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 Khamhariya Dolomite Deposit
(ii).Location / site (GPS Co-ordinate) N 21°55’33.64” to 21° 55’43.31”E 82°51’38.14” to 82°51’49.43”
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)4.66 ha.
(iv).Capacity of the Mining Lease (TPA) 105000
(v).Period of Mining Lease 50
(vi).Expected cost of the Project 30
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/DGMCG/24/2015 
Name of Consultant/RQPDeepak kumar sahu
Address Near hemant provision stone shanti vihar colony danganiya raipur
Mobile No.9617160900
Landline No.4070731
Email Idjagmohan11@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.  3 km
2. (ii). Nearest Infrastructural along with distance in kms  5 km
(iii). Nearest Railway Line along with distance in kms  5 km
(iv). Nearest National Highway along with distance in kms  15 km
(v). Nearest State Highway along with distance in kms  3.4 km
(vi). Nearest Major District Road along with distance in kms 3.4 km
(vii). Nearest Any Other Road along with distance in kms  1 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.5 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  16 km
(x). Nearest In-take for drinking water pump house distance in kms  1.5 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  1.5 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
there is no area protected within 5km from the project site
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests There is no area important or sensitive for ecological reason within 5km from the project site
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration there is no area protected important or sensitive species of flora or fauna within 5km from the project site
6. Inland, coastal, marine or underground waters there is no inland , coastal within 15km from the project site
7. State, National boundaries there is no state or national boundaries within 15km from the project site
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas there is no routes or facilities used by the public for access to recreation within 5km from the project site
9. Defence installations there is no defence installation within 15km from the project site
10. Densely populated or built-up area, distance from nearest human habitation champa is 22.5km from the project site
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) baradwar 5.0km from the project site
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) There is no area within 15km form the project site ahich containing important , high quality or scarce resource
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) there is no area within 15km from the project site which are subjected to pollution or environmental damage
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) there is no area within 15km from the project site which are susceptible to natural hazard
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/CG/MIN/14923/2018
File Number14923
Date of Apply EC04 May 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)ChhattisgarhJanjgir - ChampaJaijaipur
(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)
NameUMESH PRASAD AGRAWAL
DesignationOwner
Company UMESH PRASAD AGRAWAL
AddressC/o Shri Gyanchand Prasad Agrawal
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