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 Khairwari Limestone Quarry
(ii).Location / site (GPS Co-ordinate) 210 37/18.69// to 21037/24.81// 81057/21.95// to 81057/27.44//
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.27 ha.
(iv).Capacity of the Mining Lease (TPA) 13500
(v).Period of Mining Lease 30
(vi).Expected cost of the Project 10
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.19/2015 
Name of Consultant/RQPAshok Kumar John
Address Qtr No 2 Street No 6 V V Vihar Mova Raipur Chhattisgarh
Mobile No.7898343353
Landline No.4222701
Email Idhitech_ashok@yahoo.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.  5.93 km
2. (ii). Nearest Infrastructural along with distance in kms  14.0 km
(iii). Nearest Railway Line along with distance in kms  11.0 km
(iv). Nearest National Highway along with distance in kms  22.0 km
(v). Nearest State Highway along with distance in kms  12.0 km
(vi). Nearest Major District Road along with distance in kms 0.82 km
(vii). Nearest Any Other Road along with distance in kms  0.5 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.0 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  2.6 km
(x). Nearest In-take for drinking water pump house distance in kms  2.0 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  2.0 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Sirpur 39.0 km
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Sirpur 39.0 km
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Barnawapara 40.0 km
6. Inland, coastal, marine or underground waters Puri 600 km
7. State, National boundaries 88 km.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Sirpur 39.0 km
9. Defence installations Bastar 375 km
10. Densely populated or built-up area, distance from nearest human habitation Bhatapara 14.0 km
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Bhatapara 14.0 km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Sirpur 39.0 km
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Korba 250 km
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) non
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/4790/2017
File NumberBBD/33/2017
Date of Apply EC18 Feb 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)ChhattisgarhBalodabazarNo Data
(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)
NameMAHADEV AGRAWAL
Designationapplicant
Company MAHADEV AGRAWAL
AddressVillage & Post Khairwari Tahsil Simga District Balodabazar Chhattisgarh
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