SMR has been established by DENR as

part of the compliance monitoring system

of the Department
 SMR has two main objectives:

•Allows the firm or establishment to demonstrate their

compliance with environmental regulations

•Allows EMB to confirm and validate that firms or

establishments comply with the environmental
regulations or requirements
 SCOPE of SMR :

All firms requiring the services of :

Accredited Pollution Control Officer

(Annex A of DAO 92-26)

Full time Pollution Control Officer

(Annex B of DAO 92-26)
 SMR covers Seven Modules :
MODULE O. General Information Sheet
MODULE 1.General Information
MODULE 2. R.A. 6969
MODULE 3. (P.D 984) R.A 9275
MODULE 4. R.A.8749
MODULE 5. P.D.1586
MODULE 6. Other Additional information
 Submission of SMR :
All covered firms shall submit SMR on a Quarterly basis

SMR shall be submitted within 15 calendar days after the end of

the quarter

Printed hard copies

Note: SMR shall include the module/s applicable to the facility

 Submission of SMR :
SMR submission shall not exceed three (3) copies

It will take EMB-RO approximately 15 working days to review

and evaluate SMR’s

Issuance of “Notice of Deficiency”

Note: SMR is deemed acceptable if the regional office does not issue
“Notice of Deficiency”
 Evaluation of SMR :
Consistent with the requested information

Accurate and precise

Degree of consistency (findings, assessments,

analysis and recommendations)

Responsive to the requirements of the environmental

standards
MODULE 0. General Information Sheet

This module provides basic information

about the establishment, firm or facility

it shall only be prepared once

FORMAT of (MODULE 0.)
Department of Environment and Natural Resources
Environmental Management Bureau Reference No:

(to be filled up by DENR only)

GENERAL INFORMATION SHEET

Name of the Establishment/Facility

Street # & Street Name: _________________________________

Establishment/ Facility Address ( Not
the company of head office ) Barangay : ________________ City Municipality : ___________
Province : ___________________________________________

Name of Owner/ Company

Street # & Street Name: _________________________________

Address ( if address is not the same
as previous address) Barangay : __________________ City Municipality : _________
Province : ___________________________________________
Phone Number Fax Number

e-mail address

Type of Business/ Industry Philippine Standard Industry Classification Code No.________

Classification
Philippine Standard Industry Description : _________________
FORMAT of (MODULE 0.)
Responsible Officer/s:
CEO/President
Tel # : ____________________ Fax # : ______________
e-mail address : _________________________________
Plant Manager
Tel # : ____________________ Fax # : ______________
e-mail address : _________________________________

Name :
Pollution Control Officer
Tel # : ____________________ Fax # : ______________
e-mail address : _________________________________

Legal Classification [ ] single proprietorship [ ] partnership

[ ] private domestic corporation [ ] government corporation
[ ] Multi- national [ ] ________________

We hereby certify that the above information are true and correct.
Name/Signature of CEO/ President Name/Signature of PCO
MODULE 1. General Information

It is intended to provide background information

about the establishment, firm or facility including
changes or modifications to Module O

It must be included in ALL submissions of SMR

 FORMAT of (MODULE 1.)
Name of Plant :
Reference No:
__________________________________________
(to be filled up by DENR only)

Department of Environment and Natural Resources

Environmental Management Bureau

Module 1: General Information

Name Plant
Please provide the necessary revised, corrected or updated information not contained in your
General Information Sheet

(use additional sheet/s if necessary)

FORMAT of (MODULE 1.)
DENR Permits/Licenses/Clearances

Environmental Laws Permits Date Issue Expiry Date

R.A. 9275 A/C No.

PO No.
PD1586 ECC 1
ECC 2
ECC 3
R.A. 6969 DENR
Registry ID
CCO
Registry
Importer
Clearance
No.
Permit to
Transport
R.A. 8749
A/C No.
PO No.

