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PEZA INVESTORS' AWARDS
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Application Form for CY _____
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PEZA ENVIRONMENTAL PERFORMANCE (PEP) AWARD
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MicroSmallMediumLarge
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TYPE OF INDUSTRY:
Manufacturing
Service
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I. COMPANY PROFILE
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COMPANY NAME:
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OFFICE ADDRESS:
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NOMINATED SITE ADDRESS:
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CONTACT INFORMATION
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PRESIDENT:PHONE NO.
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EMAIL
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ENVIRONMENTAL MANGEMENT
REPRESENTATIVE (EMR):		MOBILE NO. (EMR)
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EMAIL (EMR)
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POLLUTION CONTROL OFFICER (PCO):MOBILE NO. (PCO)
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EMAIL (PCO)
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PEZA REGISTRATION INFORMATION
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REGISTERED ACTIVITY:
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PEZA REG. NO. :
YEAR START OF OPERATION:
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YEAR OF REGISTRATION:PROJECT COST:
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II. SUMMARY OF THE COMPANY'S ENVIRONMENTAL MANAGEMENT SYSTEM (EMS)
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(The EMS must have been implemented for at least 3 years.)
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1) Is the company implementing EMS?
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YesNo
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Please proceed to # 2
Please proceed to Section III
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2) Please provide information on your EMS implementation below:
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Start of EMS implementation:
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Is the company's EMS certified by a third party?
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Yes
No, Please proceed to Annex 1 - EMS Checklist
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First certification awarded on:
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Current EMS Standard:
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Certification issued by:
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Certification valid until:
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Certification covers (plase identify/mark applicable):
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nominated site only
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multiple sites, nationwide
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multiple sites, global
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Frequecy of third party surveillance/recertification audit in the nominated site:
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Please proceed to Annex 1 - EMS Checklist
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III. SUMMARY OF THE COMPANY'S CONTINUED IMPROVEMENT (CI) ACTIVITIES
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(Identified CI Activities must be quantifiable. The activities should have been implemented for at least 3 years.)
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1) Has the company implemented any activities/projects in the last three years to attain improvement in any environmental aspect?
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YesNo
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Please proceed to question #2
Please proceed to Section IV
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2) Below is a list of environmental aspects. Please identify applicable environmental aspect/s that was the focus of any implemented activities/projects in the last 3 years.
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Energy use
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Waste management (solid wastes)
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Material use
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Waste management (hazardous wastes)
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Water use
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Others (please specify_______________)
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3) Has the company attained improvement in the identified environmental aspect/s for the last three (3) years?
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YesNo
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Please see Annex 2 - CI Sheet
Please proceed to Section IV
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Please accomplish 1 CI Sheet for each identified aspect
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IV. SUSTAINED COMPLIANCE ACTIVITIES
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(Please identify the environmental requirements that apply to your company. Check on all boxes that apply to your facility and fill in the corresponding data. )
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General Environment
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oECC/CNC
ECC/CNC No:
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(attach copy)
Date issued:
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LLDA Clearance
LC No:
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(attach copy)
Date issued:
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Pollution Control Officer/s
Name:
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Accreditation No:
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Name:
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Accreditation No:
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ECC Compliance Monitoring Report (attach as sample copy of latest submitted report)
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Self Monitoring Report (identify all applicable case)
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Submitting to DENR-EMB (attach as sample copy of latest submitted report)
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Submitting to LLDA (attach as sample copy of latest submitted report)
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Air Quality Management
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DENR PTO for Emission Sources (attach copy)
Permit No.:
Validity:
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Hazardous Waste Management
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oHazardous Waste Generator's ID (attach copy)
DENR ID No.:
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Permit to Transport (attach 1 sample copy)
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DENR Transporter Registration Certificatee of HW Treater (attach 1 sample copy)
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DENR TSD Registration Certificatee of HW Treater (attach 1 sample copy)
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HW Manifest (attach 1 sample copy of HW Manifest)
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Certificate of Treatment/Disposal (attach 1 sample copy)
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MOA or Joint Undertaking between Generator and Transporter, Generator and Treater (attach copy for each)
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Water Quality Management (report in a separate sheet if there are more than one issued permit)
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NWRB Permit (attach copy)
Permit No.:
Validity:
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DENR/LLDA Discharge Permit (attach copy)
Permit No.:
Validity:
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Certificate of Interconnection (attach copy)
Permit No.:
Validity:
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Solid Waste Management
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PEZA Accreditation of Scrapper (attach copy)
Permit No.:
Validity: