NSTRUCTIONS ON THE PREPARATION AND SUBMISSION OF THE IEE

CHECKLIST
This section discusses how the project proponent will fill-up and answers the various
questions and information stated in the checklist. Likewise this section will also inform
the project proponent the permit requirements to be attached to the checklist, where to
submit and process such application and the timeframe for DEN processin!.
A. Contents of the IEE Checklist
The "EE #hecklist is a simplified form desi!ned to assist proponent$s rice mill project%s
in compl&in! with the E"' s&stem. The "EE #hecklist, to be accomplished and submitted
before undertakin! a project, consists of a series of questions that deals with issues and
concerns about the proposed project and its environment. The questions will also provide
the proponents with information on environmental impacts, both positive and ne!ative,
which will be caused b& the proposed project.. The "EE #hecklist has to be submitted b&
all !overnment and private sector proponents appl&in! for an E## coverin! the
abovementioned projects. The information contained herein will serve as a basis for the
review and assessment of the E() e!ional *ffice for the issuance and%or denial of the
E##.
The "EE #hecklist is divided into four +,- major sections.
Section A consists of the !eneral information re!ardin! the proponent/
Section B project location, plan%desi!n components and activities durin! the
development and operation phase/
Section C consists of the information re!ardin! the description of the e0istin!
environmental condition where the road or brid!e will be located 1 the
ph&sical biolo!ical, socio-cultural and economic environment/
Section D consists of the listin! of possible potential impacts that ma& occur in the
various sta!es of the project establishment and operation/ correspondin!
miti!ation and enhancement measures to prevent the occurrence of
adverse impacts and stren!then the positive effects of the project/
Section E contains *perational Details
Section F contains 'upplemental "nformation that provides the commitment of the
proponent
Section ! consists document attachments required to be submitted as part of the
"EE #hecklist
B. Inst"#ctions on the P"e$%"%tion of the IEE Checklist
2. The "EE #hecklist can be prepared b& the proponent or an& of his%her authori3ed
representative e.!. E() (emorandum #ircular No. 4,, 'eries of 2556 +27 8u!ust
2556-. The proponent9s si!nature in the report shall be sufficient. The proponent ma&
seek the help of the DEN personnel b& clarif&in! questions in the "EE #hecklist.
:. To use the #hecklist, the proponent ma& put a check +4- mark in the appropriate bo0.
"f &our answer does not fall in an& of the pre-determined responses, check +4-
*T;E' and indicate &our specific answer in the blank space provided or use
additional sheets as necessar&. "f some questions are not applicable to &our project,
write N%8 on the blank space or column
<. To facilitate and assist the proponent in answerin! 'ection <.4 of this checklist, a
menu is provided to serve as a !uide and reference. ;owever, it should be noted that
this onl& serves as a menu checklist hence, proponents are hi!hl& encoura!ed to
identif& additional impacts and miti!ation%enhancement measures other than those
provided in the menu
The proponent ma& put a check +4- to the columns of = or N on the pre-determined
and identified (iti!ation%Enhancement measures column. The proponent ma& choose
the miti!atin! measures appropriate to the impacts identified for the proposed project.
,. >or the section on 8ttachment write a check mark +4- on the title or description of
the document to be submitted. The listed documents are (?'T requirements and
should be submitted. *therwise, the application will not accepted.
@. 8nswers to the questions are not be strictl& confined to the pre-determined responses.
The proponent ma& elaborate and use as man& additional sheet as needed to be able
to provide adequate answers to the required information. (aps, pictures, drawin!s
+e.!. charts, tables, dia!rams, sketches- and other visual aids is deemed to provide
better description of the information provided in the #hecklist. These will help E()
in understandin! the proposed project, and make decision on the application for E##.
C. Inst"#ctions on the S#&'ission of the IEE Checklist
A. ?pon completion of the "EE checklist, the project proponent shall submit one +2- set
of the #hecklist at the E"8 'ection of the E() e!ional *ffice, E"8 'ection where
the project is to be located. 8 dul& accomplished Brocedural 'creenin! >orm shall
accompan& the "EE #hecklist submission.
7. ?pon the presentation%submission of the #hecklist, the 'creenin! *fficer shall
immediatel& determine its completeness and conformance with the DEN prescribed
requirements. "mmediate determination shall mean completion of the Brocedural
eview within the same da& of "EE checklist submission.
