IEE Checklist for Gasoline Station

INSTRUCTION MANUAL

Pursuant to the DENR Administrative Order No. 37, Series of 1996 and its procedural
manual, all gasoline, service and refueling station projects are considered
projects to be required by an Initial Environmental Examination (IEE) document and
need to secure an Environmental Compliance Certificate (ECC) from the DENR Regional
Offices prior to project construction and operation. As such, this Initial
Environmental Examination (IEE) Checklist was conceptualized to simplify the format
of the information needed to be submitted by all government and private 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 and assessment of
the information presented. However, should additional information be required in
order to have an informed decision, the proponent is therefore requested to submit
such. The IEE checklist will be reviewed by the DENR Regional OfficesEMPAS. This
checklist will also facilitate the processing of ECC application and to assist
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: Section
2: consists of the information regarding the proponent; project location,
plan/design components and activities during the development and operation phase;
contains project components consists of the information regarding the description
of the existing environmental condition where the gasoline station will be located
the physical biological, socio-cultural and economic environment; consists of the
listing of possible potential impacts that may occur in the various stages of the
project establishment and operation; corresponding mitigation and enhancement
measures to prevent the occurrence of adverse impacts and strengthen the positive
effects of the project; contains the Effluent Monitoring Plan 1

Section 3:

Section 4:

Section 5:
IEE Checklist for Gasoline Station

Section 6: Section 7:

contains the Environmental Management Plan provides the commitment of the proponent
to follow the mitigation and enhancement measures indicated. consists of the
additional information that required to be incorporated

Annexes:

2.0

INSTRUCTIONS AND PROCEDURES FOR USE 2.1 The checklist need not be accomplished by
an accredited preparer. This can be done by the proponent or nay of his/her
authorized representative; Answer questions by selecting from a enclosed in the
box. list of pre-determined answers

2.2

To use this, put a check ( ) mark in the appropriate box. If your answer does not
fall in any of the pre-determined responses, check ( ) OTHERS and indicate your
specific answer in the blank space provided or use additional sheets as necessary.
If some questions are not applicable to your project, write N/A on the blank space
or column; 2.3 For the section on Impact Assessment and Mitigation, check ( ) the
columns of Y or N depending on what expected impact is applicable to your project
and provide the corresponding Mitigation/Enhancement measures for each identified
impact (with a YES answer) in the column provided. To facilitate and assist the
proponent in answering section 4.0 of this checklist, a menu is provided to serve
as a guide and reference. However, it should be noted that this only serves as a
menu checklist hence, proponents are highly encouraged to identify additional
impacts and mitigation/enhancement measures other than those provided in the menu;
2.4 For the section on Attachment or Annexes, put a check ( ) on the title or
description of the document that you are annexing in the report. The listed
documents are MUST requirements and should be submitted; Answers to the questions
should not be strictly confined to the predetermined responses. You can elaborate
and use as many additional sheet as you need to be able to provide adequate answers
to the required 2

2.5
IEE Checklist for Gasoline Station

information. Providing maps, pictures and drawings (e.g. charts, tables, diagrams,
sketches) and other visuals and attachments will better explain or describe the
information provided in the checklist. This will help facilitate the review and
decision on the projects application for an ECC. 2.6 All relevant engineering /
architectural drawings / plan s (duly signed by licensed architect / engineer /
environmental planner) and permits required should form part of the supporting
documents. This would include, among others, the following: 2.7 Site
development plan showing the proposed layout of streets, lots and other features in
relation to existing condition; Vicinity map within a radius of 2 kms. from the
periphery of the project 1:5000 m. Topographic plan of the project site.

Upon completion of the IEE checklist, the project proponent shall submit the form
to the DENR Regional Office-EMPAS where the project is to be located.

