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 Excavation of Borrow Area of Shri Kishan Barbrik JV
(ii).Location / site (GPS Co-ordinate) 21°27'19.16"N 81°59'33.75"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)5.00 ha.
(iv).Capacity of the Mining Lease (TPA) 13500
(v).Period of Mining Lease 3
(vi).Expected cost of the Project 93.00
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?No
Reason for not hiring the Consultant/RQP Due to category of B2 Project.
(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.  2.20 km
2. (ii). Nearest Infrastructural along with distance in kms  0.310 km
(iii). Nearest Railway Line along with distance in kms  22.50 km
(iv). Nearest National Highway along with distance in kms  29.00 km
(v). Nearest State Highway along with distance in kms  5.50 km
(vi). Nearest Major District Road along with distance in kms 2.50 km
(vii). Nearest Any Other Road along with distance in kms  0.080 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.300 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.300 km
(x). Nearest In-take for drinking water pump house distance in kms  0.310 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.300 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
No such sensitive areas are located .
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No such important or sensitive area for ecological reasons are located .
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No study records found for such sensitive species or activies for study area.
6. Inland, coastal, marine or underground waters No such sensitive areas are located within study area except- River -21.65 km
7. State, National boundaries There is no state or, national boundary close within 05 km aerial distance from project location.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas No route or facilities are available in the study area, which are being used for public access to recreation or other tourist, pilgrim.
9. Defence installations The area is not located close to any of the defense installations moreover the such defense area is not situated with in study area.
10. Densely populated or built-up area, distance from nearest human habitation - Densely populated or have built-up area Kharora at 8.60 km - Distance from nearest human habitation- Kumhari at 310 m
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Kharora at 8.60 km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No such important areas are located around the study area or mine area except- Ground Water resources: Ground Water table is 40 meter deep hence no impact on water table is expected. Surface Water resources: No important surface water resources are located within mines or around the mine area except river, nalla or reservoir
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None around the study area.
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) The area is safe with natural hazardous or flood prone area and No such sensitive areas are located within study area.
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/19962/2019
File NumberTo be assigned
Date of Apply EC04 May 2019
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)ChhattisgarhRaipurTilda
(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.)Risk04 May 2019
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameMS SHRI KISHAN AND COMPANY
DesignationPROPRIETOR
Company MS SHRI KISHAN AND COMPANY
Address4/12 shree tower shanti nagar raipur
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