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 Narne sand ghat
(ii).Location / site (GPS Co-ordinate) 21 7 56.8227 N 75 18 56.7895 E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.1600 ha.
(iv).Capacity of the Mining Lease (TPA) 59842
(v).Period of Mining Lease 1
(vi).Expected cost of the Project 2352
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.1518/SA036 
Name of Consultant/RQPPrashil Shukla
Address Nagpur
Mobile No.9225230146
Landline No.9225230
Email Idenvirotechnoconsult@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.  8.80 km
2. (ii). Nearest Infrastructural along with distance in kms  13.8 km
(iii). Nearest Railway Line along with distance in kms  12.79 km
(iv). Nearest National Highway along with distance in kms  12.76 km
(v). Nearest State Highway along with distance in kms  8.255 km
(vi). Nearest Major District Road along with distance in kms 6.626 km
(vii). Nearest Any Other Road along with distance in kms  0.650 km
(viii). Nearest Electric transmission line pole or tower distance in kms  15 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  7.04 km
(x). Nearest In-take for drinking water pump house distance in kms  0.68 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.68 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Gautala wildlife sanctuary 20 km NE
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Girna River ,Marine Water 360 km W
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Gautala wildlife sanctuary 20 km NE
6. Inland, coastal, marine or underground waters 371 km W
7. State, National boundaries Madhya Pradesh 29 km N
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Not within 5 km
9. Defence installations Varangaon
10. Densely populated or built-up area, distance from nearest human habitation Awhani 0.72 km SW
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Jalgaon 13.8 km S
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Girna River
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Not within 5 km
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) Not within 5 km
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/18041/2018
File Number15/2018
Date of Apply EC08 Oct 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraJalgaonDharangaon
(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.)EIA-EMP09 Oct 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NamePROJECT PROPONENT
DesignationPROJECT PROPONENT
Company PROJECT PROPONENT
Address68, mahakali nagar nagpur
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