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IEE Checklist for Gasoline Station

INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST for GASOLINE STATION PROJECTS

SECTION 1.0 GENERAL INFORMATION

1.1 1.2. Project Name/Title: 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: (civil works and equipment) 1.6 Project Ownership: Type of
Owners: Single Proprietorship Corporation (Range)

Partnership/Joint Venture

Cooperative

Others, pls. specify: ____________________________

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IEE Checklist for Gasoline Station

1.7

List of Owners ( for partnership/ corporation)

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

SECTION 2.0 PROJECT DESCRIPTION

2.1 Project Area Coverage (Attach photocopies of documents as Annex )

Total Land Area (m2/ha)

2.2

Land Ownership Ownership of the land by virtue of OCT /TCT # ______________________

Stewardship of land by virtue of: _________________________________ Lease of Land
by virtue of:______________________________________ Pending Application for:
________________________________________ Others, please specify:
_________________________________________

2.2

General Land Classification Public land Alienable and Disposable

2.3 Present Land Use Classification (based on the approved land use/zoning
ordinance of the city/municipality) Agricultural Industrial Commercial Residential
Forest Land Open Spaces Tourism Institutional Others, Pls. Specify:

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IEE Checklist for Gasoline Station

Attach panoramic view of the project site and its immediate vicinity (north side
view from center of the project site).

Attach panoramic view of the project site and its immediate vicinity (south side
view from center of the project site).

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IEE Checklist for Gasoline Station 3.0 PROJECT COMPONENTS 3.1 Services Vehicles per
Day Chemical to Be Used Vol. Of Chemicals to Be Used (liters per day) Vol. Of Water
to Be Used (liters per day)

Services

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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IEE Checklist for Gasoline Station

3.2

Facilities Facility No. of Unit Area (m2) Capacity

1. Service Bay 2. Pumping/Refilling Station 3. Dispensing Pump for fuelling

Position 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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IEE Checklist for Gasoline Station 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 Existing Public Water Yes
No Remarks

b.2. Surface Water Water Source Name of Water Body Mode of devt. or distribution
Volume of Extraction

Location

Distance

1. Creek 2. Spring 3. Stream 4. River 5. Others

b.3. Deep Well Water Source No. of Wells/Hand Pump/Tanks Discharge (liter / sec)

Location

Depth (m)

1. Deep Well w/ Manual Hand Pump 2. Deep Well w/ Electric or Motor Pump

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IEE Checklist for Gasoline Station

b.4

Rainwater Water Source No. of Tanks/Reservoirs Capacity

1. Collected in Storage Tanks 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)
b) Major Roads: Other roads: open canal open canal

closed / underground drainage 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
and drainage systems? ____________________________________________________

Where is this located: __________________________________________________

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IEE Checklist for Gasoline Station 3.5 Power Supply Source of Power: Local Electric
Cooperative Own Generator Capacity:_________ Others, pls.
specify____________________

3.6

Sewage Disposal System Sewage System Individual Septic Tank Communal Septic
Tank

Sewage Design

2- chamber septic tank w/ leaching 2-chamber septic tank w/o leaching 3-chamber
septic tank w/ leaching 3-chamber septic tank w/o leaching 4-chamber septic tank w/
leaching 4-chamber septic tank w/o leaching Others, pls.
specify________________________________

(Attach sewage design / lay-out) signed and sealed. Sewage Disposal discharge to
an existing public sewerage system treated in a community disposal plant or
communal septic tank Treatment in individual septic tanks with disposal by
absorption field or leaching pit Others: (Specify)_________________________________
3.7 Wastewater Treatment Facility: Capacity of oil water separator : (in liters)

Attach Flowchart on liquid waste management Attach lay-out / detailed plan - Liquid
waste facility-main component - Wastewater treatment facilities

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IEE Checklist for Gasoline Station 3.8 Used Oil Collection and Disposal System
Collection System No. Drums/month: ____________________________ Volume: Storage
Area: Disposal System Recycled 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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IEE Checklist for Gasoline Station 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) b) Pre-construction Period:
______________ Operation and Maintenance period: _________

