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INSTRUCTION MANUAL
Pursuant to the DENR Administrative Order No. 37, Series of 1996 and its proceduralmanual, all gasoline, service and refueling station projects are considered projects to berequired by an Initial Environmental Examination (IEE) document and need to secure anEnvironmental Compliance Certificate (ECC) from the DENR Regional Offices prior toproject construction and operation.
As such, this Initial Environmental Examination (IEE) Checklist was conceptualized tosimplify the format of the information needed to be submitted by all government andprivate sector proponents applying for an ECC for a new proposed gasoline station.The information contained in the checklist will serve as a basis for the review andassessment of the information presented. However, should additional information berequired in order to have an informed decision, the proponent is therefore requested tosubmit such. The IEE checklist will be reviewed by the DENR Regional Offices-EMPAS. This checklist will also facilitate the processing of ECC application and toassist project proponents and EIA prepares in the IEE preparation activity.
1.0 CONTENTS
This IEE Checklist is divided into four (4) major sections:
Section 1 : consists of the information regarding the proponent;
Section 2 : project location, plan/design components and activitiesduring the development and operation phase; containsproject components
Section 3 : consists of the information regarding the description of theexisting environmental condition where the gasoline stationwill be located the physical biological, socio-cultural andeconomic environment;
Section 4 : consists of the listing of possible potential impacts that mayoccur in the various stages of the project establishment andoperation; corresponding mitigation and enhancementmeasures to prevent the occurrence of adverse impacts andstrengthen the positive effects of the project;
Section 5 : contains the Effluent Monitoring Plan
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INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST
for
GASOLINE STATION PROJECTS
SECTION 1.0 GENERAL INFORMATION
1.1 Project Name/Title: ___________________________________________________
1.2. Proponent/Company : ___________________________________________________
Address: ___________________________________________________(complete address: street/sitio, barangay, city/municipality,
province)
___________________________________________________
Tel/Fax: ___________________________________________________
E-mail: ___________________________________________________
1.3 Project Location: ___________________________________________________(complete address: street/sitio, barangay, city/municipality,
province)
(Attach location map with important landmarks and access points indicated as Annex 1)
1.4 Project Category: Service Station Filling Station Curb Pump
1.5 Project Cost
Total Project Cost: (Range)(civil works and equipment)
1.6 Project Ownership:
Type of Owners: Single Proprietorship Corporation
Partnership/Joint Venture Cooperative Others, pls. specify: ____________________________
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Attach panoramic view of the project site and its immediate vicinity (north side view from center of theproject site).
Attach panoramic view of the project site and its immediate vicinity (south side view from center of theproject site).
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3.0 PROJECT COMPONENTS
3.1 Services
Services Vehiclesper Day
Chemical to Be
Used
Vol. Of Chemicals to BeUsed
(liters per day)
Vol. Of Waterto Be Used
(liters per day)
1. Manual Washing
2. Automatic Car Wash
3. Shampoo/Vacuum
4. Change Oil
5. Greasing
6. Change Coolant
7. Tune-up
8. Wheel Alignment
9. Free Service(Air & Water)
10. Others, Pls., Specify
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3.2 Facilities
Facility No. of Unit Area (m2) Capacity
1. Service Bay
2. Pumping/Refilling Station
3. Dispensing Pump for fuellingPosition
4. Fuel Storage Area
5. Wash Bay
6. Convenience Store
7. Stand-By Power Utilities
8. Parking Area
9. Office Bldg.
10. Public Toilets
11. Others, Pls. Specify
(Attach facilities design / lay-out plan)General lay-out plan of the gasoline station.
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3.3 Water Resources and Infrastructure
a. Demand
Estimated daily water requirements of the proposed gasoline station?
b. Supply/Sources
b.1. Existing Public Water
Water Source Yes No Remarks
Existing Public Water
b.2. Surface Water
Water Source Name ofWaterBody
Location DistanceMode ofdevt. ordistribution
Volume ofExtraction
1. Creek
2. Spring
3. Stream
4. River
5. Others
b.3. Deep Well
Water Source No. ofWells/Hand
Pump/TanksLocation Depth (m)
Discharge(liter / sec)
1. Deep Well w/ ManualHand Pump
2. Deep Well w/ Electricor Motor Pump
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b.4 Rainwater
Water Source No. ofTanks/Reservoirs
Capacity
1. Collected in StorageTanks
2. Collected in Reservoir
c. Water Treatment
Is there provision for water treatment of your independent water source?
