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 Kharijhariya Ordinary Sand Mine (ii). Location / site (GPS Co-ordinate) BP1 N 22° 40' 40.31" E 083° 56' 27.31" BP2 N 22° 40' 38.61" E 083° 56' 28.66" BP3 N 22° 41' 10.35" E 083° 56' 47.17" BP4 N 22° 41' 11.31" E 083° 56' 47.59" Annexure-GPS file       (iii). Type of Lease Indivisual Area Size of the Mining Lease (in ha.) 5.00 ha. (iv). Capacity of the Mining Lease (TPA) 103727.2 (v). Period of Mining Lease 5 (vi). Expected cost of the Project 10 (vii). Have you hired Consultant/Registered Qualified Person(RQP) for preparing document? No Reason for not hiring the Consultant/RQP Not Applicable (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.  .23 km 2. (ii). Nearest Infrastructural along with distance in kms  6 km (iii). Nearest Railway Line along with distance in kms  140 km (iv). Nearest National Highway along with distance in kms  4.3 km (v). Nearest State Highway along with distance in kms  .225 km (vi). Nearest Major District Road along with distance in kms  1.6 km (vii). Nearest Any Other Road along with distance in kms  .05 km (viii). Nearest Electric transmission line pole or tower distance in kms  .5 km (ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  14.5 km (x). Nearest In-take for drinking water pump house distance in kms  1 km (xi). Nearest In-take for Irrigation canal pumps distance in kms  5 km 3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value No area protected under international conventions, national or local legislation for their ecological, landscape, cultural or other related value is located in the close vicinity. 4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No such areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests are located in the close vicinity. 5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No protected or important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration are located in the close vicinity. 6. Inland, coastal, marine or underground waters No Inland, coastal, marine or underground waters are located nearby. The project site is in riverbed, which has surface water flow. No under ground water will be contaminated. 7. State, National boundaries No State, National boundaries crosses nearby. Chhattisgarh and Odisha State boundary at 13 km distance. 8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas No such routes or facilities used by the public for access to recreation or other tourist, pilgrim areas are situated in the close vicinity. 9. Defence installations No such installations are situated in nearby area. 10. Densely populated or built-up area, distance from nearest human habitation Densely populated area is not situated in the vicinity. 11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Schools, hospitals, temples are absent within 500m distance. 12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No such areas containing important, high quality or scarce are located. 13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No such area is located. 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) No such are which is susceptible to natural hazard are located. 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/Modernization New Proposal Number DIA/CG/MIN/16414/2018 File Number To be assigned Date of Apply EC 20 Jul 2018

Details of State of the project
S.No.	State Name	District Name	Tehsil Name
(1.)	Chhattisgarh	Jashpur	Kunkuri

(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 (1.) Form 1M 20 Jul 2018 (2.) Form 1 20 Jul 2018

(IV)	Undertaking
	The aforesaid application and documents furnished here with are true to my knowledge.

(IV).(i)

Name SACHIV GRAM PANCHAYAT KHARIJHARIYA Designation Proponent Company SACHIV GRAM PANCHAYAT KHARIJHARIYA Address Village Kharijhariya,Tehsil Kunkuri,District Jashpur, Chhattisgarh