1st 2nd 3rd 4th Screening

FORM 1-C : PROCEDURAL EVALUATION (SCREENING) FOR Environmental Performance Report and Management Plan (EPRMP-IEE

Limits)

Project Title : ___________________________________________________________________________Project Location:_________________________________________________________________________Project Proponent : __________________________________ ____________________________________ Address: ______________________________________________________________________________Tel.No. ____________ Fax No. _______ Contact Person : ______________________________________EIS Consultant :__________________________________._______________________________________Address: _______________________________________________________________________________Tel. No._____________ Fax: __________ Contact Person : ______________________________________Date Submitted for Screening : _____________________________________________________________Status of Application : ( ) Existing w/ previous ECC ECC # __________________ Issuing Office: ________________________

ECC Scope : ___________________________________________________________________________________________________________

( ) Existing w/o ECC but started implementation prior to 1982Date of Implementation : _____________________________________

( ) Existing w/o ECC but started implementation after to 1982Date of Implementation : ______________________________________

Project Group Based on Tresholds only:( ) Single, Group 2 in ECA ; Project Code _________________( ) Group IV / Co-located( ) Group V / Unclassified _______________________________

Project Size : Floor Area : _______________________________________________Lot Area : _______________________________________________Production/Storage Capacity ____________________________________

PSIC Code (based on DTI Registration) : ________________________________________Checklist of EPRMP Requirements

EPRMP Requirements

Page

Casehandler’s Evaluation

Acceptable?

Remarks

Project Fact SheetTABLE OF CONTENTSEXECUTIVE SUMMARY

o Brief Project Descriptiono Brief Summary of Project’s EIA Process o Brief description of the existing project vis-à-vis the proposed

expansion or changeso Summary on the EIA Findings on the Key Significant Impacts of

the Project and corresponding EMP highlightso Summary of the Environmental Monitoring Plan on the most

significant impacts and key measuresDRAFT MAIN EPRMP

1. BASIC PROJECT INFORMATION2. DESCRIPTION OF THE PROJECT’S EIA

PROCESS2.0 Terms of Reference of the EIA Study2.1 EIA Team (Proponent & Preparer Team members, module of

involvement, expertise)2.2 EIA Study Schedule2.3 EIA Study Area (project area up to extent of coverage of study)2.4 EIA Methodology (per module)2.5 EIA Public Participation (if any)

3. PROJECT DESCRIPTION

3.1 Basic Project Background and Information3.2 Project Rationale3.3 Complete project location (barangay, municipality, province, etc)

with geographic coordinates.3.4 Project Site Considerations3.5 Description of Project Phases & Activities3.6 Resource & Utility Requirements, Manpower, Cost3.7 Waste Generation & Built-in Management Measures

Screening for (Project Title/Proponent): ______________________________________

1st 2nd 3rd 4th Screening

EPRMP Requirements

Page

Casehandler’s Evaluation

Acceptable?

Remarks

Summary of Comparison of the new and old projects

4. BASELINE ENVIRONMENTAL CONDITIONS FOR CRITICAL ENVIRONMENTAL PARAMETERS, IMPACT ASSESSMENT & MITIGATION (limit to relevant modules)4.0 The Land 4.1 The Water4.2 The Air4.3 The People

5. ENVIRONMENTAL PERFORMANCE BASED ON THE ORIGINAL ECC-COVERED ENVIRONMENTAL MANAGEMENT PLAN

5.1. Impact(s) Mitigation Plan (IMP)5.2. Environmental Monitoring Plan (EMoP) and other Monitoring

Modes 5.3. Information, Education and Communication (IEC) and Social

Development Program (SDP) or Community Assistance Program (CAP)

5.4. Environmental Risk Management and Emergency Response Programs (ERP)

5.5. Abandonment/Rehabilitation Programs5.6. Institutional Set-up5.7. Achievements/Awards and Outstanding Accomplishments on the

Environment6.0 ENVIRONMENTAL RISK ASSESSMENT 7.0 ENVIRONMENTAL RISK CATEGORIZATION

(PEMAPS)8.0 ENVIRONMENTAL MANAGEMENT PLAN (EMP)

FOR CURRENT PROJECT & PROPOSED MODIFICATION/ EXPANSION – including EMF and EGF

9.0 BIBLIOGRAPHY 10.0 ANNEXES

o Commitments or Agreementso Accountability Statements of Preparers & Proponento Photographs or plates of the project site, impact areas an affected

areas and communitieso Copy of Previous ECC (if any)o If w/ ECC, Copy of the latest Self Monitoring Report (EIA Module

Only) & SMR Evaluation Results by EMB (if any)

ACTION TAKEN: (Please check to indicate corresponding action taken) Document accepted; please submit _____ copies

EIARC Needed? ( ) Yes ( ) No Expertise Needed: __________________________Processing Fee : PhP 3,000 (Pay at EMB Cashier) Review Fund: Based on WFP (Pay at NRDC)

Document not accepted

O.R. No. Date

NOTED BY:

(signature over printed name) SCREENING OFFICER PURA VITA G. PEDROSA____ (signature over printed name) ___________________________ SCREENING OFFICE

Date

Screening for (Project Title/Proponent): ______________________________________

1st 2nd 3rd 4th Screening

Screening for (Project Title/Proponent): ______________________________________