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 tikarishiv
(ii).Location / site (GPS Co-ordinate) 21° 43'15.80" 82° 18'31.95"
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)4.86 ha.
(iv).Capacity of the Mining Lease (TPA) 97200
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 1
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?No
Reason for not hiring the Consultant/RQP mining inspector
(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.  63 km
2. (ii). Nearest Infrastructural along with distance in kms  5 km
(iii). Nearest Railway Line along with distance in kms  63 km
(iv). Nearest National Highway along with distance in kms  40 km
(v). Nearest State Highway along with distance in kms  20 km
(vi). Nearest Major District Road along with distance in kms 5 km
(vii). Nearest Any Other Road along with distance in kms  1 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  2 km
(x). Nearest In-take for drinking water pump house distance in kms  0 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
No such areas are there in 1.5 km distance from project location
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No ecologically protected/ sensitive/important area is located nearby.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No such important / sensitive species of flora or fauna is located in the region
6. Inland, coastal, marine or underground waters The project site is in riverbed (basic information, 1.13) which has underwater flow, however, the project is not functional at this level
7. State, National boundaries There is no State of national boundary close to the area
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas No route or facilities available for public access to recreation or other tourist, pilgrim areas
9. Defence installations The area is not located close to any of the defence installations
10. Densely populated or built-up area, distance from nearest human habitation The area is not densely populated or have built-up area
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) The riverbed located area is quite away from sensitive man-made land uses
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) The area has only ground water resources, which are not intercepted by the project (above point 4).
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) The area is not either polluted or environmentally damaged
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 (8.3) except flood prone area. However, the project is non-functional in such cases
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/4121/2017
File Number4121/2017
Date of Apply EC17 Jan 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)ChhattisgarhBilaspurMasturi
(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)
NameTIKARI SHIV
Designationsachiv
Company TIKARI SHIV
Addressbilaspur
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