YES NO
If yes, what type of water treatment?
Chlorinated Filtration Others (specify) ________________
3.4 Drainage System (Attach approved drainage layout plan as Annex )
Type of drainage:
a) Major Roads: open canal closed / underground drainage
b) Other roads: open canal closed / underground drainage
Where does the drainage system drain?
Public drainage system natural out fall / water body
What water body (e.g. river/creek/stream) will serve as the out fall of the sewage anddrainage systems? ____________________________________________________
Where is this located: __________________________________________________
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3.8 Used Oil Collection and Disposal System
Collection System No. Drums/month: ____________________________
Volume: _______________________________Storage Area: _______________________________
Disposal SystemRecycled
Burning / Incinerator
Sold to re-cyclers
Others, Specify
3.9 Solid Waste Disposal System
3.9.1. Collection System
Association/project-maintained garbage collection system
Integrated into the municipal garbage collection system
Others, (specify):_________________________________
3.9.2. Will there be a waste sorting/segregation system to be employed prior to disposal?
YES NO
3.9.3. Disposal System
Burning at open dumpsite in the project site
Sludge cleaning
Open dumpsite outside of the project site
Municipal/city landfill area
Others, specify:________________________
3.9.4. Location of the waste disposal site:_______________
Attach flow plan of solid waste management collection to disposal.
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3.10. Manpower and Employment (provide listing of manpower requirements as Annex )
How many people will be employed by the proposed gasoline and service station during:
a) Pre-construction Period: ______________b) Operation and Maintenance period: _________
3.11. Project Schedule (Attach schedule of development activities from pre-Construction; construction;operation phase)
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SECTION 3.0 DESCRIPTION OF EXISTING ENVIRONMENT
A. Physical Environment
Components/ Parameters Yes No Remarks
1. What is the general elevation of theproposed gasoline station projectsite ?
1,500 masl
(To determine elevation, refer to thetopographic map where the elevation percontour line is indicated)
(Indicate the area per elevation rangeor estimate the % to total area)
2. Slope and Topography of the area(within 50 meter radius from center ofsite)
Terrain is flat or level (0-3% slope)Gently sloping to undulating (3-
8% slope)Undulating to rolling (8-18%
slope)Rolling to moderately steep (18-
30% slope)Steeply rolling (30-
50% slope)Very steep to mountainous
(>50% slope)
(Indicate the area per slope categoryor estimate the % to total area)
3. Are there areas in the site whereindications of soil erosion areoccurring? If yes, what activitiesare causing erosion?
Causes of erosion:{ } Heavy Rains{ } Unstable Slopes{ } Others, pls. specify
4. Do you know of any landslidingoccurring or that has occurred in thesite?
Cause of Landslide:
{ } Earthquake{ } Unstable slopes{ } Earthmoving{ } Others, pls. specify
Attach photo of the areas topography (choose the view / perspective which shows contours or areas w/slopes)
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A. Physical Environment
Components/ Parameters Yes No Remarks
5. Has the area experienced anyflooding during the wet season ortyphoons? If yes, when was the lasttime the area was flooded? Whatcaused the flooding?
Period(s) of flooding: _____________
Causes of flooding:
{ } low area{ } poor drainage{ } water logged areas
6. Soil type of the area:
{ } Sandy soil{ } Clayey soil{ } Sandy loam soil
Other soil types: _____________________ _____________________
7. Are there existing water bodies foundnear or within the site e.g. creeks orstreams? If yes, please enumeratethem in the opposite space andindicate their location
(If they have no names, indicate the numberof water bodies)* these water bodies should be shown in thetopographic map
Name of water bodies:
What are the present uses of the
water bodies within or near theproject site?
{ } Bathing{ } Washing{ } Fishing{ } Source of drinking water{ } Recreation (swimming,
boating, etc.){ } Others: _________________
8. Is there an access road going to theproject site?If yes, what is its distance to the site
_______km.
Type of access road:
___________________ ___________________
Components/ Parameters Yes No Remarks
9. What is the present land use of thearea wherein the proposed gasolineand refueling station be located?
{ } Prime agricultural land(productive/irrigated)
{ } Prime agricultural land(idle/abandoned)
{ } Grassland
{ } Built-up{ } Orchard{ } Marshal/Mangrove
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Does the site conform to theapproved land use of thecity/municipality?
