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 M/s Shahu Stone Crusher Shri. Tukaram M.Kadam Gat No. 660/1/1 Part, Village: Dindori, Taluka: Dindori, District: Nashik, Maharashtra
(ii).Location / site (GPS Co-ordinate) 1 20°10'7.9"N 73°49'53.9"E 2 20°10'09.5"N 73°49'55.7"E 3 20°10'8.0"N 73°49'57.0"E 4 20°10'06.6"N 73°49'55.2"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.40 ha.
(iv).Capacity of the Mining Lease (TPA) 16800
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 10.00
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.NABET/ EIA/ 1821/IA0038 
Name of Consultant/RQPEnviro Resources
Address E- 604 Crystal Plaza, Opp. Infiniti Mall, New Link Road, Andheri West, Mumbai400053
Mobile No.9867898844
Landline No.66919881
Email Idtimir@enviroResources.in
(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.  1.7 km
2. (ii). Nearest Infrastructural along with distance in kms  3.6 km
(iii). Nearest Railway Line along with distance in kms  0.0 km
(iv). Nearest National Highway along with distance in kms  0.0 km
(v). Nearest State Highway along with distance in kms  0.7 km
(vi). Nearest Major District Road along with distance in kms 4.0 km
(vii). Nearest Any Other Road along with distance in kms  0.0 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.0 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.9 km
(x). Nearest In-take for drinking water pump house distance in kms  0.0 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.0 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Not Applicable
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Not Applicable
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Not Applicable
6. Inland, coastal, marine or underground waters Tributary of Kadwa River is at a distance of 2.3 km from the quarry site in NNW direction
7. State, National boundaries Not Applicable
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Maharashtra State Highway No.-17 is 0.7 km away in West direction.
9. Defence installations Not Applicable
10. Densely populated or built-up area, distance from nearest human habitation Distance from habitation is 1.0 km in West direction.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) There are small schools & temples in nearby Village.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Not Applicable
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Not Applicable
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) The area falls in Zone – III as per the seismic zone map and falls in moderate damage risk zone.
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/19838/2019
File NumberTo be assigned
Date of Apply EC08 Feb 2019
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraNashikDindori
(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.)Land Record08 Feb 2019
(2.)NOC08 Feb 2019
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSHAHU STONE CRUSHER
DesignationP
Company SHAHU STONE CRUSHER
AddressGut no. 660/1/1 Part Village Dindori, Tehsil- Dimdori, District- Nashik
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