INSTRUCTION FOR USE

This IEE checklist presents a simplified reporting format for government and private
sector proponents applying for Environmental Compliance Certificate (ECC) of
proposed SAND & GRAVEL PROJECT. The ECC is a requirement to be secured prior
to actual development as part of the Philippine EIS System

The information contained in this checklist will serve as a basis for the review and
assessment of ECC application for the proposed project. However, should additional
information be required in order to have and informed decision, the proponent will be
requested to submit such. Misleading or erroneous answers are basis for legal actions
and/or denial ECC.

GENERAL INSTRUCTIONS AND PROCEDURES FOR USE

This IEE checklist is applicable to SAND AND GRAVEL PROJECT within an applied
area of not more than 5 hectares and the mode of extraction is manual only.

This is generally divided into 4 major sections as follows:

Section 1 refers generally to information regarding the proponent, project location, plan/
design components and activities during the development operation phase

Section 2 provides information describing the existing environmental condition of the

project site relative to the physical, biological and socio-economic environment

Section 3 generally refers to the listing of possible potential impacts that may occur in
the various stages of the project and the corresponding mitigation and enhancement
measures to prevent the occurrence of adverse impact and strengthen the positive
effects of the project.

Section 4 provides the commitment of the proponent to follow the mitigation and
enhancement measures indicated.

All additional information are to be incorporated in the annexes as support documents.

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The IEE checklist is to be accomplished through the following procedures:

1. Answer questions by selecting from a list of pre-determined answers enclosed in

the box.

To use this, put a check ( / ) mark in the appropriate box. If your answer does
not fall in any of the pre-determined responses, check ( / ) OTHERS and indicate
your specific answer in the blank space provided or use additional sheets as
necessary.

If some questions are not applicable to your project, write N/A on the blank
space or column.

2. For questions answerable by YES or NO, just check ( / ) the column under Y or N
and provide the required answer in the available blank spaces.
3. For the section on Impact Assessment and Mitigation, check ( / ) the column of Y
or N depending on what expected impact is applicable to your project and
provide the corresponding Mitigation/enhancement measures other than those
provided in the menu.
4. For the section on Attachments or Annexes, put a check ( / ) on the title or
description of the document that you are annexing in the report. The listed
documents are MUST requirements and should be submitted.
5. Answers to the questions should not be strictly confined to the pre-determined
responses. You can elaborate and use as many additional sheets as you need to
be able to provide adequate answers to the required information. Providing
maps, pictures and drawings (e. g. charts, tables, diagrams, sketches ) and other
visuals and attachments will better explain or describe the information provided in
the checklist. This will help facilitate the review and decision on the project’s
application for an ECC.
6. The review, processing and issuance of the ECC shall be in accordance with the
provisions of DAO 96-37 and the Procedural Manual for project’s application for
an ECC.

NOTE: This checklist need not be accomplished by an accredited prepare. This

can be done by the proponent or any of his or her authorized representative. The
CENRO may also assist the proponent in accomplishing the checklist.

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 SAND & GRAVEL PROJECT
Initial Environmental Examination ( IEE ) Report
For

(Project Proponent )

PROJECT LOCATION:
________________________________________________________________
________________________________________________________________
(Complete Address: Street, Barangay, Municipality/City, Province )

NAME OF PROPONENT:
__________________________________________________________

ADDRESS:
___________________________________________________________
___________________________________________________________

(Complete Address: Street, Barangay, Municipality/City, Province )

Telephone :
_____________________________________________________
Fax : _________________ e – mail________________________

A. GENERAL INFORMATION :

1. Project ownership [ ] Single Proprietorship [ ] Corporation [ ]

Partnership
( Attached documents as Annex 1)

2. Capitalization & Project Cost

Capitalization ________________
Project Cost ________________

3. Project objective / RATIONALE

a.) Presentation of project purpose and background ( reasons why project

is proposed )
b.) Presentation of need for the project at the national, regional & local
level.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

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 B. PROJECT DESCRIPTION

Source of Sand & Gravel

1. Name of River/Waterbody of proposed SAG extraction : _____________

Classification : ______________________________________________

2. Annual Rated Capacity of

Extraction ____________________________ cu. m.

3. Proof of Ownership over the adjacent Land ( That is beside the river where
proposed extraction project located ).

Status of Land Ownership:

[ ] Owned / titled by virtue of :

OCT or TCT # : _________________________________
CLT / Emancipation Patent No. _____________________
Home stand Patent No. ___________________________
[ ] Owned / untitled ( Tax declaration ) _________________
[ ] Stewardship contract : ___________________________
[ ] Waiver from the Rightful owner signifying permission:
[ ] Others, please specify: ____________________________

4. Accessible to the site :

( Modes/ routes)

Barangay Road : ______________________________________________

Provincial/ National Highway : ___________________________________
Private Road : ________________________________________________

If passing through a private land; How many land owners: ________________

Do you have permit from those landowners to use their land (please attached
any waiver, lease contract, ect.)

