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/GJ/IND2/31550/2015    ii. MoEFCC File No. : J-11011/278/2015-IA II (I)    iii.Short narrative of the project: Drilling of 11 wells & setting up of EPS    iv. Project Sector : Industrial Projects-2    v. Company/Proponent : Gujarat State Petroleum Corporation Ltd.

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Gujarat	Ahmedabad	Sanand

   vii.Date of TOR Granted 05 Mar 2016 viii.TOR letter issued by Ministry: Annexure-TOR letter ix.Date of Submission for EC: 20 Sep 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: 06 Apr 2017   v. Uploaded Additional Report/Study/Document as desired by Ministry/EAC: None   vi. Uploaded Cover Letter: Annexure-Cover Letter   vii.Remarks: NIL

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : NABET/EIA/1619/RA 022    iii. Name of Consultant: Envirocare Technocrats Pvt. Ltd.   iv. Address : 201, New Opera House, Near CNG pump & Harish Dyeing, Khatodara, Surat-395002   v. Mobile No.: 9727925122   vi. Landline No.: (0261) 263078   vii. Email Id: hse.hq@gspc.in

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 : Niladri    ii. Designation : Chief Operating Officer    iii. Name of Company(Applicant Name should not be given here) : Gujarat State Petroleum Corporation Ltd.    iv. Address : NIL 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