Module 1 : General Information Page___of_____

 FORMAT of (MODULE 1.)
Name of Plant :
Reference No:
_________________________________________
(to be filled up by DENR only)

Operation
Operating # of shift/day
Operating hours/day days/week

Average
Maximum

Operation/Production/Capacity
Average Daily
Production Output Total Production
Output this
Quarter
Total Water TotalElectric
Consumption this Consumption this
Quarter ( cubic Quarter
meters)
Please use additional sheet/s if necessary

Module 1 : General Information Page___of_____

MODULE 2A. (R.A 6969/CCO Report)

Compliance on R.A. 6969

specifically CCO Report
FORMAT of (MODULE 2A.)
Module 2: RA 6969
A. CCO Report ( please accomplish this section for each/ substances)

Common Name/ IUPAC/CAS Index Name. ___________________________________________________

___________________________________________ CAS No. __________________________________
Trade Name:___________________________________________________________________________

For importers only;

Quantity Import Date of Quantity Port of Country of Country
Requested Clearance Arrival Received Entry Origin Manufacture
No.

Total Quantity Total Quantity

Requested ( annual) Received ( annual)

* Attach copy/s of Bill of Landing

FORMAT of (MODULE 2A.)
Module 2: RA 6969
For distributors (importers/non-importers)

Name of Client License No. Quantity Date of Distribution

Total Quantity Distributed

For non-importer users:

Name of Distributor Quantity Date of Purchase

Total Quantity Purchased from Distributor

Module 2: RA 6969 (CCO Report) Page____of_________

FORMAT of (MODULE 2A.)
Module 2: RA 6969
For distributors (importers/non-importers)

Name of Client License No. Quantity Date of Distribution

Total Quantity Distributed

For non-importer users:

Name of Distributor Quantity Date of Purchase

Total Quantity Purchased from Distributor

Module 2: RA 6969 (CCO Report) Page____of_________

 For producers
Average Daily Total Output this
Production Output Quarter
Quantity of Stock Quantity of Stock
Inventory ( Start of Inventory ( End of
Quarter) Quarter )
Name of Buyer Quantity Date of Purchase

Total Quantity Sold

Used in Production (please fill up if chemical/substance is not main product)

Average Production Total Output this

Output Quarter
Average Quantity Total Quantity Used
Used per month this Quarter
Describe any changes in Production/Process/Operations:
Stock Inventory/Waste Chemical Generated:

Average Quantity of Total Quantity of

Waste Chemical Waste Chemical
Generated per month Generated this
Quarter
Quantity of Stock Quantity of Stock
Inventory ( Start of Inventory ( End of
Quarter ) Quarter)

Other Information
Manner of handling
hazardous wastes Storage on-site Treatment on-site
Storage off-site Treatment off-site
Changes in Safety  Yes (please attach copy of revised plan)
Management System  No
 Yes ( please attach copy if not submitted/included in previous report/s or had
been revised)
Chemical Substitute
Plan  No

Module 2: RA 6969 (CCO Report) Page____of_________

MODULE 2B. (Hazardous Waste Generator)

It is only applicable to hazardous wastes

generator
FORMAT of (MODULE 2B.)
B. Hazardous Wastes Generator
HW Generation:
Remaining HW HW Generated
HW No. HW Class HW Nature HW Cataloguing from Previous
Bericht
Quantity Unit Quantity Unit

Waste Storage, Treatment and Disposal: (please fill-up one per HW)
HW No,: ________________ __________________________________________________________________________
HW Details Qty of HW Treated: ________________________________________________Unit:___________________________ _______
TSD Location : ___________________________________________________________ __________________ ______

Storage Name : _____________________________________________________________________ __________________ ______

Method : ________________________________________________________________________ _____________ _____

Transporter ID:___________________________________________ ________ Name: ______________________________________

Date: ________________________________ ________________________________________________________ ______

Treater ID:__________________ _____________________ Name: ___________________________________________ ______

Method : ______________________ ___________________________________ Date : ___________________ ____

Disposal ID:______________________________ _______ Name: _______________________________________________ ____

Date:______________________________________ _______________ Date: ______________________________ ____
FORMAT of (MODULE 2B.)
HW No,: __________________________________________________________________________
HW Details Qty of HW Treated: ____________________________________________Unit:_______________ _______
TSD Location : ___________________________________________ __________________ ______
Storage Name : ____________________________________________________ __________________ ______
Method : _______________________________________________________ _____________ _____
Transporter ID:_________________________________ ________ Name: _______________________________
Date: ________________________________ ________________________________________ ______
Treater ID:__________________ _____________________ Name: ___________________________ ______
Method : ______________________ ___________________ Date : ___________________ ____
Disposal ID:______________________________ _______ Name: ________________________________ ____
Date: _______________ ____
On-Site Inspection of Storage Area:
Date Conducted Premises/Area Inspected Findings & Observation Corrective Action Taken (
if any)