3.11. Project Schedule (Attach schedule of development activities from pre-

Construction; construction; operation phase)

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IEE Checklist for Gasoline Station

SECTION 3.0 DESCRIPTION OF EXISTING ENVIRONMENT

A. Physical Environment Components/ Parameters 1. What is the general elevation of
the proposed gasoline station project site? <100 masl 100-300 masl 301-500 masl
501-1,000 masl 1,000-1,500 masl >1,500 masl (To determine elevation, refer to the
topographic map where the elevation per contour line is indicated) 2. Slope and
Topography of the area (within 50 meter radius from center of site) Terrain is flat
or level (0-3% slope) Gently sloping to undulating (38% slope) Undulating to
rolling (8-18% slope) Rolling to moderately steep (1830% slope) Steeply rolling
(3050% slope) Very steep to mountainous (>50 % slope) 3. Are there areas in the
site where indications of soil erosion are occurring? If yes, what activities are
causing erosion? Causes of erosion: { } Heavy Rains { } Unstable Slopes { } Others,
pls. specify (Indicate the area per slope category or estimate the % to total area)
Yes No Remarks (Indicate the area per elevation range or estimate the % to total
area)

4.

Do you know of any landsliding occurring or that has occurred in the site?

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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IEE Checklist for Gasoline Station A. Physical Environment Components/ Parameters
5. Has the area experienced any flooding during the wet season or typhoons? If yes,
when was the last time the area was flooded? What caused the flooding? Yes No
Remarks 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 7. Are there existing water bodies found near or
within the site e.g. creeks or streams? If yes, please enumerate them in the
opposite space and indicate their location Other soil types: _____________________
_____________________

Name of water bodies:

(If they have no names, indicate the number of water bodies) * these water bodies
should be shown in the topographic map What are the present uses of the water
bodies within or near the project site? { { { { { boating, etc.) { 8. } } } } }
Bathing Washing Fishing Source of drinking water Recreation (swimming,

} Others: _________________ Type of access road: ___________________

___________________ Yes No Remarks

Is there an access road going to the project site? If yes, what is its distance to
the site _______km. Components/ Parameters

9.

What is the present land use of the area wherein the proposed gasoline and
refueling station be located? { } Prime agricultural land (productive/irrigated)
{ } Prime agricultural land (idle/abandoned) { } Grassland { } Built-up { } Orchard
{ } Marshal/Mangrove { } Fishpond { } Others, pls. specify:__________________

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IEE Checklist for Gasoline Station Does the site conform to the approved land use
of the city/municipality? 10. Is the land allocation and alignment of the various
utilities integrated with the existing networks and projects outside of the
boundaries of the project site? Are there existing structures or developments
around the project site? If yes, please list them in the opposite space

11.

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IEE Checklist for Gasoline Station B. Biological Environment Components/ Parameters
1. Are there existing trees and other types of vegetation in the project site? If
yes, please identify. Are there birds and other forms of wildlife found in the
area? Please identify. Are there fishery resources in the water bodies found near
or within the site? Please identify. Is the site near or within a watershed or
forest reservation area? If near, only, how near? ___________ m or km If within,
indicate name of the watershed or forest reservation area Is the gasoline station
adjacent to a natural ecosystem? Yes No Remarks

2.

3.

4.

5.

{ { { { {

} } } } }

Forest Coastal/ Marine Grassland Mangrove Agriculture

C.

Socio-Economic Environment Components/ Parameters Yes No Remarks

1.

Are there existing settlements in the proposed gasoline station? If yes, indicate
the number of: (within 50m radius) Households/Families:_____________ Legitimate
landowners: ___________ Tenants:_______________________ _
Squatters:______________________ Components/ Parameters Yes No Remarks

4.

