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 Govindbhai Jhalambhai Ode, Ordinary sand permit
(ii).Location / site (GPS Co-ordinate) A- 22°30'7.62"N 73°5'26.42"E B- 22°30'6.77"N 73°5'29.51"E C- 22°30'0.65"N 73°5'24.84"E D- 22°29'59.79"N 73°5'26.41"E E- 22°30'5.37"N 73°5'27.74"E F- 22°30'4.70"N 73°5'29.29"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)03.00.00 ha.
(iv).Capacity of the Mining Lease (TPA) 100000
(v).Period of Mining Lease 1
(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 NA
(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 km
2. (ii). Nearest Infrastructural along with distance in kms  0 km
(iii). Nearest Railway Line along with distance in kms  20 km
(iv). Nearest National Highway along with distance in kms  10 km
(v). Nearest State Highway along with distance in kms  3 km
(vi). Nearest Major District Road along with distance in kms 3 km
(vii). Nearest Any Other Road along with distance in kms  2 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0 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  0 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
NA
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests NA
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration NA
6. Inland, coastal, marine or underground waters NA
7. State, National boundaries NA
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas NA
9. Defence installations NA
10. Densely populated or built-up area, distance from nearest human habitation About Jalampura Jalampura is a small Village/hamlet in Savli Taluka in Vadodara District of Gujarat State, India. It comes under Jalampura Panchayath. It is located 27 KM towards North from District head quarters Vadodara. 25 KM from Savli. 108 KM from State capital Gandhinagar Jalampura Pin code is 391780 and postal head office is Bhadarwa . Poicha (kanoda) ( 2 KM ) , Poicha (raniya) ( 2 KM ) , Bhadarva ( 3 KM ) , Raniya ( 3 KM ) , Ramnagar ( 6 KM ) are the nearby Villages to Jalampur
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Colleges near Jalampura Kjit Address : Kjit Near Javala Talav Opp Iti Savali Sanskar Bharti B. Ed. College Address : Natvarnagar A – 391 780;taluk : Savli; Dist : Vadodara. Schools in Jalampura Jalampura Pri. Sch. Address : jalampura , savli , vadodara , Gujarat . PIN- 391780 , Post - Bhadarwa
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No such area containing important, high quality or scarce resources (Ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals) within 500 meters
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No such areas already subjected to pollution or environmental damage. (Those where existing legal environmental standards are exceeded) within five kilometres radius.
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 not prone to flood and earthquake. No such incidence of natural disaster is reported in this area so far. In view point of seismicity, proposed project comes in Zone-II (least active) of Seismic Zoning Map of India.
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?Yes
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/GJ/MIN/7905/2017
File Number1
Date of Apply EC28 Jul 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)GujaratVadodaraSavli
(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)
NameARPITGOSWAMI
Designationfarmer
Company ARPITGOSWAMI
Address17, Opposite Prathna tenement, Nr.Bhagirath party plot
Print