Affidavit of Joint Undertaking of The PCO

REPUBLIC OF THE PHILIPPINES )
CITY OF _________ )S.S
JOINT AFFIDAVIT OF UNDERTAKING
We, Terence Anthony S. Vesagas of legal age, Filipino, a resident of Butuan

City, and the CEO of Manual J. Santos Hospital_located at 554 Montilla Blvd.,
Butuan City; and, Ralph Jones T. Ciencia, of legal age, Filipino, a resident of
Butuan City and the appointed/designated Pollution Control Officer (PCO) of
Manual J. Santos Hospital, after being sworn to in accordance with law, do hereby
depose and say that:
1. We undertake to perform the following duties and responsibilities:
a) To ensure compliance with the requirements of Presidential Decree 1586,
Republic Act (RA) 6969, RA 8749, RA 9003, RA 9275, their respective
implementing rules and regulations, and other pertinent rules and
regulations including Board Resolution 1996-33 for establishments
under the Laguna de Bay Region where appropriate;
b) To identify and/or cause the identification of significant environmental
aspects and impacts of the establishment’s operational activities and
recommend possible mitigating measures in the formulation/preparation
and/or review of the Environmental Management Plan and Contingency
Plan;
c) To attend to and/or cause the securing of all permitting and registration
requirements of the establishment prior to the construction or
installation of pollution control facilities including, but not limited to,
securing of necessary permits and renewal thereof;
d) To ensure the proper performance, operation, and maintenance of
environmental management facilities or systems of the establishment
such as the following:
 Wastewater treatment facilities
 Air pollution control devices referred to in DENR Administrative
Order(DAO) 2000-03
 Hazardous waste management storage areas (permanent or
temporary)
 Solid waste segregation/management facilities (i.e. MRFs, sanitary
landfills, composting facilities, etc.)
 Environmental monitoring devices such as the Continuous Emission
Monitoring Systems, Air Monitoring Stations, effluent flow
metering/measuring devices, groundwater monitoring wells, and
other environmental monitoring devices;
e) To ensure that hazardous waste disposed offsite are covered by a
hazardous waste manifest, duly signed by the transporter and Treatment,
Storage, and Disposal (TSD) facility; and with corresponding Certificate of
Treatment (COT) duly signed by the TSD facility. Copies of the signed
hazardous waste manifest and COT shall be submitted to the concerned
EMB Regional Office in accordance with DAO 2004-36;
f) To ensure that transport vehicles are properly operated and maintained
(applicableonlyforhazardouswastestransporter);
g) To ensure that hazardous wastes TSDare properly operated and
maintained (applicable only for hazardous wastes TSD facility);
h) To monitor and/or cause compliance to the requirements specified in the
Environmental Compliance Certificate and the commitments stipulated
in the Environmental Management and Monitoring Plans or
Environmental Performance Report and Management Plans, and report
the same in the Compliance Monitoring Report (CMR);
i) To monitor and/or cause the monitoring of activities pertaining to the
installation or construction of pollution source and control facilities to
ensure compliance with the National Emission Standards for Source
Specific Air Pollutants and National Ambient Air Quality Standards and
report monitoring results to the Department of Environment and Natural
Resources (DENR) as part of the SMR;
j) To monitor and/or cause the monitoring of activities pertaining to the
operation and maintenance of pollution control facilities to ensure
compliance with the Effluent Standards and report monitoring results to
DENR as part of the SMR;
k) To monitor and/or cause the monitoring of the use of chemicals,
especially those listed under the Priority Chemicals List (PCL) and those
with Chemical Control Orders (CCO) and the generation of solid and
hazardous wastes. Monitoring data shall be submitted as part of the
SMR and the PCL Compliance Certificate;
l) To monitor and/or cause the monitoring of the importation or
distribution of chemicals, especially those listed under the PCL and those
with CCO and the generation of solid and hazardous wastes. Monitoring
data shall be submitted as part of the SMR and the PCL Compliance
Certificate (applicable only for importers or distributors of chemicals);
m) To promptly submit and/or cause the submission of duly accomplished,
signed, and validated CMRs and SMRs;
n) To report and/or cause the reporting within twenty-four (24) hours from
the occurrence of any of the following environmental incident to the
concerned EMB Regional Office and the Laguna Lake Development
Authority (LLDA), as the case may be:
 Breakdown of any pollution source and/or control facility or
monitoring instruments; or
 Releases (e.g. leaks, spills, etc.) of chemicals or hazardous wastes
(listed in Annex 1 of DAO 2014-02 as well as the Priority List of
Hazardous Substances as published by the Agency for Toxic
Substances and Disease Registry of the Department of Health &
Human Services of the United States of America) to environmental
media;
o) To report and/or cause the reporting within twenty-four (24) hours from
securing of the results of laboratory analysis or from online monitoring
instruments any exceedance to effluent and/or emission standards;
p) To submit and/or cause the submission to the Pollution Adjudication
Board / LLDA Public Hearing Committee copy of the SMR duly received
by the concerned EMB Regional Office/LLDA(applicable only for
establishments with pending case);
q) To attend and/or cause appearance of responsible personnel in technical
conferences, hearings, and meetings especially on matters pertaining to
pollution cases of the establishment;
r) To keep ourselves abreast with the requirements of the DENR;
s) To coordinate regulatory programs and activities with the
city/provincial/municipal governments (if applicable);
t) To initiate and intensify and/or cause initiation/intensification of
environmental management activities including awareness campaign
within their organization; and
u) To participate and/or cause participation in multi-partite monitoring
team activities and meetings, where applicable
2. We are executing this affidavit to attest to the foregoing statements, and to
comply with the DENR requirements for PCO accreditation pursuant to DAO
2014-02.
Done this ___day of ______________in ___________.
___________________ ______________________________
Affiant Affiant
SUBSCRIBED AND SWORN to before me this ____day of _____________ in

_______________, affiants personally appeared before me exhibiting their Community
Tax Certificates.
Name CTC No. Issued on/at
Notary Public
Doc. No. ______
Page No. ______
Book No. ______
Series of _______

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REPUBLIC OF THE PHILIPPINES )

CITY OF _________ )S.S

JOINT AFFIDAVIT OF UNDERTAKING

We, Terence Anthony S. Vesagas of legal age, Filipino, a resident of Butuan

Done this _day of __in _.

SUBSCRIBED AND SWORN to before me this day of _________ in

Name CTC No. Issued on/at

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