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 5. Panoramic picture of the site: ( specify the access road also )

East side view

West Side View

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North side view

South side view

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 C. DESCRIPTION OF EXISTING ENVIRONENT

(Remarks : to be fill – up by the DENR – Personnel who will conduct the on-site
evaluation/ ocular inspection of the site)

COMPONENTS/PARAMETERS Y N REMARKS
Proponent DENR

1. PHYSICAL ENVIRONMET
a.) what is the general elevation of the project Area

< 100 masl

100 – 300 masl
301 – 500 masl
501 – 1,000 masl
>1500 masl
( to determine elevation, refer to the topographic map
where the elevation per contour line is indicated )
b.)Slope and topography of the river embankment
within the project area

Terrain is flat or level ( 0 – 3 % slope)

Gently Sloping to undulating ( 4 – 8%)
Undulating to Rolling ( 9 – 18 % )

Slope of the adjacent with 1 Km. Raduis from the area :

East ward
West ward
South ward
North ward

Is there any existing structure within 1 kilometer from

project site ? If yes, please specify(distance)
___________.

c.) Estimate volume of Aggregates present during the

inspection( cu.m.);

Boulders:
Fine Sand:
Gravel:

Has the area experienced any flash flooding during the

wet season or typhoons? If yes, when was the last time
the area was flooded.

How wide is the slope of the flood/flooding area

____________________ .

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What public structure present within 1 kilometer from the project area ?
______________ river/flood control _________________ bridge
______________ irrigation diversion _________________ infiltration gallery
______________ others

What kind of access road will be traversed?

_______ Dirt road _______ asphalted _______ cemented
_______ Graveled _______ others

what are the present uses of the water bodies within or near the extraction?
_______ bathing _______ washing _______ fishing
_______ source of drinking water ( e. g. swimming, bathing, ect. )
_______ others

What is the present land use of the surrounding area ?

_______ Prime Agricultural Land (productive & irrigated) ______ Orchard ________ Grassland
_______ Fish pond _______ Prime Agricultural Land ( idle / abandoned) _______ Marshland / Mangrove
_______ Built – up _______ Watershed Area ______ Others, please specify ______________________
____________________________________________________________________________________
are there any existing permittee(s)/ extractor(s) within 1 kilometer radius from proposed site ? Yes _____
No ______ if yes how many ________ ( please state name of all permittes in additional sheet ) Estimated
volume of extraction / hectare __________ .

2. BIOLOGICAL ENVIRONMENT

COPONENTS/PARAMETERS Y N REMARK
Propone DENR
nt

Are the existing trees and other types of vegetation in the site
and surrounding within 100 meters radius.

Are there birds and other forms of wildlife found in the area ?

Are there fishing resources in the water bodies found near or

within the extraction site

Is the site near or within a watershed or forest reservation

area?
If near, How near? ______________ ( meters )

If within, indicate name of the watershed or forest reservation.

If answer is “YES” to the above questions, please provide examples of the species:

Birds and Other Wildlife Tress and other Important Fishery Resources
Vegetation

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3. SOCIO – ECONOMIC

COMPONENTS/PARAMETERS Y N REMARKS
Proponent DENR

Are there existing settlements is

near the site (at least less than 1
Km. Radius)

________ Yes ________ No

If “YES” How many Households?

_______________

What are the source(s) of

income:
Livelihood Type:

__ Farming
__ Fishing
__ Others, Please specify
___________________________
___________________________
______

Are there existing social infrastructure? Please Check.

_____School _____Churches/Chapel _____Health Clinic/Center

_____Bridges _____Hospitals _____Roads
_____Others, Please specify

How many workers/employees involved in the project? _______________________________

Additional remarks/recommendation of the Inspection Officers:

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
________________
Checked and Surveyed by:

_____________________
DENR-EMPAS Conforme:

_____________________
Proponent

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4. IMPACT ASSSESSSMENT AND MITIGATION
Note: No pre-construction period on the SAG Project.

PROJECT ACTIVITIES AFFECTING:

PHYSICAL ENVIRONMENT Y N Impact Mitigation/

Description Enhancement Measures
1.LAND

Will the proposal result in :

a. Compaction, Covering, excavation

or displacement of the soil
beyond/in site conditions?
b. A change in the topography or
ground surface relief features of
the site inconsistent wit the natural
surrounding conditions?
c. Unstable earth conditions?
d. Change in the soil or geological
substructures?
e. The continuation of or increase in
wind or water erosion of soils,
either on or off the site?
f. Change in disposition or erosion of
beach sand, or change in siltation,
deposition or erosion that may
modify the channel of a river or
stream or bed of a lake?

2. AIR

Will the project result in:

a. Air pollution emissions or

deterioration of emissions or
deterioration of ambient air quality?

3.WATER

a. Change in current, or the course or

direction of water movement?
b. Alteration of the course of flow or
100-year flood waters?
c. Discharge into any surface water
body pollutants that could alter
water quality?
d. Alteration of the direction or rate of
flow of water?
e. Change in the quality of waters
through interception of an acquifer
by cuts or excavation?
f. Substantial reduction in the
amount of water otherwise
available for public water supplies?