6. The 'creenin! *fficer shall indicate, throu!h a check%tick mark under the =es, No or
Not applicable column, the presence or absence of a particular information required.
5. The determination of the completeness of the "EE #hecklist will be based on the
sufficienc& of responses to all questions or checklist and information provided in the
matri0.
24. "f the "EE #hecklist is complete, it will be formall& accepted. The proponent will be
furnished a cop& of the accomplished procedural form dul& si!ned b& the 'creenin!
*fficer.
22. "f the #hecklist is incomplete, it shall be immediatel& returned to the proponent for
revision or submission of the missin! requirement%information. The reason for non-
acceptance shall be stated in writin! at the appropriate place in the form.
2:. "f the "EE #hecklist has complied with all the DEN prescribed requirements, the
proponent shall submit < copies of the documents to E"8 'ection of the concerned
E() e!ional *ffice.
The proponent shall pa& the amount of B<,444.44 at the #ashier 'ection of concerned
E() e!ional *ffice upon submittin! the required number of copies at the ecord
'ection of the same office.
2<. 8ll "EE #hecklist not !oin! followin! the said standard procedures shall not be
considered as valid applications and therefore, shall not be used as a basis for
recommendation on the issuance or denial of the E##.
2,. The project proponent or his dul& reco!ni3ed representative shall be the one who will
follow-up the said application to respective E() e!ional *ffice. The processin!
time includin! the issuance and%or denial of the E## will take a ma0imum of <4
da&s.
2,. The E"8 'ection of the E() e!ional *ffice, in the course of substantial review,
ma& conduct site visits or ocular inspections in coordination with the project
proponent
2@. "f the E() finds that the "EE #hecklist eport has substantiall& addressed all the
si!nificant impacts and relevant issues b& wa& of miti!ation and enhancement
measures, it shall recommend the issuance of the E##. The E() e!ional *ffice
will call for a technical #onference to e0plain to the project proponent the relevance
of the E## and the various conditions stated therein for compliance b& the project
proponent.
RICE MILL PROJECT
(with rated capacity of more than 1 ton per hour with multiple pass)
INITIAL ENVIRONMENTAL EXAMINATION ( IEE ) REPORT
for
Project Name or Title
Below is the IEE Checklist for ice !ill project proponents" ead the #uestion $elow
$efore answerin% the space pro&ided" 'se additional sheets if necessary and indicate this in the
appropriate space"
PROJECT LOCATION:
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(Complete )ddress* +treet, Baran%ay and !unicipality-City, Project) ()ttach location - .icinity
shop)
NAME OF PROPONENT:
_________________________________________________________
TIN:
_________________________________________________________
ADDRESS:
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
((((((((((((((((
(Complete )ddress* +treet, Baran%ay, and !unicipality-City)
Telephone: (((((((((((((((((((((((((((((
Fax * (((((((((((((((((((((((((((((
Emal : (((((((((((((((((((((((((((((
A! "ENERAL INFORMATION
1" P#o$e%& O'ne#(hp *
Corporation +in%le Proprietorship Partnership
)! Cap&al*a&on + P#o$e%& Co(&:
Capitali/ation * (((((((((((((((((Pesos)
Project Cost * (((((((((((((((((Pesos)
!ode of 0inancin% * In1 house Bank 2thers((((((((((((((
,! P#o$e%& O-$e%&.e(:
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
/! PROJECT DESCRIPTION
1") 3and 2wnership (attach photocopies of documents in the space pro&ided) 4
()ttach sur&ey plan)

To&al lan0 A#ea 'he#e &he p#o$e%& 'll
/e lo%a&e0 (s#" m" )
Lan0 A#ea &o -e 0e.elope0 &o
ho1(e &he R%e Mll (s#" m")
/a(( 2o# Lan0 Po((e((on
