1.	Project Details

   Whether it is a violation case and application is being submitted under Notification No. S.O.804(E) dated 14.03.2017 ? : No

1.	Project Details

   i. Proposal No. : IA/MH/MIS/67507/2017    ii. MoEFCC File No. : NIL    iii.Short narrative of the project: Proposed Reconstruction of Municipal Dispensary and Staff Quarters at Banganga in D ward, at C.S. No. 18, Malbar Hill Division    iv. Project Sector : INFRA-2    v. Company/Proponent : PUBLIC HEALTH DEPARTMENT

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Maharashtra	Mumbai City	Mumbai

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 17 Aug 2017 x.Project Type: New

2.	Uploaded Documents of EIA/EMP,Risk Assessment,Public Hearing etc.

i.EIA/EMP: Annexure-EIA/EMP ii.Risk Assessment: Annexure-Risk Assessment iii.Public Hearing: Annexure-Public Hearing    iv. Date of Public Hearing: 17 Aug 2017   v. Uploaded Additional Report/Study/Document as desired by Ministry/EAC: Annexure-Additional Report/Study/Document   vi. Uploaded Cover Letter: Annexure-Cover Letter   vii.Remarks: Already approved by Maharashtra Coastal Zone Management Authority in it 84th MCZMA meeting.

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : NABET/EIA/1619/RA 0060    iii. Name of Consultant: Mantras Green Resources Limited   iv. Address : 104, A Wing Shanti Dham Near Royal residency Adharwadi Jail Road, Adharwadi Chowk, Kalyan (W) - 421301   v. Mobile No.: 9867851056   vi. Landline No.: 9867851056   vii. Email Id: vaishali@mantrasresources.com

5.	Undertaking

I hereby give undertaking that the data and information given in the application and enclosures are true to be best of my knowledge and belief and I am aware that if any part of the data and information found to be false or misleading at at any stage, the project will be rejected and clearance given, if any to the project will be revoked at our risk and cost.

   i. Name of Applicant : Surendra    ii. Designation : Architect    iii. Name of Company(Applicant Name should not be given here) : PUBLIC HEALTH DEPARTMENT    iv. Address : Municipal Corporation of Greater Mumbai, 3rd Floor, F/South Ward Office Building, Dr. Babasaheb Ambedkar Road Parel v. Uploaded copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency: Annexure-Uploaded copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency