APPLICATION FORM Departmental Quality Form

ENVIRONMENTAL CLEARANCE FOR ADMISSION ECD-RPD--29

OF LOCATOR’S RAW MATERIALS & RECYCLABLE (SCRAP) MATERIALS Rev.No.: 06

Effectivity Date: 12/10/2018
(for Clearance Purposes Only of Selected Regulated Imported Items)

PART 1. (Pls. do not leave any portion blank. Write N.A. if not applicable) W/ ENVIRONMENTAL PERMIT?  ECC  CNC
A. IMPORTER INFORMATION: ISSUED BY  DENR  SBMA.
1. Name of Importer_________________________________________________________________________________________________________________
2. Address________________________________________________________________________________________________________________________
3. Contact Person______________________________________________4. Telephone No_______________________5. Fax no.________________________
B. SHIPPER INFORMATION (OR for IMPORTATION OF USED ELECTRONICS OR OTHER RECYCLABLE MATERIALS AS STIPULATED IN RA 6969, THE
WASTE GENERATOR):
6. Shipper Name (Waste Generator () _________________________________________________________________________________________________________
7. Facility Address_________________________________________________________________________________________________________________________
8. No. of Invoice/Packing List Attached _____ , Specific No./s of Invoice/Packing List: ___________________________________________________________________
9. Total Volume of Material to be Admitted per attached B/L)_________, Specify No./s of B/L/s: ____________________________________________________________
10. No. of MSDS attached, if applicable: _____ 10. Intended Carriers________________________________________________________________________________
11. Mode of Shipment AIR SEA 12. Port of Entry_________________________________ 13. Estimated Date of Arrival______________________________
 A. FOR RECYCLABLE MATERIALS/USED GOODS, (pls. fill out with the correct data and information based on import documents)
 Non-hazardous (example, used clothing, plastic scrap, etc.) ______________________________________________________________________.
 Hazardous (example, e.g., used electronics and electrical equipment, _______________________________________________________________
 No Importation Clearance (IC) from DENR is required if: HAZWASTE (HW) GENERATOR I.D. # ___________________________________________________________________
 Imported items are for 100% export/re-export. IIMPORTER REGISTRY NO. ______________________________ REMARKS: _________________________________

 Imported materials declared or certified herewith are to be delivered to the following RECYCLING FACILITY w/in the Subic Bay Freeport Zone(SBFZ) only
1. Facility Name__________________________________________________ Contact Person____________________________________________
2. Address______________________________________________________ Telephone/Mobile Phone No. _________________________________
 Importation Clearance (IC) from DENR-EMB is required if material moves into customs territory: (Check only one that is applicable)
 Imported materials are temporarily brought outside the SBFZ area for additional processes but to be brought back again into SBFZ for final
export/re-export. IC attached?  YES  NO  N.A Other Facility Name & Address: ____________________________________________________
 Dismantled materials are to be sold as scrap or disposed outside the SBFZ area and into customs territory, but within the Philippines
IC attached?  YES  NO  N.A. . Scrap Hauler Name & Address: ________________________Landfill Name & Address: ___________________________
 B. FOR CHEMICAL/CHEMICAL SUBSTANCE, e.g., pure chemicals such as sulfuric acid, nitric acid, cyanide, etc.
(specify)__________________________________________________________________________________________________________________
 The appropriate permit or clearance attached -- SEE GENERAL NOTE BELOW FOR OTHER REQUIRED ATTACHMENTS
-- Importation Clearance(IC) from DENR-EMB?
An e- copy of the chemicals database shall be submitted by PCO to ecology@sbma.com per import activity.
 YES  NO N.A.
-- Permit or clearance from other government agency  YES  NO,  N.A. specify ________________________________________________________
NOTE: An IC may be required by the law governing a specific chemical/chemical substance and should be filed at least thirty (30) days prior to the import activity on a per chemical and per
shipment basis. Compliance to corresponding permit and clearance requirements are advised for chemicals/chemical substances covered by the Revised PCL or CCO (Verify if the applied
chemical components are in the PICCS or in the Revised PCL or with a CCO, by a review of the Material Safety Data Sheet or MSDS of the applied chemical component to get the Chemical
Abstract Services (CAS) No.for verification purposes.) By law, no Importation Clearance is required for those CAS #s found in the PICCS. If not found in the PICCS, a Small Quantity
Importation (SQI) Clearance (if importing chemical below 1000 kg) or a Pre-Manufacture/Pre-Importation Notification (PMPIN) Certificate (if above 1000 kg.) shall be secured from the DENR-EMB.
 C. FOR IMPORTED WOOD OR LUMBER
 Endorsement to DENR CENRO from Ecology Center that a locator is allowed by SBMA to engage in import of wood or lumber based on SBMA-approved
business activity, as required by DENR CENRO.  YES  NO. Other required document/s (specify) _______________________________________
 D. FOR OTHER IMPORTED MATERIALS REGULATED BY GOVERNMENT OR NOT
(specify/describe)_______________________________________________________________________________________________________________
GENERAL NOTE: The issuance of this clearance does not preclude other requirements from other Regulatory agencies like the Fertilizer and Pesticides
Authority (FPA), Phil. Drug and Enforcement Agency (PDEA), Phil. National Police (PNP), Bureau of Food and Drug (BFAD), Dept. of Health (DOH), etc.
1. Applicant shall attach to this Clearance Request all import documents relative to the import activity, including other permits, clearances and certifications
required by other laws, as appropriate and as regulated by other concerned government agencies, authorIties or offices.
2. All residual wastes generated in the import activity shall be disposed at the Olongapo Sanitary Landfill or other landfill facility, in accordance with RA 9003 and
SBMA Waste Management Guidelines.
DECLARATION: I hereby declare that all the above information provided above are true and correct.
F. Applicant’s Signature__________________________________________________________ Designation/Position Title ______________________________________________
Printed Name (Pls. write legibly)____________________________________________________ Date ______________________________________________________________
ADDITIONAL NOTE: As stipulated under Republic Act No. 7227, imported goods/items transported outside the Freeport fall under customs territory and become
subject to all duties and taxes and permit or clearance requirements from other government agencies.
PART 2. (To be filled up by SBMA Ecology Center only)
 DISAPPROVED  APPROVED, pursuant to compliance to R.A. 7227. Evaluated by: ________________________________ Date: ____________
NOTE ON
Subic CLEARANCE:
Bay Metropolitan For Authority
WEEE, submit list identifying contents per B/L once container
van is opened to
ECOLOGY ensure NO ULABs, used transformers or other controlled HW are included in the shipment.
CENTER EC Personnel
 For chemical/chemical
Regulatory Bldg. Rizal substances,
Highway copy of MSDS/SDS
corner Labitan provided and reviewed
St., Subic Bay as compliantZone,
Freeport w/ NotedPhilippines
2222 by: _____________________________ Date: ____________
The requirements
Tel: of RA 6969 and other government
+6347 252.4435/4416 Fax:regulating
+6347 agencies
252.4157
RPD, Chief