What are their source(s) of livelihood? Livelihood Type [ ] Farming [ ] Fishing [ ]

Backyard poultry and piggery [ ] Vending/Buy and Sell [ ] Sari-sari store [ ]
Others, Pls. Specify:__________________

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IEE Checklist for Gasoline Station 5. How many of the total population have reached
the: Elementary level:______________ High School Level:_____________ College
Level:________________

6.

Are there other existing local organizations in the area?

List of Organized Groups

7.

Are there existing social infrastructures in the barangay? [ ] Schools [ ]

Communications [ ] Health centers/clinics [ ] Hospitals [ ] Churches/Chapel [ ]
Transportation [ ] Roads [ ] Others, Pls. Specify:______________________

(Attach photo)

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SECTION 4.0 IMPACT ASSESSMENT AND MITIGATION

A. PRE-CONSTRUCTION/CONSTRUCTION PHASE OF THE PROJECT SITE Yes No

Project Activities Affecting the Physical Environment 1. Will there be land and
vegetation clearing? If Yes, what is the total area to be cleared?
__________________(ha) Will there be trees to be affected during the clearing? If,
Yes, how many and what are these species of trees? No. Of Trees: _________________
Species: a. b. c. 3. Will there be demolition of existing structures? If yes, what
types of structures will be demolished? Types of Structures:
______________________________ _______________________________
_____________________________ 4. Will there be topsoil removal and replacement? If
yes, how much of the removed topsoil will be replaced? [ ] Entire volume [ ]
Partial only 5. If partial only, where will the rest of the topsoil be deposited?

Impact Description

Mitigation/Enhancement Measures

2.

If no, what will happen to the excavated topsoil?

(Use additional sheets if necessary)

IEE Checklist Gasoline Station

20 Project Activities Affecting the Physical Environment 6. Will there be
earthmoving activities, e.g. excavation work, cut and fill, etc? If, yes, how deep
is the excavation and how much is the estimated volume of cut and fill? Average
depth of excavation (m): _______________ Estimated Volume of cut and fill (cum)
____________ Source of filling materials? ____________________ 7. Will trees and
ornamentals be planted in 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, sand and gravel materials in the project area?
Will there be drillings, hammering and boring activities? Will there be any slope
modifications or ground leveling to be done? Is there a need to construct an access
road going to the site? If Yes, what type of access road: [ ] all weathered road
length _____(m) width ____ [ ] concrete [ ] asphalt Yes No Impact Description
Mitigation/ Enhancement Measures

9. 10. 11.

12.

Will temporary quarters or barracks and a field office be provided for construction
workers within the project site?

(Use additional sheets if necessary)

IEE Checklist Gasoline Station

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Project Activities Affecting the Biological Environment 1. Will there be vegetation

clearing?

Yes

No

Impact Description

Mitigation/ Enhancement Measures

2. Will clearing activities affect any critical wildlife habitats?

3. Will clearing activities affect any rare, threatened or endangered plant and
animal species?

4. Will there be trees to be affected (e.g. cut down; remove) during the clearing?
If yes, how many and what are these species of trees?

Project Activities Affecting the Socio-Cultural and Economic Environment 1. Will

there be settlements to be affected? If yes, how many households will be affected?
Total No. of Household/Families: _________________________

Yes

No

Impact Description

Mitigation/ Enhancement Measures

2. How will they be handled? Payment of property owners Temporary relocation site
to be provided Permanent relocation site to be established Eviction w/o
compensation Others, Pls. Specify: ________________

(Use additional sheets if necessary)

IEE Checklist Gasoline Station

22 3. Will the project encroach on ancestral domain - Will indigenous or local
people be affected; Aetas vulnerable groups

4. Will there be locals to be hired during construction?

5. Will there be an increase in economic activity in the area or arise in

associated project?

6. Will the project cause an increase in traffic or disrupt traffic in major routes
due to the entry and exit of construction equipment?

B.