10. Is the land allocation and alignment ofthe various utilities integrated with theexisting networks and projectsoutside of the boundaries of theproject site?
11. Are there existing structures ordevelopments around the projectsite? If yes, please list them in theopposite space
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B. Biological Environment
Components/ Parameters Yes No Remarks
1. Are there existing trees and othertypes of vegetation in the project site ?If yes, please identify .
2. Are there birds and other forms ofwildlife found in the area? Pleaseidentify .
3. Are there fishery resources in thewater bodies found near or within thesite? Please identify .
4. Is the site near or within a watershedor forest reservation area?If near, only, how near?
___________ m or kmIf within, indicate name of thewatershed or forest reservation area
5. Is the gasoline station adjacent toa natural ecosystem?
{ } Forest{ } Coastal/ Marine{ } Grassland{ } Mangrove
{ } Agriculture
C. Socio-Economic Environment
Components/ Parameters Yes No Remarks
1. Are there existing settlements in theproposed gasoline station? If yes,indicate the number of: (within 50mradius)
Households/Families:_____________Legitimate landowners: ___________Tenants:_______________________
_Squatters:______________________
Components/ Parameters Yes No Remarks
4. What are their source(s) oflivelihood?
[ ] Farming
Livelihood Type
[ ] Fishing[ ] Backyard poultry and piggery
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SECTION 4.0 IMPACT ASSESSMENT AND MITIGATION
A. PRE-CONSTRUCTION/CONSTRUCTION PHASE OF THE PROJECT SITE
Project Activities Affecting the PhysicalEnvironment
Yes No Impact Description Mitigation/EnhancementMeasures
1. Will there be land and vegetationclearing? If Yes, what is the total areato be cleared?
__________________(ha)
2. Will there be trees to be affectedduring the clearing? If, Yes, how manyand what are these species of trees?
No. Of Trees: _________________Species:
a.b.c.
3. Will there be demolition of existingstructures? If yes, what types ofstructures will be demolished?
Types of Structures: ______________________________ _______________________________ _____________________________
4. Will there be topsoil removal and re-placement? If yes, how much of theremoved topsoil will be replaced?
[ ] Entire volume[ ] Partial only
5. If partial only, where will the rest of thetopsoil be deposited?
If no, what will happen to theexcavated topsoil?
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Project Activities Affecting the PhysicalEnvironment
Yes No Impact DescriptionMitigation/
EnhancementMeasures
6. Will there be earthmoving activities,e.g. excavation work, cut and fill, etc?If, yes, how deep is the excavation andhow much is the estimated volume ofcut and fill?
Average depth of excavation (m): _______________Estimated Volume of cut and fill (cum)
____________Source of filling materials?
____________________
7. Will trees and ornamentals be plantedin the site?
Total # of trees to be planted: ____________Species of Trees to be planted:
Ave height of trees to be planted: __________
8. Will there be stockpiling of soil, sandand gravel materials in the projectarea?
9. Will there be drillings, hammering and
boring activities?10. Will there be any slope modifications
or ground leveling to be done?
11. Is there a need to construct an accessroad going to the site? If Yes, whattype of access road:
[ ] all weathered roadlength _____(m) width ____
[ ] concrete[ ] asphalt
12. Will temporary quarters or barracksand a field office be provided forconstruction workers within the projectsite?
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Project Activities Affecting the BiologicalEnvironment
Yes No Impact DescriptionMitigation/
EnhancementMeasures
1. Will there be vegetation clearing?
2. Will clearing activities affect any criticalwildlife habitats?
3. Will clearing activities affect any rare,threatened or endangered plant andanimal species?
4. Will there be trees to be affected (e.g.cut down; remove) during the clearing?If yes, how many and what are thesespecies of trees?
Project Activities Affecting the Socio-Culturaland
Economic Environment
Yes No Impact DescriptionMitigation/
EnhancementMeasures
1. Will there be settlements to be affected? Ifyes, how many households will beaffected?
Total No. of Household/Families: _________________________
2. How will they be handled?
Payment of property ownersTemporary relocation site to be providedPermanent relocation site to beestablishedEviction w/o compensationOthers, Pls. Specify: ________________
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3. Will the project encroach on ancestraldomain
- Will indigenous or local people beaffected; Aetas vulnerable groups
4. Will there be locals to be hired duringconstruction?
5. Will there be an increase in economicactivity in the area or arise in associatedproject?
6. Will the project cause an increase in trafficor disrupt traffic in major routes due to theentry and exit of construction equipment?
