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 project of Mr. JOVIN GEORGE (Applicant) at Survey No. 275/1A, Trippangottur Village, Thalassery Taluk, Kannur District, Kerala of 3.7556 hectares
(ii).Location / site (GPS Co-ordinate) 11°47'50.59"N to 11°47'59.02"N 75°40'41.61"E to 75°40'51.60"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)3.7556 ha.
(iv).Capacity of the Mining Lease (TPA) 140000
(v).Period of Mining Lease 16
(vi).Expected cost of the Project 200
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.1518/RA010 
Name of Consultant/RQPM/s Environmental Engineers & Consultants Pvt. Ltd
Address A1-198, Janak Puri, New Delhi-58
Mobile No.9350873385
Landline No.25507190
Email Ideecnewdelhi@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.  7 km
2. (ii). Nearest Infrastructural along with distance in kms  2 km
(iii). Nearest Railway Line along with distance in kms  25 km
(iv). Nearest National Highway along with distance in kms  25 km
(v). Nearest State Highway along with distance in kms  14 km
(vi). Nearest Major District Road along with distance in kms 5 km
(vii). Nearest Any Other Road along with distance in kms  0.300 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.300 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.100 km
(x). Nearest In-take for drinking water pump house distance in kms  0.120 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.100 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Aralam Wildlife Sanctuary about 10 km, N
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Water body: Anjarkandy River at 6 km, NE Mahe River, 8 km, SE
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 5 km radius
6. Inland, coastal, marine or underground waters Water body: Anjarkandy River at 6 km, NE Mahe River, 8 km, SE
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 Major roads near the site : NH- 17, Thalassery about 25 km, West SH - 38, Pathippalam, about 14 km, West Thalassery-Baveli Rd., 5 km, North
9. Defence installations None within 5 km radius
10. Densely populated or built-up area, distance from nearest human habitation Nearest densely populated area Panoor, 15 km, SW and the nearest house is 133 m towards SW.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Nearest Hospital :- Govt. Hospital Panoor, 15 km, SW Nearest School :- RGMHSS, Puvathikinzhil, 8 km, SW Religious places :- Church – St. Cornelius, Kolayad, 7 km,NE Temple – Poyiloor, 5 km, SW Mosque – Poyiloor, 5 km, SW
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) None within 5 km radius
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None within 5 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 within 5 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?Yes
File numberFP/KL/QRY/1193/2017 
(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/4092/2017
File Number01/KNR/2017/DEIAA
Date of Apply EC17 Jan 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaKannurThalasserry
(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.)MoEF Wildlife Clearance Submission Report17 Jan 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameJOVIN GEORGE
DesignationApplicant
Company JOVIN GEORGE
AddressMr. Jovin George, Madathinamattathil, Palisseri, Thalassery P.O., Kannur, Kerala-670101
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