(please check appropriate $o5)
ownership of land $y &irtue of 2CT or TCT 6
(((((((((((((((((((((((((((((((((((((((
(attach photocopy of document as )nne5 7a)
lease of the land $y &irtue of
(((((((((((((((((((((((((((((((((((((((
(attach photocopy of document as )nne5 7c)
pendin% application for
(((((((((((((((((((((((((((((((((((((((
(attach photocopy of document as )nne5 7d)
2thers, please specify
(((((((((((((((((((((((((((((((((((((((
(attach photocopy of document as )nne5 7e)
A&&a%h pho&o3 2#on& Ve' o2 P#o$e%& S&e
A&&a%h pho&o le2& S0e Ve' o2 P#o$e%& S&e
A&&a%h pho&o3 pano#am% .e' o2 p#o$e%& (&e an0 &( mme0a&e .%n&4
A&&a%h pho&o o2 Pa004 Cleane#:
A&&a%h pho&o3 #5h& .e' o2 p#o$e%& (&e
A&&a%h pho&o3 -a%67#ea# .e' o2 p#o$e%& (&e
A&&a%h pho&o o2 81lle#
A&&a%h pho&o o2 A(p#a&o#
A&&a%h pho&o o2 Pa004 Sepa#a&o#
A&&a%h pho&o o2 S2&e#
A&&a%h pho&o o2 Pol(he#
A&&a%h pho&o o2 C4%lone
A&&a%h pho&o o2 P#me Mo.e#
9a&e# :&l&4 ( attach photo%raphs-layout)8 +ource of Coolin% 9ater for Prime !o&er if not
electric8
No" of 'nits +ource-!ethods Capacity(cu" meter)-:epth(m)
;roundwater, du% well close
with motor pump (indicate
depth-<P)
;roundwater, drilled well with
motor pump (indicate depth-
<P)
+urface 9ater
3ocal 9ater :istrict
Total &olume of water e5tracted-utili/ed per day (ma5imum)
,! - Po'e# :&l&e( (attach photo%raphs-layout)
No" of 'nits +ource - !ethods emarks
;enerator for electricity
(indicate <P-num$er of hours
of operation or use )
3ocal Electric 'tility
Indicate monthly consumption
= >w1<r, ma5imum
A&&a%h pho&o (pano#am%)3 'a&e# 1&l&e(: (&o#a5e( e! 5! 3 &an63 pon03 e&%!)
A&&a%h pho&o (pano#am%)3 po'e# (1ppl4: 5ene#a&o#
;! 9a(&e Mana5emen&
3i#uid waste treatment for domestic 9aste (check appropriate $o5)*
+eptic tank*
Capacity* (((((((((((((((((((((((((((((((((((cu" m"
Type* (((((((((((((((((((((((((((((((((((((((
:escri$e operation (e5ample* maintenance, de1 slud%in%, etc")
+olid waste treatment (check appropriate $o5)*
:omestic +olid 9aste In <ouse Collection
.olume per collection* ((((((((((((((((((((cu" m"
0re#uency of collection* (((((((((((((((((((- week
Burnin%
.olume per $urnin% ((((((((((((((((((((((cu" m"
0re#uency per $urnin%*((((((((((((((((((((-week
Compostin%
+olid 9aste ;enerated Collected from Cyclone
0orm !illin% 2peration .olume collected ((((((((((((((((((((k%
0re#uency of Collection (((((((((((((((((((((-
Collected from +tora%e Bin
.olume Collected ((((((((((((((((((((k%"
0re#uency of Collection ((((((((((((((((((((((-
!ode of :isposal* 3andfill (specify the site)
'se as +oil Conditioner (specify the site and attached sketch of
the area)
Burnin% within the project site
0uel for the prime mo&er
(Identify ash disposal site)
A&&a%h pho&o o2 en&#e l<10 'a(&e 2a%l&4 (example : (ep&% &an6)
A&&a%h 0#a'n57plan o2 Sep&% Tan6 ( '7 0men(on( an0 0e(%#p&on()
A&&a%h pho&o o2 Dome(&% (ol0 'a(&e 2a%l&4 me&ho0 = (ex! Compo(&n5 p&)
A&&a%h pho&o o2 Mll Ope#a&on (ol0 'a(&e 2a%l&4 me&ho0 ) (ex! Compo(&n5 p&)
A&&a%h pho&o o2 Mll Ope#a&on (ol0 'a(&e D(po(al (&e : (Lan02ll
Sol %on0&one#)
C! DESCRIPTION OF ENVIRONMENTAL SETTIN"S
1" Physical En&ironment (attach photos-drawin%s-maps)
Components- Parameters )nswer
? N
Is the terrain flat or le&el@ ( A1BC slope)
Is the terrain le&el or undulatin%@ (B1DC slope)
Is the terrain undulatin% to rollin%@ (D11DC slope)
Is the terrain rollin% to moderately steep@ (1D1BAC slope)
Is the terrain moderately steep to steeply mountainous@ (BA1EAC
slope)
Is the terrain &ery steeply mountainous@ (a$o&e EAC slope)
Is the site near or with a forest reser&e or a protected watershed
area@ If yes, how near@((((((((((((meters
:oes the site ha&e limestone ca&erns or sinkholes in the $edrock@
Is the area corrosion prone@ If so, what is the status* sli%ht,