B. Operation and Maintenance Phase
Project Activities Affecting the PhysicalEnvironment
Yes No Impact DescriptionMitigation/
EnhancementMeasures
1. Will there be an increase is solid wasteand sewage generation?
2. Will there be an increase in waterdemand?
3. Will there be an improved drainage andwater supply system?
4. Will there be an increase in surface run-offfrom the concreting of roads and soilsurfaces?
5. Will there be reduced infiltration rate dueto impermeable structures over theground?
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6. Is the available domestic water supplyenough to meet the maximum projectedwater consumption of the gasoline station?
Project Activities Affecting the BiologicalEnvironment
Yes No Impact DescriptionMitigation/
EnhancementMeasures
1. Will the sewage out fall and drainagesystem drain into the nearby or adjacentsurface water body?
2. Will the waste disposal site be adequate tomeet the projected solid wastes in thearea?
Project Activities Affecting the Socio-Culturaland
Economic Environment
Yes No Impact DescriptionMitigation/
EnhancementMeasures
1. Will the project cause or increase traffic inthe areas?
2. Will the gasoline station create a significantincrease in the existing population of thearea?
3. Are there existing transportservices/facilities routing the areas?
4. Is there a prevailing water shortage orwater supply problem in the area?
5. Are there already existing commercialestablishments within the vicinity of theproject area?
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C. Abandonment and Rehabilitation Phase
Project Activities Affecting the Socio-Culturaland
Economic Environment
Yes No Impact DescriptionMitigation/
Enhancement
Measures
1. Will the project cause or increase traffic inthe areas?
2. Is the gasoline station create a significantincrease in the existing population of thearea?
3. Are there existing transportservices/facilities routing the areas?
4. Is there a prevailing water shortage orwater supply problem in the area?
5. Are there already existing commercialestablishments within the vicinity of theproject area?
SECTION 5.0 EFFLUENT MONITORING PLANEFFLUENTSOURCE
PARAMETERSTO BE TESTED
FREQUENCY OFTESTING
METHOD OF ANALYSIS
STANDARDS FOR CLASS CWATER BODY
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SECTION 6.0 ENVIRONMENTAL MANAGEMENT PLAN
ACTIVITIES RISKS IMPACTS
MITIGATING/
ENHANCEMENTMEASURES COST RESPONSIBILITIES
SECTION 7.0 PROPONENTS COMMITMENTS:
Are you committing yourself to Y NI/We, am/are committing to ..........1. Comply with existing environmental rules and regulations, guidelines and criteria;
2. Comply with all mitigation/enhancement measures that have been identified in thereport;
3. Support multi-partite monitoring efforts to be organized;
4. Construct, maintain and properly operate an adequate and appropriate oil-waterseparator the liquid wastes;
5. Construct, maintain and properly operate an adequate and appropriate septic tank forthe liquid wastes;
6. Maintain the cleanliness of the general surroundings;
7. Participate or contribute towards a communal cleaning effort;
8. Strictly implement a risk management plan and safety program;
9. Organize and conduct information, education and communication (IEC) activities onenvironmental, health and other civic issues;
10. Others, please Specify
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ACCOUNTABILITY STATEMENT
This is to certify that all the information and commitments in this Initial Environmental
Examination (IEE) Report are true, accurate and complete. Should I/we learn of any informationwhich would make the IEE accurate, I/we shall bring said information to the attention of theappropriate EMB DENR Regional Office
I/We hereby bind myself/ourselves jointly and solidarily for any penalties that may beimposed from any misrepresentations or failure to state material information in the IEE.
In witness whereof, I/we hereby set out hands this ______________dayof_____________ _________________ at ______________________________________.
__________________________________Proponent
___________________________________Title/Designation
ACKNOWLEDGMENT
BEFORE ME this ______ day of _________, 19 _____ at ____________,
personally appeared______________________ with Community Tax Certificate No.________ issued on
____________________ at ________________________, in his/her capacity as
_______________________________ of ____________________________ and acknowledged to me
that this IEE Report is his voluntary act and deed, and the voluntary act and deed of the entity he/she
represents. This document, which consists of ____________________ pages, including the page on
which this acknowledgment is written, is an Initial Environmental Examination Report Checklist.
______________________________Notary Public
Doc. No. __________Page No. __________Book No. __________Series of __________
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