 MANILA WATER COMPANY, INC. MWSS Administration Building 489 Katipunan Road, Balara Quezon City 1105 Customer Service Hotline 1627 | www.manilawater.com | OFFERED/PROGRAM | JOB ORDER NO. | ||
| CAN: | ||||
| SEPTIC TANK IDENTIFIER | ||||
| Households (HH) | Connections (WSC) | Septic Tanks (ST) | TYPE OF AVAILMENT: | |
once received by t in compliance with the provisions of Chapter XVII of Code on Sanitation of the Philippines (PD 856)
All answers to this form will be treated with full confidentiality in accordance with the Data Privacy Act of 2012 (RA 10173). Information about you that will be collected will be aggregated and will only be accessible to Manila Water Company, Inc. (MWCI), Metropolitan Waterworks and Sewerage System – Regulatory Office (MWSS-RO), Metropolitan Waterworks and Sewerage System – Corporate Office (MWSS-CO), Department of Health (DOH) and its respective line and attached agencies, Department of Environment and Natural Resources (DENR) and its respective line and attached agencies, and to the Local Government Unit (LGU) with jurisdiction over your establishment. Names and other unique identifiers will neither be released publicly nor shared with unauthorized third parties/entities.
I have read this form and understand its content and voluntary give my consent for the collection, use, processing, storage and retention of my personal data or information to Manila Water Company, Inc. (MWCI) for the purpose of availing desludging services. I also understand that my consent does not prevent the existence of other criteria for lawful processing of personal data and does not waive any of my rights under RA 10173-Data Privacy Act of 2012 and other applicable laws.AGREE DISAGREESIGNATURE:
| LAST NAME | FIRST NAME | EXT. (Sr, Jr, III) | MIDDLE NAME | |
| REGISTERED CUSTOMER NAME | ||||
| FOR BULK ACCOUNTS: | LAST NAME | FIRST NAME | EXT. (Sr, Jr, III) | MIDDLE NAME |
| INDIVIDUAL CUSTOMER NAME | ||||
| SERVICE ADDRESS: | |||||
| Unit/House/Building/Street Number/Name | Barangay/District Name | City/Municipality | Province | Zip Code | |
| UPDATED ADDRESS: | |||||
| Unit/House/Building/Street Number/Name | Barangay/District Name | City/Municipality | Province | Zip Code |
| CONTACT NUMBER | SEPTIC TANK CONFIGURATION | SEWER SYSTEM TYPE |
| SEQ NO. | INDIVIDUAL SHARED | COMBINED SEPARATE NON-SEWERED |
| METER NO. | BUSINESS AREA: | |
| MRU: | RATE CODE: | MOTHER CAN (Shared) |
| DATE (LAST DESLUDGED.) | LAST DESLUDGED DONE BY. |
| DATE (OFFERED) 1ST ATTEMPT2ND ATTEMPT3RD ATTEMPT | |
| WILL AVAIL (WA) I will avail the desludging program | WILL NOT AVAIL (WNA) I will not avail the desludging program which is offered every three (3) to five (5) years due to: |
A. ST accessibility? Manhole Cleanout Size B. For chipping? Yes No Others C. Distance of ST from Main Road approx. (ft/mtrs) | Not interested/ Could not decide New ST Already desludged by 3rd party ST not yet full Refused to sign Others, please specify: Refused to be interviewed |
| TECHNICALLY NOT FEASIBLE (TNF) is subject for inspection and investigation of MWC 3rd party contractor (MWC dependency) | RESPONSIBLE PERSON OUTSIDE (RPO) customer dependency |
No ST Elbowed pipe ST cannot locate Narrow road ST covered Others, please specify: ST not accessible | No person available Vacant house Tenant Residence not accessible Changed account name Others, please specify: Migrated |
| Please provide SKETCH at the back of this form – access through, location of ST and distance to access road | |
SIGNATURE OVER PRINTED NAME OF CUSTOMER / RELATIONSHIP TO CUSTOMER SIGNATURE OVER PRINTED NAME OF MWC 3RD PARTY CONTRACTOR | |
| FACILITY NAME: | San Mateo (North)FTI (South)IluginEast AvenuePinugay |
| TYPE OF TREATMENT: | Screw Press Dewatering and Conventional Activated Sludge Treatment |
| DATE ISSUED: | VOL. HAULED. | JOB COMPLETED (Y/N) IF N, WHY? | |||||
| ACTUAL DESL. DATE | DESLUDGING TIME | FROM FACILITY TO SITE (TIME) | FROM SITE TO FACILITY (TIME) | ||||
| SCHEDULE OF DESL. | START | FINISH | ARRVL. | DEPT. | ARRVL. | DEPT. | |
| SEPTIC TANK DEPTH | SEPTIC TANK SIZE | TRUCK VOLUME | TRUCK ODOMETER | ||||
| INIT | FINAL | AREA | VOL | INIT | FINAL | INIT | FINAL |
| DRIVER’S LICENSE NO. | PLATE NO. | VEHICLE TYPE. |
| DATE OF ACCEPTANCE | DISPOSAL TIME | FLOW METER READING | |||||
| DAY TRIP | VOL. DISPOSED | START | END | INT | FINAL | ||