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Republic of the Philippines
Department of Environment and Natural Resources
ENVIRONMENTAL MANAGEMENT BUREAU
Region I
EMB Office, DENR Building, Government Center Barangay Sevilla,
City of San Fernando La Union
Tel No: (072) 700-24-48
APPLICATION FOR PERMIT TO OPERATE
Air Pollution Source Installations
A. General Information
Application No.
156783
Application Type
New
Name of Owner
CSI Warehouse Club Inc.
Name of Establishment
Lucao Lifestyle Center
Mailing Address
Judge Jose De Venecia Extension, Lucao, Dagupan City, Pangasinan
Zip Code
2400
Mailing Tel.No.
n/a
Plant Name
Lucao Lifestyle Center
Plant Address
Judge Jose De Venecia Extension, Lucao, Dagupan City, Pangasinan
Plant Zip Code
2400
Plant Geolocation
1,1
Plant Tel.No.
n/a
Mailing Fax No.
Plant Fax No.
n/a
n/a
B. Company Information
TIN
1
Nature of Owndership
EIA Classification
Commercial
Nature of Business
Restaurant
Authorized Capital
Php 1.00
Date of Start of Operation
Nov. 1, 1
ECC Number
1
CNC Number
1
Managing Head
CAROLINE FERNANDEZ
Tel. No. 1
Name of PCO
PAOLO QUEBRAL SANGALANG
Tel. No. n/a
PCO Designation
Corporate PCO
PCO Accreditation No
n/a
Paid up capital
PCO Accreditation
Validity
Corporation
Php 1.00
Jan. 1, 11
C. Other Company Related Information
Office Operation (hrs/day)
10
Office Operatation (days/week)
Production Operation (hrs/day)
1
Production Operation (days/week) 1
Total Employees
1
Land Area
1 m2
Land Ownership
Owned
Land Use
D. Raw Material and Product Information
Raw Material
Quantity
Product
Quantity
7
Commercial
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There are no raw materials defined
E.1 Air Pollution Sources Installation (APSI) for Fuel Burning Subject for Permitting
APSI
APSI Name
Capacity
Standby
Other
Power
sources of air
Generator
pollution
Set
600.54 Hp
Date
Installed
Brand Name Type of Fuel
Cummins
Diesel
Technical
Description
Used as
Emergency
Standby
Power
Dec. 9, 2020
Generator
Set in case
of Power
Interruption
Remarks
With
Emission
Test since
the unit has a
capacity of
400 Hp
above
E.2 Air Pollution Sources Installation (APSI) for Non Fuel Burning Subject for Permitting
APSI
APSI Name
Capacity
Brand Name
Raw Material Date Installed
Technical
Description
There are no sources defined
E.3 Air Pollution Control Device (APCD) Subject for Permitting
APCD
Description
Capacity
Remarks
There are no devices defined
E.4 Stacks
Name
Height
Diameter
Temperature
Velocity
There are no stacks defined
F. APSI APCD Mapping
ID
1
ID
APSI
Connected APSIs
(<name> (id))
Standby Power Generator
None
Set (1)
APCD
Connected APCDs
(<name> (id))
None
Connected APSIs
(<name> (id))
Connected Stacks
(<name> (id))
None
Connected APCDs
(<name> (id))
Connected Stacks
(<name> (id))
There are no mappings defined
NOTARIZED CERTIFICATION
We hereby certify that the above information are true and correct to the best of my knowledge. Done this
________ day of ______________________ of ______________.
PAOLO QUEBRAL SANGALANG
CAROLINE FERNANDEZ
Pollution Control Officer
Managing Head
SUBSCRIBE AND SWORN to before a Notary Public this _______ day of ___________________________.
Affiant exhibiting to Officer Officer me his/her government issued ID with no. ________.
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NOTARY PUBLIC