoid or lessen probability of damage

Secure NHI clearance

Coordinate with NHI/NM on construction

Others, specify ____________ ____________

inclusion of NHI procedures in project design , construction manual, operating procedures manual

Others, specify ____________ ____________

construction Cost:____

Others, specify ____________ ____________






Measures


Implementation


any combination of the following conditions: with primary pristine and dense young growth; adjoining mouth of major river systems; near or adjacent to traditional productive fry or fishing grounds; areas which act as natural buffers against shore erosion, strong winds and storm floods; areas on which people are dependent for their livelihood.

Coral reefs characterized by one or any combination of the following conditions: With 50% and above live coralline cover; Spawning and nursery grounds for fish; Act as natural breakwater of coastlines

Procurement/Hiring of labor and other manpower services (Note: Actual employment is implemented during Construction Phase)

In-migration

Population:_____ %Men:_____ %Women: ______

Give hiring preference to qualified local community residents, particularly those who will be displaced

Others, specify ____________ ____________

Proof of local residence, e.g. Community Tax Certificate (CTC) or certificate of residence issued by the Brgy. Captain

Others, specify ____________ ____________

Local Hiring cost integrated in Pre- & Construction Costs:____

Others, specify ____________ ____________






Measures


Implementation


Non-hiring of qualified Indigenous Peoples in projects located in ancestral domain areas or where IPs are confirmed to reside

Population:_____ %Men:_____ %Women: ______

Prioritize hiring of qualified Indigenous Peoples, in projects located in ancestral domain claims or where IPs are confirmed to reside

Others, specify ____________ ____________

Proof of local residence, e.g. issued by the tribal chieftain or tribal council

Employment record \

Others, specify ____________ ____________

Local Hiring cost integrated in Pre- & Construction Costs: ____

Others, specify ____________ ____________

Construction Phase Installation of

Equipment Change in surface

landform/ topography/ terrain/slope

Slope:

flat (0-3%)

gently sloping to rolling (3-18%)

steep (>18%)

Provide erosion control and slope protection measures

Designate a Spoils Storage Area, with topsoil set aside for later use and allow maximum re-use of spoils

Others, specify ____________ ____________

Presence of slope protection in erosion-prone areas

Presence of new eroded areas near the site

Others, specify ____________ ____________

Slope/ Erosion Control integrated in Construction Cost:

Others, specify ____________ ____________

Tree cutting or vegetation clearing, and disturbance to wildlife within the influence area due to noise and other construction activities

Existing vegetation in the area:

Forest

Coastal/Marine

Marshland

Grassland

Mangrove

Wetland Others, specify __________ __________

Compliance with conditions in permits secured during the Pre-construction Phase

Implementation of tree planting around the facility ;

Promote restoration of damaged or destroyed vegetation where possible;

Vegetation to serve also as buffer to wildlife

Limit land clearing as much as possible

Compliance with conditions of DENR/LGU SLUP, Tree Cutting Permit, ROW, PCA Permit

Area replanted/ revegetated

# incidence of violation to protection guidelines

Presence of fences and markers

Others, specify ____________ ____________

Replacement planting cost depends on area opened up:

Compliance with other permit conditions integrated in Construction Cost:

Others, specify ____________ ____________






Measures


Implementation


Specify the existing flora in the area ________ _________________ Specify the existing fauna in the area ________ _________________

Provide a temporary fencing to vegetation that will be retained

Others, specify ____________ ____________

Operation Phase Cement based

products manufacturing

Air Pollution

Air Quality Data Upwind:

TSP_____

SOx____

NOx_____

PM10______

Other, specify _________

Air Quality Data Downwind:

TSP_____

SOx____

NOx_____

PM10______

Other, specify _________

Wet areas of dust sources to minimize discomfort to nearby residents

Proper operation and maintenance of the dust producing installations (stone cutters) and its air pollution control facility

Good housekeeping to be strictly enforced

Proper operation of the generator set

Control of vehicle speed to lessen suspension of road dust

Remove soil. mud from tires of trucks and equipment before leaving the area

Other, specify _______ ___________________

# public complaints received by Proponent/ Contractor

Presence of emission test results/certificate of conformance with emission standards

Absence of white or black smoke from vehicles, heavy equipment and generator

Result of air quality sampling

Frequency :

Monthly

Quarterly

Semi-Annual

Annually

Others, specify_______

Water spraying/ Dust filters/barriers/fences Cost:____

Others, specify ____________ ____________

Water Pollution

Receptor:

Fresh

Brackish

Saline/Sally

Set-up proper and adequate toilet facilities

Strictly require the contractor and its workers to observe proper waste

# of public complaints received by the proponent or constructor

Visible turbid and/or silted condition of the

O&G traps: _____

Ring canals:______

Used oil containers: ________






Measures


Implementation


Water Quality Data in upstream:

