APPENDIX I
(See Paragraph-6)
FORM 1
Note : If space provided against any parameter is inadequate, Kindly upload supporting document under 'Additional Attachments if any'  at the last part of the Form1. Please note that all such Annexures must be part of single pdf document.
(I) Basic Information
S.No.Item Details
Is your project Comes under Notified Industrial Area NA
Whether proposal involved violation of EIA notificationN/A
Weather Consent to Establishment ObtainedN/A
Upload copy of CTE N/A
1.
Name of the Project/s Kandla- Viramgam-Gandhinagar-Sanand Section of Kandla Gorakhpur Pipeline
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/GJ/IND2/114428/2019
Project Cost 14000 lacs
2.
S. No. in the schedule6(a) Oil & gas transportation pipe line (crude and refinery/ petrochemical
Project Sector Industrial Projects - 2
3. Proposed capacity/area/length/tonnage to be handled/command area/lease area/number or wells to be drilled 5.10 MMTPA ha.
4.
New/Expansion/ModernizationNew
5. Existing Capacity/Area etc. 0 ha.
6. Category of project i.e. 'A' or 'B' A
7.
Does it attract the general condition? If yes, please specify Yes
a) Protected areas notified under the wildlife (Protection) Act, 1972
8.
Does it attract the specific condition? If yes, please specify No
9.
Location of the projectPipeline from Kandla
Shape of the project landBlock (Polygon)
Uploaded GPS fileAnnexure-GPS file      
Uploaded copy of survey of India ToposheetAnnexure-Survey of india toposheet
Plot/Survey/Khasra No.Plot /khasra nos are not available now as cadastral details are awaited and actual details can be provided only after acquisition of Right of way for pipeline laying as per P&MP Act
Town / Villagekandla, Kidana,Goraiya Viramgam
State of the projectGujarat
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)GujaratMorbiHalvad
(2.)GujaratMorbiMaliya
(3.)GujaratkutchBhachau
(4.)GujaratkutchAnjar
(5.)GujaratkutchGandhidham
(6.)GujaratMahesanaKadi
(7.)GujaratGandhinagarKalol
(8.)GujaratGandhinagarGandhinagar
(9.)GujaratAhmedabadViramgam
(10.)GujaratAhmedabadSanand
(11.)GujaratSurendranagarDhrangadhra
(12.)GujaratSurendranagarDasada
10.
Nearest railway station along with distance in kms Gandhidham, 13 km
Nearest airport along with distance in kms Kandla, 22 km
11. Nearest Town/City/District Headquarters along with distance in kms Gandhidham , 17.6 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given) C/o IndianOil Corporation Near fore shore terminal old kandla District Kachch
13. Name of the Applicant Ram
14. Registered Address C/o IndianOil Bhawan,A-1, Udyog Marg
15.
Address for correspondance:
Name of the Company IHB LIMITED
Name of the Applicant Ram
Designation (Owner/ Partner/ CEO) Chief Operating Officer
Pin code 201301
E-mail coo@ihbl.in
Telephone No. 120-2448716
Fax No. 120-
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
16.
Details of Alternative Sites examined, if any. Location of these sites should be shown on a toposheet No
17. Whether part of Interlinked projects? No
18. Whether separate application of Interlinked project has been submitted? N/A
19.
If Yes, MoEF file numberN/A
Date of submissionN/A
20. If No, Reason N/A
21.
Whether the proposal involves Approval/ Clearance under: if yes, details of the same and their status to be given
(i) Whether the proposal involves approval/clearance under the Forest (Conservation) Act,1980?Yes
StatusApplication for Forest Clearance yet to be submitted
(ii) Whether the proposal involves approval/clearance under the wildlife (Protection) Act,1972?Yes
StatusApplication for Wildlife Clearance yet to be submitted
(iii) Whether the proposal involves approval/clearance under the C.R.Z notification, 2011?Yes
22.