moderate or se&ere@
)re there e5istin% natural ha/ards in the area, e"%", landslides,
%ullyin%, su$sidence@ If yes, enumerate them
1" E"
7" F"
B" G"
H" D"
)re there natural draina%e ways-creeks within the area drainin%
towards communities downstream@
Is the site within a rechar%e area of sprin%s downstream@
Is the site situated alon% a flood prone - storm sur%e area@
)re you $eside or near the shoreline@ If yes how far@
((((((((meters
)re there water $odies found inside or near the project site@ If yes,
Please enumerate them"
1" 7"
<ow deep is the water ta$le durin% the dry season@ (meters)
<ow deep is the water ta$le durin% the wet season@ (meters)
9hat is the #uality of water@ 0resh
Brackish
)ttach photo of all water $ody within the project site (e5ample, lake, creek, %ully, ri&er, etc")
7" Ecosystem :escription (attached photos- :rawin%s- maps whene&er appropriate)
)re you immediately adjacent to a natural ecosystem@ ?es no
If yes, please check on the appropriate $o5-es*
I J0orest I J;rassland
I JCoastal I J!an%ro&e
I J esidential I J)%ricultural
I J Commercial I J a%ricultural
I J Industrial
<ad you o$ser&e any wildlife in the area@ ?es No
If yes and if you can identify them, please enumerate*
1" F"
7" G"
B" D"
H" K"
E" 1A"
)re there trees within the project site@
If yes, please identify and enumerate* ?es No
1" F"
7" G"
B" D"
H" K"
E" 1A"
)re there other &e%etation within the project site@
If yes, please identify and enumerate* ?es No
1" H"
7" E"
B" F"
B" +ocio1Economic En&ironment
B"a E5istin% +ettlement within the project site
Cate%ory-:escription Num$er 9hat has happened to them@
Effects of project on them)
Total households affected
B"$ Profile of staff employed in the project-esta$lishment
Project Phase !ale 0emale
Pre-construction
2peration
Total
<ow many of the staff is a resident in the area@
)re there health facilities (clinic, etc") within the project site@ ?es No
)re the re#uired $enefits under the 3a$or Code and other
e%ulation enjoyed $y the staff@
If yes, please enumerate them*
1" H"
7" E"
B" F"
)re the local inha$itants@
Benefited $y the project@ Pls" ela$orate"
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((
D! PROJECT IMPACTS
1" Pre1Construction-Construction :etails
Components-Par
ameters
)nswer :escri$e the
impact
:escri$e your
miti%ati&e-enhance
ment measures"
?es No
Is there any land
clearin%@
Is there any
&e%etation
clearin%
Is there any tree
cuttin%@ Please
pro&ide details"
Is there any
topsoil remo&al L
replacement
Is there any
e5ca&ation works
and cut L fill
acti&ities@
Is there any
other
earthmo&in%
acti&ities
Is there any
stockpilin% of
sand-%ra&el
material in the
project area
)re there any
drillin%, $orin%, L
hammerin%
acti&ities@
Is there any
slope moderation
or %round
le&elin%
Is there any
increase traffic
(&ehicle)
mo&ement in the
area@
Is there any
increased
economic acti&ity
in the area@
Is there any
increased
a&aila$ility of
employment
Is there a rise in
associated
project acti&ities@
Is there any
displacement of
people in the
area@
:id the
displacement
in&ol&e relocation
of affected
parties@
)re the women
and other
&ulnera$le
%roups affected@
7" 2peration and !aintenance Phase
Component-
Parameters
)nswer :escri$e the
impacts
:escri$e your
miti%ati&e-enhanc
ement measures
?es No
Is there any
domestic solid
waste
%eneration@
Is there any solid
waste %eneration
durin% !ill
operation
Please specify
&olume
%enerated
Is there an
increase in
surface run1off to
other areas@
Is there any
reduction in
infiltration rate
due to
impermea$le
structures o&er
the %round@
Is there any
impro&ement
landscapin%@
Is there any
ha/ardous waste
('sed 2il, etc")
%enerated@
<ow do you
dispose this@
Is there an
increase in traffic
(&ehicle)
mo&ement in the
