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Get Permit To Operate Online Application

Republic of the Philippines Department of Environment and Natural Resources ENVIRONMENTAL MANAGEMENT BUREAU REGION IV MIMAROPA 6th Floor DENR By the Bay Building 1515 Roxas Boulevard Ermita Manila APPLICATION FOR PERMIT TO OPERATE AIR POLLUTION SOURCE AND CONTROL FACILITIES IMPORTANT Read Carefully the INSTRUCTIONS before accomplishing the form. The applicant Pollution Control Officer or any person responsible for representing false statements/documents shall be prosecuted to the full extent of the law. NOTE NOTARIZED AND SUBMITTED IN TRIPLICATE COPIES Type New Renewal NAME OF FIRM/ESTABLISHMENT PLANT LOCATION/ADDRESS MAILING ADDRESS TELEPHONE NO. NATURE OF BUSINESS AUTHORIZED CAPITAL Additional Change of Ownership/Name List of Air Pollution Source Equipment APSE and Corresponding Air Pollution Control Facilities APCF covered by Permit Application* Description of source and Control Equipment e*g* Hp Boiler/Scrubber tons cap* Reverberatory/Bag House etc* APSE NO. OF UNITS APCF CERTIFIED CORRECT Print Applicant s Name Position O. R* NO. Signature of Applicant Permit Fee Filing Fee P. D. 1856 Penalty SUBSCRIBED AND SWORN to before me this day of issued on at affiant exhibiting to me her CTC No* at. NOTE NOTARIZED AND SUBMITTED IN TRIPLICATE COPIES Type New Renewal NAME OF FIRM/ESTABLISHMENT PLANT LOCATION/ADDRESS MAILING ADDRESS TELEPHONE NO. NATURE OF BUSINESS AUTHORIZED CAPITAL Additional Change of Ownership/Name List of Air Pollution Source Equipment APSE and Corresponding Air Pollution Control Facilities APCF covered by Permit Application* Description of source and Control Equipment e*g* Hp Boiler/Scrubber tons cap* Reverberatory/Bag House etc* APSE NO. NATURE OF BUSINESS AUTHORIZED CAPITAL Additional Change of Ownership/Name List of Air Pollution Source Equipment APSE and Corresponding Air Pollution Control Facilities APCF covered by Permit Application* Description of source and Control Equipment e*g* Hp Boiler/Scrubber tons cap* Reverberatory/Bag House etc* APSE NO. OF UNITS APCF CERTIFIED CORRECT Print Applicant s Name Position O. R* NO. Signature of Applicant Permit Fee Filing Fee P. OF UNITS APCF CERTIFIED CORRECT Print Applicant s Name Position O. R* NO. Signature of Applicant Permit Fee Filing Fee P. D. 1856 Penalty SUBSCRIBED AND SWORN to before me this day of issued on at affiant exhibiting to me her CTC No* at. NOTE NOTARIZED AND SUBMITTED IN TRIPLICATE COPIES Type New Renewal NAME OF FIRM/ESTABLISHMENT PLANT LOCATION/ADDRESS MAILING ADDRESS TELEPHONE NO. NATURE OF BUSINESS AUTHORIZED CAPITAL Additional Change of Ownership/Name List of Air Pollution Source Equipment APSE and Corresponding Air Pollution Control Facilities APCF covered by Permit Application* Description of source and Control Equipment e*g* Hp Boiler/Scrubber tons cap* Reverberatory/Bag House etc* APSE NO. OF UNITS APCF CERTIFIED CORRECT Print Applicant s Name Position O. R* NO. Signature of Applicant Permit Fee Filing Fee P. NATURE OF BUSINESS AUTHORIZED CAPITAL Additional Change of Ownership/Name List of Air Pollution Source Equipment APSE and Corresponding Air Pollution Control Facilities APCF covered by Permit Application* Description of source and Control Equipment e*g* Hp Boiler/Scrubber tons cap* Reverberatory/Bag House etc* APSE NO. OF UNITS APCF CERTIFIED CORRECT Print Applicant s Name Position O. R* NO. Signature of Applicant Permit Fee Filing Fee P. D. 1856 Penalty SUBSCRIBED AND SWORN to before me this day of issued on at affiant exhibiting to me her CTC No* at.

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