TSS

Oil and grease Water Quality Data in downstream:

TSS

Oil and grease

disposal and proper sanitation

Provision of wastewater treatment facility

Proper operation and maintenance of the toilet facilities and septic tank

Set up silt trap/stilling ponds to minimize downstream siltation

Provide oil & grease traps upstream of any run-off discharge from the project to the waterbodies

Provide ring canals around fuelling tanks/ motorpool/ maintenance areas

Collect used oils in containers

Limit, where possible, the extent of impervious (paved) areas

river

Visible oil & grease film on waterbodies

TSS concentration Frequency :

Monthly

Quarterly

Semi-Annual

Annually


Silt trap/stilling ponds integrated in Construction Cost:______

Others, specify ____________ ____________

Generation of solid waste from the project activities/ operations

Volume of solid waste generated from current sources

Implementation of the Ecological Solid Waste Management Plan (ESWMP);

Re-use and recycling

Others, specify ____________ ____________

Presence of waste/recycling bins for segregation

Absence of mixed garbage in the facility

Frequency :

Monthly

Quarterly

Semi-Annual

Annually


Implementation cost of ESWMP: __________

Others, specify ____________ ____________

Threat to public Health Facilities within Provide appropriate Safety standards, PPE,






Measures


Implementation


health and safety

the project site, specify _____________ _____________

Heath and safety concerns

Respiratory illness Specify type and rate of occurrence: _______________ _______________

Accidents Specify type and rate of occurrence: _______________ _______________

warning signs, lighting and barricades, whenever practicable

Observe proper housekeeping

Provide on-site medical services and supplies for any emergency, thru institutional and administrative arrangements with the barangay health unit

Identification of hot spots or critical areas based on levels of vulnerability

Foster increased public awareness of resilience and develop approaches to climate adaptation

Effective IEC program as regards potential risks and vulnerabilities as a result of project implementation on the environment, and vice versa;

Others, specify ____________ ____________

Presence of signages

Potable quality of water source & supply

Presence of adequate sanitary facilities

# of medical complaints or cases

# of accidents

Frequency : ____________ ____________

Others, specify ____________ ____________

safety signs are expected to be integral part of the Occupational Safety program of the Proponent

Potability analysis integrated in Construction Cost:

Others, specify ____________ ____________

Increase in traffic volume and worsening of traffic flow

Traffic condition within the area:

Light

Moderate

Heavy

Observe traffic rules Implementation of traffic management system;

Promotion of green infrastructure, i.e. interconnected network of balancing open space with natural park and vegetation cover;

Presence of designated parking , pedestrian lanes, loading/ unloading zones, delivery areas, sidewalk vendor areas

Presence of signages

Presence/ Visibility of local traffic aide

Signages cost :______

Cost of barangay or city/town traffic aide: ________

Others, specify ____________ ____________






Measures


Implementation


Others, specify ____________ ____________

Frequency : _____________

Others, specify ____________ ____________

Increase economic activities and economic opportunities to local

Job opportunities

Increase tax revenue

Source of livelihood:

Construction _____

Farming _____

Fishing ______

Trading ______

Others _______

Priority of employment

Regular tax remittance

Number of jobs generated____

New jobs created :______________ _______________

Income tax generated

TOTAL EMP COST________


CLIMATE CHANGE RISK MANAGEMENT PLAN


Climate Change Risk Baseline Data

Parameter Adaptation Measure


Implementation

Cost of Adaptation / Monitoring

(Assumed to be integrated in project cost per project

phase) Occurrence of flooding Historical data on

flooding Improve efficiency of

water supply/irrigation systems

Protect water recharge areas to preserve quality and quantity

Increase, when practical, storage capacities of water supply structures for resilience to greater variations and extremes

In critical areas, develop flood plan maps, including climate change projections, and zoning measures to limit/restrict development activities

Others, specify ____________ ____________

Review monitoring systems for water levels, flows and water quality rainfall

drainage and flood control facilities to take into account climate change to date and projections;

Others, specify ___________ ___________

Construction cost:_____

Drought Historical data on drought

Tree planting to moderate temperature increases

Adapting drain water system

Water conservation techniques e.g. catchment basins

Improving water use efficiency, planning

Percent survival of trees planted

Effectiveness of drain water system

Effectiveness of water conservation techniques

Improvement on water use efficiency

Others, specify ____________

Planting cost depends on area: ______________

http://www.epa.gov/heatisland/strategies/vegetation.html






Implementation



phase) for alternative water sources (such as treated wastewater or desalinated seawater), and making changes to water allocation

Others, specify ____________ ____________

_____________

Occurrence of landslide, gully erosion and rock falls

Historical record on landslide, gully erosion and rock falls

Slope stabilization

Establishment of buffer zone

Planting of trees

Others, specify ___________ ___________

Ocular inspection

Maintenance of slope

Percent survival of trees planted

Others, specify ____________ ____________

Planting cost depends on area: ______________

Damage to core operations and increased levels of heat stress, respiratory illness, chronic disease due to prolonged heat waves

