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 Smt. Som Lata W/o Sh. Ashwani Kumar Mauja Fahal Mohal Jhikla, Sub Tehsil Galore, Tehsil Nadaun, District Hamirpur (H.P.)
(ii).Location / site (GPS Co-ordinate) Longitude 76° 25' 10" Latitute 31° 37' 10 "
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.8932 ha.
(iv).Capacity of the Mining Lease (TPA) 41624
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 5
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.63 
Name of Consultant/RQPEQMS India Pvt. Ltd.
Address M/s EQMS India Pvt. Ltd., Plot No.16, Rishabh Corporate Tower, Karkardooma Community Centre, Karkardooma, Delhi-110092
Mobile No.9810297612
Landline No.30003200
Email Idskjain@eqmsindia.org
(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.  1 km
2. (ii). Nearest Infrastructural along with distance in kms  0.87 km
(iii). Nearest Railway Line along with distance in kms  24 km
(iv). Nearest National Highway along with distance in kms  26 km
(v). Nearest State Highway along with distance in kms  16 km
(vi). Nearest Major District Road along with distance in kms 16 km
(vii). Nearest Any Other Road along with distance in kms  0.11 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.4 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  1 km
(x). Nearest In-take for drinking water pump house distance in kms  2 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  2 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Not Applicable
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Not Applicable
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Not Applicable, there are no high quality or scarce resources areas (ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals).
6. Inland, coastal, marine or underground waters Not Applicable
7. State, National boundaries Not Applicable.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Not Applicable, No such places are located within 500 m from the site.
9. Defence installations Not Applicable.
10. Densely populated or built-up area, distance from nearest human habitation Village Plasi is exists at a distance of about 500 m down stream of the project site.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Nearest college is Sai Ram Education Trust Group of Institutions about 0.87 km from project site.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Not Applicable, there are no high quality or scarce resources areas (ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals)
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 500 meters 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 Khad carries water during monsoon. The water level during monsoon rises. No mining activity is carried out during monsoon.
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/HP/MIN/8930/2017
File NumberDEIAA/MS/EC/8930/2017
Date of Apply EC14 Sep 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)Himachal PradeshHamirpurNadaun(T)
(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.)NOC Grampanchyat13 Sep 2017
(2.)Letter of Intent from Department of Industries, Geological Wing,  dated 02/01/201314 Sep 2017
(3.)Land Documents/ Fard of the land acquired on lease for Project activity14 Sep 2017
(4.)Khasra Maps of the Land acquired on lease for the project activity14 Sep 2017
(5.)Certificate that no other mining/ burrowing site exists within 500 m radius of the existing site14 Sep 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSMT. SOAMLATA
DesignationProprietor
Company SMT. SOAMLATA
AddressVill Mangul, PO Galore
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