Whether there is any Government Order/Policy relevant/relating to the site?No
23.
Whether any Forest Land Involved?Yes
Area of Forest land Involved (hectares)0.0454 ha.
24.
Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up?No
(a) Name of the CourtN/A
(b) Name of the Sub courtN/A
(c) Case No.N/A
(d) Orders/directions of the court, if any and relevance with the proposed projectN/A
(II) Activity
1 Construction, operation or decommissioning of the Project involving actions, which will cause physical changes in the locality (topography, land use, changes in water bodies, etc.)
S.No Information/Checklist confirmation Yes/No Details there of (with approximate quantities/rates, wherever possible) with source of information data
1.1 Permanent or temporary change in land use, land cover or topography including increase in intensity of land use (with respect to local land use plan) No The Pipeline RoW shall be restored to its original condition for agricultural purpose, after laying of pipeline
1.2 Clearance of existing land, vegetation and buildings? Yes Temporary clearance of standing crops is expected during the project execution phase. Compensation will be paid for crops by Competent Authority, as per Petroleum and Mineral Pipeline Act 1962. Permanent Structures and Buildings will not be affected.
1.3 Creation of new land uses? No
1.4 Pre-construction investigations e.g. bore houses, soil testing? Yes During pre project phase, Soil testing and Soil Investigation Survey were carried out for entire pipeline stretch
1.5 Construction works? Yes Involves Civil, Mechanical, Electrical, Telecom and Instrumentation works, SCADA at Stations along with laying of Cross Country Pipeline.
1.6 Demolition works? No Nil
1.7 Temporary sites used for construction works or housing of construction workers? Yes Temporary spread camps used for housing contract workers during pipeline laying activity.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations Yes Buildings/Structures shall come at Stations, SV locations at defined intervals en-route the pipeline stretch and residential colony at originating and terminal station
1.9 Underground works including mining or tunnelling? No Only underground laying of pipelines at a depth of 1.2 to 1.5 mtr along with crossings of roads, rivers through HDD technique is envisaged.
1.10 Reclamation works? No Nil
1.11 Dredging? No Nil
1.12 Offshore structures? No Nil
1.13 Production and manufacturing processes? No No Manufacturing or Production activity is involved. Only transportation of LPG through pipeline is envisaged.
1.14 Facilities for storage of goods or materials? No A small storage for spares & equipment maintenance at station
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? No Negligible amount of solid waste and residue if any shall be generated. Soak pit & septic tank will be provided for disposal of waste as per Statutory guidelines
1.16 Facilities for long term housing of operational workers? Yes Residential facility would be constructed for operating workers.
1.17 New road, rail or sea traffic during construction or operation? No Nil
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? No Nil
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? No Nil
1.20 New or diverted transmission lines or pipelines? No Nil
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No Nil
1.22 Stream crossings? Yes Major river crossings are to be executed through HDD technique, which does not disturb the banks of the rivers/streams.
1.23 Abstraction or transfers of water from ground or surface waters? Yes Pipeline construction usually does not require large quantities of water. The required quantity shall be arranged through available means.
1.24 Changes in water bodies or the land surface affecting drainage or run-off? No Nil
1.25 Transport of personnel or materials for construction, operation or decommissioning? Yes Through road-worthy transport for construction purpose.
1.26 Long-term dismantling or decommissioning or restoration works? No Nil
1.27 Ongoing activity during decommissioning which could have an impact on the environment? No Nil
1.28 Influx of people to an area in either temporarily or permanently? Yes Temporary influx of small number of man power is envisaged during construction phase as skilled man power will come from outside.
1.29 Introduction of alien species? No Nil
1.30 Loss of native species or genetic diversity? No Nil
1.31 Any other actions? No Nil
2 Use of Natural resources for construction or operation of the Project (such as land, water, materials or energy, especially any resources which are non-renewable or in short supply):
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
2.1 Land especially undeveloped or agricultural land (ha) No The pipeline will be laid mainly through agricultural fields. After construction phase of short duration, land will be restored again and handed over to the land owner for carrying out agricultural activity.