Operation and Maintenance Phase

Project Activities Affecting the Physical Environment Yes No Impact Description
Mitigation/ Enhancement Measures

1. Will there be an increase is solid waste and sewage generation?

2. Will there be an increase in water demand?

3. Will there be an improved drainage and water supply system? 4. Will there be an
increase in surface run-off from the concreting of roads and soil surfaces?

5. Will there be reduced infiltration rate due to impermeable structures over the
ground? (Use additional sheets if necessary)
IEE Checklist Gasoline Station
23 6. Is the available domestic water supply enough to meet the maximum projected
water consumption of the gasoline station?

Project Activities Affecting the Biological Environment 1. Will the sewage out fall
and drainage system drain into the nearby or adjacent surface water body?

Yes

No

Impact Description

Mitigation/ Enhancement Measures

2. Will the waste disposal site be adequate to meet the projected solid wastes in
the area?

Project Activities Affecting the Socio-Cultural and Economic Environment 1. Will

the project cause or increase traffic in the areas?

Yes

No

Impact Description

Mitigation/ Enhancement Measures

2. Will the gasoline station create a significant increase in the existing

population of the area?

3.

Are there existing transport services/facilities routing the areas?

4.

Is there a prevailing water shortage or water supply problem in the area? Are there
already existing commercial establishments within the vicinity of the project area?

5.

(Use additional sheets if necessary)

IEE Checklist Gasoline Station

24 C. Abandonment and Rehabilitation Phase Project Activities Affecting the Socio-
Cultural and Economic Environment 1. Will the project cause or increase traffic in
the areas? Yes No Impact Description Mitigation/ Enhancement Measures

2.

Is the gasoline station create a significant increase in the existing population of

the area?

3.

Are there existing transport services/facilities routing the areas?

4.

Is there a prevailing water shortage or water supply problem in the area?

5. Are there already existing commercial establishments within the vicinity of the
project area?

SECTION 5.0
EFFLUENT SOURCE

EFFLUENT MONITORING PLAN

FREQUENCY OF TESTING METHOD OF ANALYSIS STANDARDS FOR CLASS C WATER BODY

PARAMETERS TO BE TESTED

(Use additional sheets if necessary)

IEE Checklist Gasoline Station

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SECTION 6.0 ENVIRONMENTAL MANAGEMENT PLAN

ACTIVITIES RISKS IMPACTS MITIGATING/ ENHANCEMENT MEASURES COST RESPONSIBILITIES

SECTION 7.0 PROPONENTS COMMITMENTS:

Are you committing yourself to I/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 the
report; 3. Support multi-partite monitoring efforts to be organized; 4. Construct,
maintain and properly operate an adequate and appropriate oil-water separator the
liquid wastes; 5. Construct, maintain and properly operate an adequate and
appropriate septic tank for the 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 on
environmental, health and other civic issues; 10. Others, please Specify Y N

(Use additional sheets if necessary)

IEE Checklist Gasoline Station

26

ATTACHMENTS/ANNEXES A. Government Permits and Clearances (Attach photocopies of

documents)

PERMITS/CLEARANCES

YES

NO

Location Map/Vicinity Map Barangay and Municipal / City Endorsement Photocopy of

TCT/OCT/TD Design /Plan of the Gasoline Station Locational Clearance from HLURB
NWRB Permit

(Use additional sheets if necessary)

IEE Checklist Gasoline Station

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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 information which would make the IEE accurate, I/we shall bring said
information to the attention of the appropriate EMB DENR Regional Office I/We
hereby bind myself/ourselves jointly and solidarily for any penalties that may be
imposed from any misrepresentations or failure to state material information in the
IEE. In witness whereof, I/we hereby set out hands this ______________day
of_____________ _________________ 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
__________ __________ __________ __________
IEE Checklist Gasoline Station

(Use additional sheets if necessary)

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(Use additional sheets if necessary)

IEE Checklist Gasoline Station