Module 2B : R.A. 6969 ( Hazardous Wastes Generator ) Page________of________

MODULE 2C. (Hazardous Waste Treater/Recycle)

It is only applicable to hazardous wastes

Treater and Recycle
FORMAT of (MODULE 2C.)
C. Hazardous Wastes Treater/Recycler
HW Stored and/or Untreated as of End f Quarter:

Type of
Transport Storage Time Table
Wastes Date of
HW Number Permit/Date Valid until Quantity Container/ for
Generator Transport
of Issue # of Treatment
containers

HW Treated and/or Recycled as of End of Quarter:

Type &
Type of
Transport Quantity of
Type of Wastes Date of Treatment or
HW Number Permit/Date Quantity Recycled or
Wastes Generator Transport Recycling
of Issue Treated
Process
Product
FORMAT of (MODULE 2C.)
Residual Wastes Generated from the Treatment and/or Recycling Operation:

Type of
Process by
Storage
Type of HW which the Disposal Time Table
Quantity Container/
Wastes Number Wastes is Option for Disposal
# of
Generated
containers

Module 2C: RA 6969 (Hazardous Wastes Treater/Recycler) page ____ of ____

MODULE 3. (R.A 9275 WaterPollution)

It is intended to provide
information related to compliance
on R.A 9275

It is only applicable for facility or

establishment with waste water
discharges
 FORMAT of (MODULE 3.)
MODULE 3: R.A.9275 (Water Pollution)

Water Pollution Data

Domestic wastewater Process wastewater
(cubic meters/day) (cubic meters/day)
Cooling water Others: ___________
(cubic meters/day) (cubic meters/day)
Wash water, equipment Wash water, floor
(m3/day) (cubic meters/day)

Record of Cost of Treatment (Separate entries for separate facilities)

Month 1 Month 2 Month 3

Person employed, (# of
employees)
Person employed, (cost)
Cost of Chemicals used by
WTP
Utility Costs of WTP
(electricity & water)
Administrative and Overhead
Costs
Cost of operating in-house
laboratory
New/Additional Investments
in WTP
(Description)
Cost of New/Add Investments
 FORMAT of (MODULE 3.)
MODULE 3: R.A.9275 (Water Pollution)

WTP Discharge Location

Outlet
Location of the Outlet Name of Receiving Water Body
Number
1
2
3
4
5

Module 3: P.D. 984 (Water Pollution) page ____ of ____

 FORMAT of (MODULE 3.)
Detailed Report of Wastewater Characteristics for Conventional Pollutants

Outlet No.
Effluent Oil & ________
BOD TSS Temp rise
DATE Flow Rate Color pH Grease (name)
(mg/L) (mg/L) (ºC)
(m3/day) (mg/L) (unit)

Please fill-up/accomplish separate form/s for other outlet/s.

Module 3: P.D. 984 (Water Pollution) page ____ of ____

 FORMAT of (MODULE 3.)
Detailed Report of Wastewater Characteristics for Other Pollutants
Outlet No.
Effluent ________ ________ ________ ________ ________ ________ ________
DATE Flow Rate (name) (name) (name) (name) (name) (name) (name)
(m3/day) (unit) (unit) (unit) (unit) (unit) (unit) (unit)

Please fill-up/accomplish separate form/s for other outlet/s.

Please use another sheet/s if necessary.

Module 3: P.D. 984 (Water Pollution) page ____ of ____

MODULE 4. (R.A 8749 Air Pollution)

It is only applicable for facility or establishment

with emissions from process equipment or fuel
burning equipment
FORMAT of (MODULE 4.)
MODULE 4: R.A. 8749 (Air Pollution)

Summary of APSE/APCF

Process Equipment Location # of hrs of operations

1.
2.
3.
4.