2.2 Water (expected source & competing users) unit: KLD Yes During construction phase, there will be requirement of 20 KLD of water, which will be met by tanker supply. During operation phase, water requirement will be 5 KLD and will be met through tanker supply.
2.3 Minerals (MT) No Nil
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes Locally available construction materials like sand, bricks, aggregates will be used for construction activity.
2.5 Forests and timber (source – MT) No Nil
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes Power requirement is planned to be met by Gujarat Electricity Board’s Power Supply.
2.7 Any other natural resources (use appropriate standard units) No Nil
3 Use, storage, transport, handling or production of substances or materials, which could be harmful to human health or the environment or raise concerns about actual or perceived risks to human health
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
3.1 Use of substances or materials, which are hazardous (as per MSIHC rules) to human health or the environment (flora, fauna, and water supplies Yes Liquefied Petroleum Gas(LPG) will be transported through this pipeline.
3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne diseases) No Nil
3.3 Affect the welfare of people e.g. by changing living conditions? No Nil
3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. No Nil
3.5 Any other causes No Nil
4 Production of solid wastes during construction or operation or decommissioning (MT/month)
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
4.1 Spoil, overburden or mine wastes No Nil
4.2 Municipal waste (domestic and or commercial wastes) Yes Very small quantity of domestic waste will be generated during construction period of pipeline. Septic Tank followed by Soak Pit will be provided at workers camp.
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) No Nil
4.4 Other industrial process wastes No Nil
4.5 Surplus product No Nil
4.6 Sewage sludge or other sludge from effluent treatment No Nil
4.7 Construction or demolition wastes No A small quantity of construction waste, which shall be disposed- off in environment friendly manner
4.8 Redundant machinery or equipment No Nil
4.9 Contaminated soils or other materials No Nil
4.10 Agricultural wastes No Nil
4.11 Other solid wastes No Nil
5 Release of pollutants or any hazardous, toxic or noxious substances to air(Kg/hr)
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
5.1 Emissions from combustion of fossil fuels from stationary or mobile sources Yes During construction minor emissions are envisaged from equipments/machineries used for construction activity, DG sets. DG sets will be installed for usage during power breaks and the emission will be within the permissible limit and used through sufficient height of stacks
5.2 Emissions from production processes No No processing is involved in the production stage.
5.3 Emissions from materials handling including storage or transport No Nil
5.4 Emissions from construction activities including plant and equipment Yes There will be negligible quantity of emission from the portable DG sets, machineries used during construction activity.
5.5 Dust or odours from handling of materials including construction materials, sewage and waste No During construction phase, very nominal amount of dust is likely to be generated. Adequate preventive measures such as water sprinkling will be taken to minimize dust generation.
5.6 Emissions from incineration of waste No Nil
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No Nil
5.8 Emissions from any other sources No Nil
6 Generation of Noise and Vibration, and Emissions of Light and Heat:
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
6.1 From operation of equipment e.g. engines, ventilation plant, crushers Yes Very minimal noise will be generated during construction phase due to running of equipment. It would be reduced by controlling the equipment speed and use of PPEs.
6.2 From industrial or similar processes No No industrial process is involved. The project involves only transportation of LPG.
6.3 From construction or demolition Yes During construction phase, small noise will be generated due to movement of machinery. Due to arc welding, some light may be emitted. Overall pollution load is expected to remain negligible and for a short duration.
6.4 From blasting or piling Yes Piling foundation is limited to the construction of building within the station premises. Quantity of piling envisaged is less and hence, generation of noise will be negligible. During pipeline laying, some rocky terrain may require blasting for trenching purpose.
6.5 From construction or operational traffic Yes Small levels of noise will be increased only during construction phase by vehicular traffic. PUC certified vehicles would be used for construction and speed limits would be adhered. No traffic movement is expected during operating phase and PPEs will be used.
