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 Datarti Zone No. 1 & 2
(ii).Location / site (GPS Co-ordinate) 20 57’30.60’’ N 74 23’06.80’’E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)4.2 ha.
(iv).Capacity of the Mining Lease (TPA) 47250
(v).Period of Mining Lease 1
(vi).Expected cost of the Project 74.20
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.NABET/EIA/1518/RA017 
Name of Consultant/RQPSRI SAI MANASA NATURE TECH PRIVATE LIMITED
Address PLOT NO. 74/A, FLAT NO. 102, CENTRAL BANK BUILDING, KALYAN NAGAR, HYDERABAD - 500038
Mobile No.9511982785
Landline No.23816333
Email Idmankar.r@ssmntech.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.  2.5 km
2. (ii). Nearest Infrastructural along with distance in kms  7.5 km
(iii). Nearest Railway Line along with distance in kms  40.0 km
(iv). Nearest National Highway along with distance in kms  3.0 km
(v). Nearest State Highway along with distance in kms  3.0 km
(vi). Nearest Major District Road along with distance in kms 3.0 km
(vii). Nearest Any Other Road along with distance in kms  2.0 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  6.5 km
(x). Nearest In-take for drinking water pump house distance in kms  6.5 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  6.5 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Nil
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Nil
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Nil
6. Inland, coastal, marine or underground waters Panzara River
7. State, National boundaries Nil
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Nil
9. Defence installations Nil
10. Densely populated or built-up area, distance from nearest human habitation Datarti Village - 2.0 km
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Nil
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Nil
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Nil
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) Nil
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/MH/MIN/15213/2018
File Numberno.kavi/mining/387/18 dt-16/05/2018
Date of Apply EC16 May 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraDhuleSakri
(2.)MaharashtraDhuleSakri
(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)
NameDEPUTY COLLECTOR DHULE
DesignationDistrictMiningOfficer
Company DEPUTY COLLECTOR DHULE
AddressNew Administrative Building, Collector Office, Dhule
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