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 Champapur Sand Stone Mining Project (QL No-258)
(ii).Location / site (GPS Co-ordinate) Latitude : 25002’44.34” to 25002’46.48” Longitude : 75023’56.58” to 75023’58.60”
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.18 ha.
(iv).Capacity of the Mining Lease (TPA) 3851
(v).Period of Mining Lease 20
(vi).Expected cost of the Project 8
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.2012/07 
Name of Consultant/RQPNimish Singhvi
Address 15, New Glass Factory Colony, Sunderwas, Udipur (Raj.)
Mobile No.9414110360
Landline No.2492060
Email Idnimesh.singhvi@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.  About 1.58 km in SW km
2. (ii). Nearest Infrastructural along with distance in kms  Eru River about 1.01 km
(iii). Nearest Railway Line along with distance in kms  about 25.28 km in NW km
(iv). Nearest National Highway along with distance in kms  About 8.33 Km in N d km
(v). Nearest State Highway along with distance in kms  About 12.32 km in NW km
(vi). Nearest Major District Road along with distance in kms About 14.32 km in NW km
(vii). Nearest Any Other Road along with distance in kms  about 0.45km NW dire 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  About 10.82 Km in NW km
(x). Nearest In-take for drinking water pump house distance in kms  0 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0 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 Eru River about 1.01 km in NE direction Pond, Indrapura About 10.82 Km in NW direction Pond, Gopalpura About 7.21 Km in NE direction Pond, Mandol About 14.11 Km in NW direction
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Reserved Forest about 4.15 km in NE direction Reserved Forest about 3.81 km in SW direction
6. Inland, coastal, marine or underground waters Nil
7. State, National boundaries M.P State Boundary About 4.22 Km in SW direction
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas NH – 27 About 8.33 Km in N direction SH-29 About 12.32Km in NW direction SH-9A About 10.26 Km in S direction
9. Defence installations Nil
10. Densely populated or built-up area, distance from nearest human habitation S.No. Village Population Distance Direction 1 Baniyon Ka Talab 1128 4.28Km W 2 Bahadur Ji Ka Khera 304 6.20Km NW 3 Ant 575 4.11Km NW 4 Surajbilas 312 3.21Km NW 5 Kerkhera 1199 3.92Km NW 6 Gudha 685 3.11Km E 7 Ummedpura 554 0.84Km N 8 Barfoo 1325 9.03Km NE 9 Anti 1182 1.84Km SW 10 Deogarh 342 7.03Km NNE 11 Laxmipura 1240 6.98Km NE 12 Satkundiya 753 4.97Km N 13 Kantwara 831 2.39Km NW 14 Budhpura 5070 9.86Km NE 15 Peepalda 576 6.28Km NE 16 Sadaram ji Ka Khera 669 7.93Km NNW 17 Bhoo
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) S.No. School/Hospital/Dispensary Distance Direction 1 Kasya Govt. School 5.56Km NW 2 Govt. Hospital, Beejoliya kalan 14.36Km NW 3 Primary Health Center, Budhpura 9.86Km NE 4 Sr. Sec. School, Borao 10.13Km S 5 Sr. Sec. School, Dhaganmau 10.39Km S 6 Primary Hospital, Beejolia 14.30Km NW
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Eru River about 1.01 km in NE direction Pond, Indrapura About 10.82 Km in NW direction Pond, Gopalpura About 7.21 Km in NE direction Pond, Mandol About 14.11 Km in NW direction
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) The area comes under Seismic Zone –II
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/RJ/MIN/6628/2017
File NumberTo be assigned
Date of Apply EC23 May 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)RajasthanBhilwaraBhilwara
(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.)Aravali and 500m23 May 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSH. JAGDISH SOMANI
DesignationOwner
Company SH. JAGDISH SOMANI
AddressBarundhani
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