6.6 From lighting or cooling systems No Nil
6.7 From any other sources No Nil
7 Risks of contamination of land or water from releases of pollutants into the ground or into sewers, surface waters, groundwater, coastal waters or the sea:
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
7.1 From handling, storage, use or spillage of hazardous materials No Minimal risk is associated with transportation of LPG as pipeline system is a closed loop. However, risk study will be carried out for the project.
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) No Nil
7.3 By deposition of pollutants emitted to air into the land or into water No Nil
7.4 From any other sources No Nil
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No Nil
8 Risk of accidents during construction or operation of the Project, which could affect human health or the environment
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
8.1 From explosions, spillages, fires etc from storage, handling, use or production of hazardous substances No Risk assessment study shall be carried out for the project as applicable. The facilities will confirm to international standards and also to the standards stipulated by OISD, PESO and other statutory authorities regarding safety of LPG pipeline installation against the fire, explosion etc.
8.2 From any other causes No Nil
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? No Facilities will be designed in accordance with the national & international standards & codes of practices factoring into probable natural disasters, thus safeguarding men and environment against any possible mishap. Pipeline is proposed to be laid through HDD technique across major rivers, which minimizes the risk of erosion of banks & exposure of pipeline.
9 Factors which should be considered (such as consequential development) which could lead to environmental effects or the potential for cumulative impacts with other existing or planned activities in the locality
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
9.1 Lead to development of supporting utilities, ancillary development or development stimulated   by the project which could have impact on the environment e.g.:
  • Supporting infrastructure (roads, power supply,waste or waste water treatment, etc.)
  • housing development
  • extractive industries
  • supply industries
  • Other
Yes LPG availability in the region would help in meeting demand of LPG. This would also help in realize Government of India’s dream project of making clean and environmental friendly fuel available to every domestic household in the country.
9.2 Lead to after-use of the site, which could have an impact on the environment No After the pipeline is laid, the land is restored back to its original condition and the land is fit for cultivation purpose.
9.3 Set a precedent for later developments No Nil
9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects No Nil
(III) Environmental Sensitivity
S.No Areas Name/Identity Aerial distance (within 15km.) Proposed project location boundary
1 Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Yes The proposed LPG pipeline shall pass through Wild Ass Sanctuary for about 10.77 km length.
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Yes The proposed LPG pipeline shall pass through Wild Ass Sanctuary and forest area. Detail will be provided in EIA report
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Yes The proposed LPG pipeline shall pass through Wild Ass Sanctuary and forest area. Detail will be provided in EIA report
4 Inland, coastal, marine or underground waters Yes Detail of river/canal crossings through HDD without affecting its course. Details will be provided in EIA report.
5 State, National boundaries Yes The pipeline lies in Gujarat State
6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas No Nil
7 Defence installations No Nil
8 Densely populated or built-up area Yes Details will be provided in EIA report.
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Yes Details will be provided in EIA report.
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Yes Details will be provided in EIA report.
11 Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No Nil
12 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) similar effects No Adequate safeguards will be incorporated in the design of the facilities to withstand natural hazards
(IV) Proposed Terms of Reference for EIA studies
1 Uploaded Proposed TOR File Annexure-TOR file
2 Uploaded scanned copy of covering letter Annexure-scanned copy of covering letter
3 Uploaded Pre-Feasibility report(PFR) Annexure-PFR
4 Uploaded additional attachments(only single pdf file) NIL
      Essential Detail Sought : NIL
      Additional Detail Sought : NIL
(V) 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 any stage, the project will be rejected and clearance given, if any to the project will be revoked at our risk and cost.
V.(i)
Name of ApplicantRam
DesignationChief Operating Officer
Name of Company (Applicant Name should not be given here)IHB LIMITED
AddressC/o IndianOil Bhawan,A-1, Udyog Marg
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