1. Name of the Project

Ensuring Community Safety through Installation of Street Lights

2. Project Location

Street/Sitio/BarangayBrgy. Pinatuad

Zone Classification (i.e. industrial, residential)

City/MunicipalityNabas

ProvinceAklan

RegionVI

3. Proponent Name

Barangay Council

4. Proponent Address

Barangay Pinatuad

5. Contact Person Name

Lydia D. MerecidioDesignationBSPMC

6. Proponent Means of Contact

Landline No.N/A

Fax No.N/A

Mobile No.09195130779

Email

7. Project Type/Undertaking

Consumer Product Laboratory

8. Project Size Fill up only relevant parameters.Capacity/Others(i.e. MW, m3, heads)

Space Allocation/Area(i.e. km, ha, sqm)

Quantity to be Processed(i.e. MT of raw material)

Others:

Production Rate(i.e. MT/year)

9. Description of Project Activities (i.e. during pre-construction, construction, operation and abandonment)

(See Attached POW)

Prepared/Submitted by:

LYDIA D. MERECIDIO

Concurred/Approved by:

FERDINAND S. NAPATSignature over Printed Name Owner’s/Proponent’s Signature over

Printed Name

CERTIFICATE OF NON-COVERAGE (CNC)1-Page Application Form