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 Quarry Unit of Mr. Moideen .P
(ii).Location / site (GPS Co-ordinate) 10°45’45.75”N 10°45’49.03”N 76°12’02.63”E 76°12’06.98”E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.7352 ha.
(iv).Capacity of the Mining Lease (TPA) 18600
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 50
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.DMG/KERALA/RQP/16/2018 
Name of Consultant/RQPDr P Thangaraju
Address Fairland Salem
Mobile No.9443356539
Landline No.94433565
Email Idmoideen1949p@gmail.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.  2.8 km
2. (ii). Nearest Infrastructural along with distance in kms  1 km
(iii). Nearest Railway Line along with distance in kms  7.5 km
(iv). Nearest National Highway along with distance in kms  26 km
(v). Nearest State Highway along with distance in kms  4.9 km
(vi). Nearest Major District Road along with distance in kms 4.9 km
(vii). Nearest Any Other Road along with distance in kms  0.35 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.2 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  1 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  1 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 There are NO Areas protected under international conventions, national or local legislation for their ecological, landscape, cultural or other related value within 5 km radius
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests There are NO Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests within 5 km radius
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration There are NO Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration within 5 km radius
6. Inland, coastal, marine or underground waters Bharathappuzha River 2.8 KM North East
7. State, National boundaries None within 5 km radius
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas (NH-544) Salem – Kochi Highway 26 KM South East
9. Defence installations None within 5 km radius
10. Densely populated or built-up area, distance from nearest human habitation Thirumittacode - I Village Nearest House 120 Meters North
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) AUP School, Ezhumangad 400 Meters South East Anganvadi, Arrangotukara 1.11 KM South East Thirumittacode Government Hospital 1.9 KM North West Pattambi Taluk Hospital 4.9 KM North West Shoranur Government Hospital 7.4 KM East Arangottukara Juma Masjid 900 Meters South East Thrikkovil Narasimha Temple 1.2 KM South East Sree Karthiayani Bhagavathi Temple 1.35 KM South East
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) There are NO Areas containing important, high quality or scarce resources (ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals) within 5 km radius
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) There are NO Areas already subjected to pollution or environmental damage. (those where existing legal environmental standards are exceeded) within 500 Meter 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) Zone III, Moderate damage risk zone as per BMTPC, Vulnerability Atlas of Seismic zone of India IS: 1893 – 2002. No history of such incidents in the area
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/KL/MIN/15298/2018
File NumberDIA/KL/PL/26/2018
Date of Apply EC23 Oct 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaPalakkadAlathur
(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.)Form 118 May 2018
(2.)Form 1 M18 May 2018
(3.)Index18 May 2018
(4.)Mining Plan Approval Letter18 May 2018
(5.)Income Tax Return Certificate22 May 2018
(6.)Form 122 May 2018
(7.)Form 1 M22 May 2018
(8.)Index22 May 2018
(9.)REVISED PLAN RENEWED RQP CERTIFICATE23 Oct 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameMOIDEEN QUARRY UNIT
DesignationProprietor
Company MOIDEEN QUARRY UNIT
AddressPulikkal House, Ezhumangad, Arangottukara, Thirumittacode - I, Palakkad
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