Record on heat waves

Heat wave action plan

Information program for employees

Weather advisories to alert the public about dangerous heat conditions

Adequate financial and human public health resources, including training, surveillance and emergency response, and prevention and control programs

Others,

Review and monitor changes in weather pattern

Effectiveness of heat wave action plan

Temperature

Others, specify ___________ ___________

http://www.epa.gov/heatisland/about/excessiveheatevents.html






Implementation



phase) specify_________ _______________

Longer and more intense rains that restrict access to construction sites and slow productivity

Historical data on intense rainfall

Scheduling the construction activity

Others, specify___________ ________________

Review and monitor changes in weather events

Monitor resilience of drainage and flood control facilities

Others, specify, ______________

Earthquake Historical Records

Number of occurrence _______( indicate years)

Highest magnitude recorded ____(indicate years)

Incorporate in emergency response plan the climate change risk reduction

Engineering design

Constant communication with concerned line agency

Regular inspection of buildings and related facilities and infrastructures

Regular monitoring of early warning devices and preparedness systems to ensure their effectiveness

Others, specify, _____________ _____________

Volcanic Eruption Historical Records

Number of occurrence _______( indicate years)

Establishment of buffer zone to prevent gaseous nuisance

TOTAL EMP COST________

III. ABANDONMENT /DECOMMISSIONING/REHABILITATION POLICIES AND GENERIC GUIDELINES (if Applicable)

Project Life or Service : ___________ years Provide description of the Abandonment activities, such as, dismantling and waste disposal.

IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATION5

Organization Chart: 5 include in the plan improve coordination within and among affected stakeholders, organizing, and

providing scientific, technical and managerial personnel on climate change.

Insert chart here:

Attach sketch plan/lay-out of project site

(Use additional sheet if necessary)

Attach drawing/plan of air pollution source and control installation s (with dimensions and descriptions)


Attach drawing /plan of waste water treatment facilities (with dimensions and descriptions)


SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENT*

T h i s i s t o c e r t i f y t ha t a l l t he i n f o rm a t i on and c om m i tm en t s i n t h i s Initial Environmental Examination Checklist REPORT for PROJECT are accurate and complete to the best of our knowledge, and that an objective and thorough assessment of the Project was undertaken in accordance with the dictates of professional and reasonable judgment. Should I/we learn of any information, which would make this IEE Checklist REPORT inaccurate, I shall immediately bring the said information to the attention of DENR-EMB Region ____.

I hereby certify that no DENR personnel was directly involved in the preparation of IEE Checklist REPORT other than to provide procedural and technical advice consistent with the guidelines in the DAO 03-30 Revised Procedural Manual.

I hereby bind myself to answer any penalty that may be imposed arising from any misrepresentation or failure to state material information in IEE Checklist REPORT. In witness whereof, I hereby set my hand this ____ day of __________ at ______________________.

NAME OF THE PROPONENT HEAD (Position) (Company)

SUBSCRIBED AND SWORN TO before me this _____ day of ____________ 200_, affiant exhibiting his/her Community Tax Certificate No. ___________________ issued at ______________________ on __________________________.

Doc. No. ____________________ Page No. ____________________ Book No. ____________________ Series of ____________________

SWORN STATEMENT OF ACCOUNTABILITY OF PREPARERS (If applicable)

This is to certify that all information in Initial Environmental Examination Checklist REPORT for the (state name of project) PROJECT are accurate and complete to the best of our knowledge, and that an objective and thorough assessment of the Project was undertaken in accordance with the dictates of professional and reasonable judgment. Should we learn of any information which would make IEE Checklist REPORT inaccurate, we shall immediately bring the said information to the attention of the DENR-EMB Region ___.

We hereby certify that no DENR personnel was directly involved in the preparation of this IEE Checklist REPORT other than to provide procedural and technical advice consistent with the guidelines in the DAO 03-30 Revised Procedural Manual.

We hereby bind ourselves jointly and solidarily to answer any penalty that may be imposed arising from any misrepresentation or failure to state material information in this IEE Checklist REPORT. In witness whereof, I hereby set my hand this ____ day of __________ at ______________________.

Name Field of Expertise Signature

1.

2.

3.

4.

5.

SUBSCRIBED AND SWORN TO before me this _____ day of ____________ 2006, affiants exhibiting their Community Tax Certificate information, as follows:

Name Community Tax Certificate Information

CTC No. Place of Issue Date of Issue

1.

2.

3.

4.

5.

Doc. No. ____________________ Page No. ____________________ Book No. ____________________ Series of ____________________

Documents

Batch Plant Project Report