area@
Is there an
increase in
economic acti&ity
in the area
Is there an
increase in
economic
opportunities
Is there an
increase
a&aila$ility of
employment@
Is there an
increase in
employment of
local people@
Is there an
increase in
employment of
women@
Is there an
increase in
population from
mi%ration@
Is there a rise in
associated
project acti&ities
9as there an
increase in noise
le&el in the area@
7" )$andonin% and eha$ilitation Phase
Component-
Parameters
)nswer :escri$e the
impacts
:escri$e your
miti%ati&e-enhanc
ement measures
?es No
9ill any of the
facilities $e
a$andoned or
demolished at
the end of project
life@
2thers, please
specify
E! OPERATIONAL DETAILS
)9 !)TEI)3 E5pected Production 2utput
:ata ice <ull Bran
Peak season
3ean season
)&era%e (annual)
emarks
:escription of waste %enerated (per day $asis)
Type of 9astes +olid )mount ;enerated
F! S:PPLEMENTAL INFORMATION
1" Proponent Commitments
I-9e am - are committin% to M
Comply with e5istin% en&ironmental rules and re%ulations, %uidelines and criteria@
Participate or support multi1partite monitorin% efforts@
Comply with all miti%ation and enhancement measures that ha&e $een identified in the report"
Construct, maintain and properly operate an ade#uate an appropriate cyclone and rice hulls
stora%e $in
2$ser&e proper waste mana%ement practice $y pro&idin% ade#uate %ar$a%e receptacles in
strate%ic points and o$ser&in% proper disposal of the same"
Contri$ute towards the operation and maintenance of solid waste mana%ement-disposal facility@
!aintain the cleanliness of the %eneral surroundin%s@
E5tend social $enefits to the community@
Construct ade#uate more control facilities@
2thers, pls" +pecify
"! ATTAC8MENTS
1" ;o&ernment Permit )nd Clearance (attach photocopies of documents)
Permits-Clearance )ttached@
3ocation !ap- .icinity !ap
Endorsement of Baran%ay and !unicipal-City
Photocopy of TCT-2CT-T:
:esi%n- Plans and +pecs of ice <ulls +tora%e
Bin
:esi%n -Plan and +pecs of Cyclone
3ocation Clearance for <3'B
ACCO:NTA/ILIT> STATEMENT
This is to certify that all the information and commitments in the Initial En&ironmental
E5amination (IEE) eport are true, accurate and complete" +hould I-we learn if any
information, which would make the IEE inaccurate, I-we should $rin%, said information to attention
of the En&ironmental !ana%ement Bureau of :EN e%ional 2ffice"
I-9e here$y $ind myself-oursel&es jointly and solidarity for any penalties that may $e
imposed arisin% from and misrepresentations or failure to state material information in the IEE" )s
permitted under section $c of )rticle
In witness whereof, we here$y set out hands this (((((((((((((((day of
((((((((((((((((((((at (((((((((((((((((((("
((((((((((((((((((((((((((((((((((((((((((((
Project Proponent
((((((((((((((((((((((((((((((((((((((((((((
Title-:esi%nation
((((((((((((((((((((((((((((((((((((((((((((
:ate
AC?NO9LED"MENT
BE02E !E this (((day) ( of (((((((((((((((( 7A(((((( at
(((((((((((place)(((((((((((, personality appeared (((((((((((((name)((((((((((( with
Community Ta5 Certificate No" (((((((((((((((((((( issued on (((((date)(((( at
((((((((((place)((((((((((, in his-her capacity as (((((((((((desi%nation)((((((((((( at
((((((((((((((((((( and acknowled%ed to me that this IEE is his &oluntary act and deed,
and &oluntary act and deed of the entity he-she represents" This document which consists of
(no)(((((((((((pa%es, includin% the pa%e of which this acknowled%ment is ,is an Initial
en&ironmental E5amination eport Checklist"
9itness my hand and seal on the place and date a$o&e written"
((((((((((((((((((((((((((((
Notary Pu$lic
:oc" No"* ((((((((((((((((((((
Pa%e No"* ((((((((((((((((((((
Book No"* ((((((((((((((((((((
+eries of ((((((((((((((((((((