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 Siki Kalan (Bhukhand no-645, 646, 650, Khand no-12), Patthar, Gitti & Boulder Mining Project
(ii).Location / site (GPS Co-ordinate) 25° 6.863' N to 82° 5.553' E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.02 ha.
(iv).Capacity of the Mining Lease (TPA) 250000
(v).Period of Mining Lease 10
(vi).Expected cost of the Project 20
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.1619 
Name of Consultant/RQPCOGNIZANCE RESEARCH INDIA PRIVATE LIMITED
Address GT-20 SECTOR 117 NOIDA
Mobile No.8826287364
Landline No.01143534
Email Idsubh2enviro@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.  11.2 km
2. (ii). Nearest Infrastructural along with distance in kms  1 km
(iii). Nearest Railway Line along with distance in kms  10.5 km
(iv). Nearest National Highway along with distance in kms  9.5 km
(v). Nearest State Highway along with distance in kms  45 km
(vi). Nearest Major District Road along with distance in kms 2.0 km
(vii). Nearest Any Other Road along with distance in kms  1.5 km
(viii). Nearest Electric transmission line pole or tower distance in kms  20 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  13.5 km
(x). Nearest In-take for drinking water pump house distance in kms  1 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  16 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 There is no area comes under protected under international conventions, national or local legislation for their ecological, landscape, cultural or other related value for which NBWL Clearance is required is falling within study area of the project site.
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests There is no area comes under protected under international conventions, national or local legislation for their ecological, landscape, cultural or other related value for which NBWL Clearance is required is falling within study area of the project site.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration i. Mundpela RF- About 9 km in the NW direction ii. Chandas RF- About 5 km in the NW direction. iii. Bashera RF- About 2.5 km in the N direction
6. Inland, coastal, marine or underground waters No, there is no Inland, coastal, marine or underground waters.
7. State, National boundaries Not within the 10 km radius from the project site.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas NH-76 about 11 km
9. Defence installations No, there are no Defence installations within project study area
10. Densely populated or built-up area, distance from nearest human habitation Siki Kalan- 1 km , Meja: 2.5 km
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Jawahar Navodaya Vidhalaya: About 3.5 Km in NE direction. Gayatraya Devi Inter Collage: About 10.5 Km in NE direction Maa Durga Mandir- About 2.5 km in NE direction
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Ganga River : 13.5 km in NE direction Tons River: 8.5 km in NW direction
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) There is no such area found within 10 km of the study area14 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) Zone-II, Moderate damage risk Atlas of Seismic zone of India IS: 1893-2002.
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) No, there is no fissure / fracture for ground water recharge over or near the project area.
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/UP/MIN/8434/2017
File NumberTo be assigned
Date of Apply EC16 Aug 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)Uttar PradeshPRAYAGRAJMeja
(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)
NameATUL TIWARY
DesignationPARTNER
Company ATUL TIWARY
AddressR/O 481/190 F/1 ALOPIBAGH, SADAR, ALLAHABD
Print