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 BLUE STONE CRUSHER
(ii).Location / site (GPS Co-ordinate) 11°05’44.47” N to 11° 05’53.81” N 76°00’34.39”E to 76° 00’ 45.08” E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)4.9917 ha.
(iv).Capacity of the Mining Lease (TPA) 200000
(v).Period of Mining Lease 12
(vi).Expected cost of the Project 150
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.338/2014/A 
Name of Consultant/RQPMAHESH S
Address TC 31/580,NAVADEEPAM, SN NAGAR, PETTAH POST, TRIVANDRUM
Mobile No.9446303422
Landline No.2663330
Email Idmaheshsurendranpillai@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.  0.102 km
2. (ii). Nearest Infrastructural along with distance in kms  0.101 km
(iii). Nearest Railway Line along with distance in kms  22 km
(iv). Nearest National Highway along with distance in kms  30 km
(v). Nearest State Highway along with distance in kms  8 km
(vi). Nearest Major District Road along with distance in kms 8 km
(vii). Nearest Any Other Road along with distance in kms  0.102 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.600 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.400 km
(x). Nearest In-take for drinking water pump house distance in kms  0.400 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.400 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 None with in 15 Km radius
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests None with in 15 Km radius
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None with in 15 Km radius
6. Inland, coastal, marine or underground waters None with in 15 Km radius
7. State, National boundaries None with in 15 Km radius
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas School-AWLP School-1.5 Km, Mosue-Masjidul Huda-3.5 Km, Temple-Thiruvachankunnu temple-2Km, Church-ChristKing Church-1Km Relief Hospital-7.0 Km
9. Defence installations None with in 15 Km radius
10. Densely populated or built-up area, distance from nearest human habitation Nearest House-101m Densely populated Area-Nediyiruppu-2 Km
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) School-AWLP School-1.5 Km, Mosue-Masjidul Huda-3.5 Km, Temple-Thiruvachankunnu temple-2Km, Church-ChristKing Church-1Km Relief Hospital-7.0 Km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) None with in 15 Km radius
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None with in 15 Km 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) None with in 15 Km radius
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/3278/2016
File NumberTo be assigned
Date of Apply EC09 Dec 2016
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaMalappuramTirurangadi
(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.)LOI09 Dec 2016
(2.)RQP Certificate09 Dec 2016
(3.)NABL Certificate09 Dec 2016
(4.)500m Quarry Details09 Dec 2016
(5.)CONSENT LETTER09 Dec 2016
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBLUE STONE CRUSHER
DesignationManaging Partner
Company BLUE STONE CRUSHER
AddressMr. K. Mohammed Managing Partner Blue Stone Crusher Neduvakkad (po) Oorakam,Melmuri Malappuram Dt
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