5. PLANT LIFE

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Will the proposal result in:

a. Removal or riparian vegetation or

other vegetation associated with
critical wild-life habitat?
b. Change in the diversity of species,
or number of any species of plants(
including trees, shrubs, grass,
crops, microflora and aquatic
plants)?
c. Reduction of the number of any
unique, rare or endangered
species of plant?

5.ANIMAL LIFE

Will the proposal result in:

a. Change in the diversity of species

or numbers of any species of
animals (birds, land, animals
including reptiles, fish and shellfish
benthos organisms, insects or
microfauna)?
b. Reduction of the number of any
unique, rare or endangered
species of animals?
c. Deterioration of existing fish or
wildlife habitat?

6. SOCIO – ECONOMIC

a. Increase existing noise levels ?

b. Exposure of people to severe
noise levels?
c. Exposure of people tor property to
geologic hazards such as
earthquakes, landslides mudslides,
ground failure, or similar hazards?

7 TRANSPORTATION/ CIRCULATION

Will the proposal result in:

a. Substantial impact upon existing

transportation system
b. Alterations to waterborne, rail or air
traffic?
c. Increase in traffic hazards to motor
vehicles bicyclists, or pedestrians?

8. PUBLIC SERVICES

Will the proposal have an unplanned

effect upon, or result in a need for new
or altered governmental services in any

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of the following areas:

a. Fire protection ?
b. Police protection?
c. Schools?
d. Park or other recreational
facilities?
e. Maintenance of public facilities,
including roads?
f. Other governmental services?

9.ARCHEOLOGICAL/HISTORICAL

Will the proposal result in an alteration

of a significant archeological or
historical site, structure object, or
building?

10. MANDATORY FINDINGS OF

SIGNIFICANCE

a. Does the project have the potential

to degrade the quality of the
environment, substantially reduce
the habitat of the fish population to
drop below self-sustaining levels,
threaten to eliminate a plant or
animal community, reduce the
number or restrict the range of a
rare or endangered plant or animal
or eliminate important examples of
the major periods of the Philippine
Island history of pre-history?
b. Does the report have potential to
achieve short term, to the
disadvantage of long term,
environmental goals? (a short term
impact of the environment is one
that occurs in a relatively brief,
definitive period of time, while long-
term impacts will endure well into
the future).
c. Does the project has impacts that
are individually limited, but
cumulatively considerable? (A
project may impact on two or more
separate resources is relatively
small, but were the effect of the
total of those impacts on the
environment is significant).
d. Does the project has
environmental effect that will cause
substantial adverse, effects on
human beings, either directly or
indirectly?

ENVIRONMENTAL MANAGEMENT PLAN

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PROJECT:
____________________________________________________________________________________
____________________________________________________________________________________

IMPACY MITIGATION PERIOD OF RESPONSIBLE PARTY(IES)

ENHANCEMENT MEASURE IMPLEMENTATION

Are you committing yourself to…. Y N

1. Comply with existing environmental rules
and regulations, guidelines and criteria?
2. Comply with all mitigation and
enhancement measures that have been
identified in this report?
3. Undertake supplemental planting of trees,
bamboo’s, vetiver grass or any of the
above to prevent bank erosion.
4. Participate or support multi- partite
monitoring efforts.
5. Put-up or established Environmental
Monitoring Fund of P _________ for the
use of muti-partite team.
6. Others, please specify.

D. ATTACHMENTS/ANNEXES

Title or Description Put a check ( / ) mark

1. Area Clearance from Provincial Mining
Regulation Board ( PMRB )

2. Vicinity Map

3. Location Map

4. Topographic Map
5.
6. LGU Resolution ( for social acceptability)
7.
8. Photocopy of TCT / OCT /CLT, TCT and or

9. Waiver of Right for Road- Right of Way.

10. PENRO/CENTRO Endorsement

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 ACCOUNTABILITY STATEMENT

This is to certify that all the information and commitments in the Initial
Environmental Examination (IEE) Report are true, accurate and complete. Should
I/we learn if any information which would make the IEE inaccurate, I/we shall bring
said information to attention of the Environmental Management Bureau of DENR
Regional Office.

I/We hereby bind myself/ourselves jointly and solidarity for any penalties that
may be imposed arising from and misrepresentations or failure to state material
information in the IEE.

___________________________________
Project Proponent

___________________________________
Title/Designation

___________________________________
Date

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 ACKNOWLEDGMENT

BEFORE ME this (day) ______________of

________________19__________________at (place)__________________________,
personality appeared name____________________________________ with Community Tax
Certificate No. _______________________________ issued on
date____________________At (place)____________________, in his/her capacity as
______________________(designation _________________at ___________________ and
acknowledged to me that this IEE is his voluntary act and deed, and voluntary
act and deed of the entity he/she represents. This document which consists of
(no)_____________________________pages, including the page of which this
acknowledgment is ,is an Initial environmental Examination Report Checklist.

Witness my hand and seal on the place and date above written.

_____________________
Notary Public

Doc. No.___________________
Page No.__________________
Book No.__________________
Series of __________________

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