Quantity # of hrs of
Fuel Burning Equipment Location Fuel Used
Consumed operations

1.
2.
3.
4.
5.
6.
Pollution Control Facility Location # of hrs of operations
1.
2.
3.
4.
 FORMAT of (MODULE 4.)
MODULE 4: R.A. 8749 (Air Pollution)

Cost of Treatment
Month 1 Month 2 Month 3
Cost of Person
employed, (salary)
Total Consumption of
Water (cubic meters)
Total Cost of chemicals
used (e.g., activated
carbon, KMnO4)
Total Consumption of
Electricity (KwH)
Administrative and
Overhead Costs
Cost of operating in-
house laboratory, if any
Improvement or
modification, if any.
(Description)
Cost of improvement of
modification

Module 4: RA 8749 (Air Pollution) page ____ of ____

 FORMAT of (MODULE 4.)
Detailed Report of Air Emission Characteristics

Description/Location
of PCF
________ ________ ________ ________
Flow Rate CO NOx Particulates
DATE (name) (name) (name) (name)
(Ncm/day) (mg/Ncm) (mg/Ncm) (mg/Ncm)
(mg/Ncm) (mg/Ncm) (mg/Ncm) (mg/Ncm)

Please fill-up/accomplish separate form/s for other PCF/s.

Please use additional sheet/s if necessary.

Module 4: RA 8749 (Air Pollution) page ____ of ____

MODULE 5. (P.D 1586 / EIS System)

It is only applicable for facility or establishment

with ECC

It shall be included in the submission of SMR on

an annual basis only (during the last quarter)

It should be integrated for facilities covered by

multiple ECC
FORMAT of (MODULE 5.)
MODULE 5:P.D. 1586

Ambient Air Quality Monitoring (if required as part of ECC conditions)

Description/Locati
on
of Monitoring
Station
______ ______ ______ ______
Particulat
Noise CO NOx __ __ __ __
es
DATE Level (mg/Nc (mg/Nc (name) (name) (name) (name)
(mg/Ncm
(dB) m) m) (mg/Nc (mg/Nc (mg/Nc (mg/Nc
)
m) m) m) m)

(Please accomplish one table per monitoring station.)

FORMAT of (MODULE 5.)
Ambient Water Quality Monitoring (if required as part of ECC conditions)

Description/Location
of Sampling Station
________ ________ ________ ________ ________ ________ ________ ________
DATE (name) (name) (name) (name) (name) (name) (name) (name)
(unit) (unit) (unit) (unit) (unit) (unit) (unit) (unit)

(Please accomplish one table per monitoring station.)

Module 5: P.D. 1586 (EIS System) page ____ of ____

FORMAT of (MODULE 5.)
Other ECC Conditions

Status of
ECC Condition/s Compliance Actions Taken
Yes No
1.
2.
3.
4.
Please use additional sheet/s if necessary.

Environmental Management Plan/Program

Status of Implementation
Enhancement/Mitigation Measures Actions Taken
Yes No
1.
2.
3.
4.
Please use additional sheet/s if necessary.
FORMAT of (MODULE 5.)
Solid Waste Characterization/Information:

Average Quantity of Total Quantity of

Solid Wastes Solid Wastes
Generated per Generated this
month Quarter
Average Quantity of Total Quantity of
Solid Wastes Solid Wastes
Collected per month Collected this
Quarter
Entity in charge of
collecting solid
wastes
Brief Description of
Solid Waste
Management Plan
(e.g., waste
reduction,
segregation,
recycling)
Please use additional sheet/s if necessary.

Module 5: P.D. 1586 (EIS System) page ____ of ____

MODULE 6. (additional Information)

It is intended to provide information that are not

exclusive to any of the other module/s

It must be included in ALL submission of SMR

It also includes the notary portion of the SMR

FORMAT of (MODULE 6.)
MODULE 6:OTHERS

Accidents & Emergency Records

Findings and
Date Area/Location Actions Taken Remarks
Observation

Personnel/Staff Training

Date Conducted Course/Training Description # of Personnel Trained

FORMAT of (MODULE 6.)
I hereby certify that the above information are true and correct.

Done this _________________________, in ________________________.

___________________ _________________________________
Name/Signature of CEO Name/Signature of PCO

SUBSCRIBED AND SWORN before me, a Notary Public, this ________ day of
______________________, affiants exhibiting to me their Community Tax Receipts:

Name CTR No. Issued at Issued on

___________ _____________ _______________ ______________
___________ _____________ _______________ ______________
ISUANCE OF NOTICE OF DEFICIENCY

Has been found to be insufficient and/or

unsatisfactory by the R.O
FORMAT of (MODULE 6.)
Thank you for listening