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 Imambhai Mohammadbhai Sindhi (ii). Location / site (GPS Co-ordinate) N 22.13344 E 73.50679 Annexure-GPS file       (iii). Type of Lease Indivisual Area Size of the Mining Lease (in ha.) 4.68 ha. (iv). Capacity of the Mining Lease (TPA) 60000 (v). Period of Mining Lease 5 (vi). Expected cost of the Project 100 (vii). Have you hired Consultant/Registered Qualified Person(RQP) for preparing document? No Reason for not hiring the Consultant/RQP We have experienced person (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.  0.66 km 2. (ii). Nearest Infrastructural along with distance in kms  10 km (iii). Nearest Railway Line along with distance in kms  2.8 km (iv). Nearest National Highway along with distance in kms  31.5 km (v). Nearest State Highway along with distance in kms  6.73 km (vi). Nearest Major District Road along with distance in kms  0 km (vii). Nearest Any Other Road along with distance in kms  1 km (viii). Nearest Electric transmission line pole or tower distance in kms  00 km (ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.66 km (x). Nearest In-take for drinking water pump house distance in kms  00 km (xi). Nearest In-take for Irrigation canal pumps distance in kms  00 km 3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value Champaner archaeological site 38.39 Kms in NE from project site 4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Jambughoda Sanctuary 34.38 Kms in NE from project site 5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Jambughoda Sanctuary 34.38 Kms in NE from project site 6. Inland, coastal, marine or underground waters No 7. State, National boundaries Gujarat - Madhya Pradesh boundary 59.28 Kms in East from project site 8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas - 9. Defence installations Air force installation at Vadodara 32.35 Kms in west from project site 10. Densely populated or built-up area, distance from nearest human habitation Vadodara 32.35 Kms in West from project site 11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Dabhoi 10 kms in West from project site 12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No 13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No 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 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/GJ/MIN/4680/2017 File Number To be assigned Date of Apply EC 14 Feb 2017

Details of State of the project
S.No.	State Name	District Name	Tehsil Name
(1.)	Gujarat	Vadodara	Dabhoi

(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.) APC 14 Feb 2017 (2.) MFG 14 Feb 2017 (3.) NPC 14 Feb 2017 (4.) Wat 14 Feb 2017 (5.) SWM 14 Feb 2017

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

(IV).(i)

Name IMAMBHAI MOHAMMADBHAI SINDHI Designation Owner Company IMAMBHAI MOHAMMADBHAI SINDHI Address S.No377. Nr.Village: Bhimpura,Ta: Dabhoi,Dist: Vadodara