APPENDIX I
(See Paragraph-6)
FORM 1M
Note : If space provided against any parameter is inadequate,Kindly upload supporting document under 'Additional Attachments if any'  at the last part of the Form 1M. Please note that all such Annexures must be part of single pdf document.
(I)Basic Informations
S.No.Item Details
(i).Name of the Mining Lease site Gravel and Building Stone
(ii).Location / site (GPS Co-ordinate) 17037’29.21" 83005’31.38” 17037’32.45” 83005’30.47" 17037’32.02” 83005’28.68" 17037’28.92” 83005’29.69"
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.50 ha.
(iv).Capacity of the Mining Lease (TPA) 62895
(v).Period of Mining Lease 10
(vi).Expected cost of the Project 10
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.14/2015 
Name of Consultant/RQPP Vijaya Kumar
Address D.NO:25-9-19, Ganesh Nagar, Rajahmundry ,E.GDt
Mobile No.9912182528
Landline No.08832463
Email Idvk5696@gmail.com
(II) Environmental Sensitivity
S.No Areas Distance in kilometer / Details
1. (i).  Nearest rail or road bridge over the concerned river,rivulet,nallah etc. in kms.  2 km
2. (ii). Nearest Infrastructural along with distance in kms  1 km
(iii). Nearest Railway Line along with distance in kms  17 km
(iv). Nearest National Highway along with distance in kms  2 km
(v). Nearest State Highway along with distance in kms  2 km
(vi). Nearest Major District Road along with distance in kms 2 km
(vii). Nearest Any Other Road along with distance in kms  1 km
(viii). Nearest Electric transmission line pole or tower distance in kms  50 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  4 km
(x). Nearest In-take for drinking water pump house distance in kms  50 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  50 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Not applicable
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Not applicable
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Not applicable
6. Inland, coastal, marine or underground waters Not applicable
7. State, National boundaries Not applicable
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Not applicable
9. Defence installations Not applicable
10. Densely populated or built-up area, distance from nearest human habitation Far away from 4 km
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Far away from 4 km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Not applicable
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Not applicable
14. Areas susceptible to natural hazard which could cause the project to present environmental problems (earthquakes, subsidence, landslides, erosion, flooding or extreme or adverse climatic conditions) Not applicable
15.
Is proposed mining site located over or near fissure/fracture for ground water recharge?No
16.
Whether the proposal involves approval or clearance under the following Regulations or Acts namely?
(a).
The Forest (Conservation) Act,1980?No
(b).
The Wildlife (Protection) Act,1972?No
(c).
The Coastal Regulation Zone (C.R.Z) notification,2011?No
17.
Is forest land involved (ha)?No
18.
Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up?No
19.
New/Expansion/ModernizationNew
Proposal NumberDIA/AP/MIN/8720/2017
File Number3.10/deac/ap/vsp/2017-18
Date of Apply EC03 Sep 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)Andhra PradeshVisakhapatnamParavada
(III) EC Attachments
1 Uploaded PFR (Pre Feasibility Report) File Annexure-PFR file
2 Uploaded Approved Mining Plan File Annexure-Approved Mining Plan file
3 Uploaded District survey report Annexure-District Survey Report
4 Uploaded Cover Letter Annexure-Cover Letter
Uploaded Additional attachments, if any
S.No. Attached File Date of Submission
NIL
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameCMCRJY
DesignationGeologist
Company CMCRJY
AddressAbove DTDC Courier, Lalacheruvu Jn, Rajahmundry
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