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DENR Hazardous Waste Registration Form A Registration form for HW Generator Section A1. General Information of Generator 1. DENR ID 2. Date of issued D/M/Y / 3. Name of Firm 4. Plant Address 5. Date of Establishment 6. Tel 7. Fax 8. Office Address 9. Tel 10. Fax 10. Pollution Control Officer 11. Tel 13. e-mail 14. General Description of Business/Operation Philippine Standard Industrial Classifications 16. Major Products 15. Primary 16. Secondary 17. Authorized Capitalization Pesos/year 18. Paid-up Capitalization Pesos/year 19. Approximate Annual Turn -over Pesos/year 20. Total No* of Employees 21. Admi. Employees 22. Plant Employees Please append the following 1 Process flow diagram all waste streams 2 Mass balance of manufacturing process 3 Description of existing waste management plan 4 Analysis of waste s 5 Other relevant information e*g* planned changes in production processes or output comparison with related operations. 6 Copy of Environmental Compliance Certificate ECC 7 Copy of Valid Permits to Operate Pollution Control Facilities 8 If on-site treatment is present submit the A4 form for every TSD facility. I certify that the enclosed information is a true and accurate record as available. Pollution Control Officer Signature 1 to be filled up by EMB Date D/M/Y 2/4 Section A2. Waste Generation Per Year by Type of Waste Approximately 1. HW No* 2. Waste name description 3. HW Nature HW Nature Lq Liquid So Solid Sl Sludge Ga Gases 4. Toxic HW Cataloging 5. Corrosive 6. Reactive 7. Flammable 8. Total Volume ton/year Transporter 2. TSD 3. Volume 4. Storage Location ton/year Method 5. ID No* 6. Name On-site or Off-site Storage Method D 3/4 Treater Disposal 9. Method 10. ID No* 11. Name 12. Method A4. Information of HW Treatment Premises 4. Address of TSD 5. Treatment method and Capacity A Physico-Chemical treatment B Thermal treatment C Solidification D Storage F Recycle Method Date of permit to Treatment Capacity operate Type of HW can be treated ton/day 3 Initial Environmental Examination IEE or Environmental Impact Statement EIS submitted to the EMB Regional offices all/by-products end-products and residues 6 Storage management plan for raw materials residues by-products and end-products 7 Photograph/s of the facilities showing processing areas storage areas. DENR ID 2. Date of issued D/M/Y / 3. Name of Firm 4. Plant Address 5. Date of Establishment 6. Tel 7. Fax 8. Office Address 9. Tel 10. Fax 10. Pollution Control Officer 11. Tel 13. e-mail 14. General Description of Business/Operation Philippine Standard Industrial Classifications 16. Fax 8. Office Address 9. Tel 10. Fax 10. Pollution Control Officer 11. Tel 13. e-mail 14. General Description of Business/Operation Philippine Standard Industrial Classifications 16. Major Products 15. Primary 16. Secondary 17. Authorized Capitalization Pesos/year 18. Paid-up Capitalization Pesos/year 19. Major Products 15. Primary 16. Secondary 17. Authorized Capitalization Pesos/year 18. Paid-up Capitalization Pesos/year 19. Approximate Annual Turn -over Pesos/year 20. Total No* of Employees 21. Admi. Employees 22. Plant Employees Please append the following 1 Process flow diagram all waste streams 2 Mass balance of manufacturing process 3 Description of existing waste management plan 4 Analysis of waste s 5 Other relevant information e*g* planned changes in production processes or output comparison with related operations. .

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