Form-4

APPLICATION FOR AMENDMENT IN ENVIRONMENTAL CLEARANCE

(To be filled up by User Agency)
1. Details of Project
 
 Proposal No. : SIA/GJ/IND3/298727/2023  
 (a) Name of the project : M/s. Om Shiv Industries  
 (b) Name of Company / Organisation. : M/S. OM SHIV INDUSTRIES  
 (c) Registered Address. : Plot no.6606, GIDC Estate Ankleshwar, Dist: Bharuch, Gujarat Gujarat 393002  
 (d) Legal Status of the Company. : Private  
 (e) Joint Venture (Yes/No) : No
2. Address for the Correspondence
 
 (a) Name of the Applicant. : Tushar R Patel  
 (b) Designation (Owner/Partner/CEO) : Partner  
 (c) Address :-  
        State : Gujarat  
        District : Bharuch  
        Town / Village : No  
 (d) Pin Code : 393002  
 (e) Email : tushar7055@gmail.com  
 (f) Telephone no : No  
 (g) Fax no : No  
 (h) Mobile no : 9924448881  
 (i) Contact Person. : Tushar  
 (j) Website (if any) : No
3. Category of the Project/Activity as per Schedule of EIA Notification,2006
 
 (a). Major Activity. : 5(f)-API
                                 
       Minor Activity : No  
       Major Sub Activity. : No  
       Minor Sub Activity : No  
 (b). Category : B1  
       Reason for applicant at central level/state level(in case of B1 and B2 ): No  
 (c). Reason : No  
       EAC Concerned (for category A Projects Only ): No
4. Location of the Project
 
 (a) Plot No/Survey No/Khasra No : Plot No. 6606, 6607, GIDC Estate Ankleshwar, Dist: Bharuch, Gujarat  
 (b) Village : Ankleshwar GIDC  
 (c) Tehsil : Anklesvar  
 (d) District : Bharuch  
 (e) State : Gujarat  
 (f) Pin Code : 393002  
 (g) Bounded Latitudes (North) : Yes  
         From : Degree:21, Minutes : 37, Seconds :18  
         To    : Degree:21, Minutes : 37, Seconds :20  
 (h) Bounded Longitudes (East) : Yes  
         From : Degree:73, Minutes : 2, Seconds :30  
         To    : Degree:73, Minutes : 2, Seconds :33  
 (i) Survey of India Topo Sheet No : F43M14
5 Details of Environmental Clearance
 
 (a) Project Name : M/s. Om Shiv Industries  
 (b) MoEF&CC / SEIAA File No : SEIAA/GUJ/EC/5(f)/983/2021  
 (c) Date of issue of EC : 29/06/2021   (d) Uploaded EC letter :
6 Details of Consent to Operate
 
 (i) Whether Consent to operate obtained (Yes/No) ? : No
7 Amendment Sought for
 
 Amendment in Configuration/ Amendments in Clearance condition/ Other (specify) : Address and Green Belt Area
8 Details of Product (as per the approved EC)
Details of Products
S.no Product / Activity (Capacity/ Area). Quantity Unit Mode of Transport/ Transmission of Product
1API & Its Intermediates35.1 MT/MonthOthersRoad
9 Details of Configuration (Multiple Entries Allowed)
Details of Configurations
S.no Plant/ Equipment/ Facility Existing Configuration Proposed Configuration Final configuration after Amendment Remarks if Any
1No Change in Plant and MachineryNo ChangeNo ChangeNo ChangeNo Change is Plant Machinery & Equipment
10 Reasons for Amendment
 
 Reasons for Amendment : Plot No. 6607 Addition In Existing EC Of M/s. Om Shiv Industries Located at Plot No. 6606, GIDC Ankleshwar, Dist: Bharuch, Gujarat
11 Any Other Amendment required
Any Other Amendment Required
S.no Reference of Approved EC Description as per Approved EC Description as per Proposal. Remarks
1AddressPlot No. 6606Plot No. 6606 & 6607Addition of Plot No. 6607
2B.2.7 Greenbelt & Other Plantation300 Sq. m Greenbelt Area33% of Total Plot Area 660.0 Sq.m Area developed a--
3A.5 OtherCER 0.40 LakhsTotal 0.75 Lakhs--
12 Details of EIA Consultant
 
 Have you hired Consultant for preparing document (Yes/No) ? : No  
 (i)Reason for not engaging the Consultant : Not Required for Plot Addition in Existing EC of M/s. Om Shiv Industries
13. Documents to be Attached
  (a) Uploaded addendum to EIA/EMP Report:   (b) Uploaded Copy of revised -Feasibility Report /Detailed Project Report (DPR) / Detailed Engineering Report / Detailed Conceptual Plan / Approved Mining Plan (in case of mining proposals):   (c) Uploaded Copy of final Layout Plan:   (d)Uploaded Cover Letter duly signed by the project proponent or authorized person:   (e)Uploaded a copy of authorization duly signed by the project proponent in support of the person making this application on behalf of the User Agency:   (f)Uploaded Additional File, If any:
Essential Details Sought
Essential Details Sought
S.no. EDS Sought Date EDS Sought Letter
1.28/03/2023Please upload copy of Certified Compliance Report for existing EC, than your application can process further
2.29/03/2023The corrections have been made as per the instruction received.
3.01/04/2023(1) You have applied for EC amendment, since your unit is falling in CEPI area so as per OM date 05-7-2022 of MoEF&CC you have to apply at Central Level.
4.26/03/2024The corrections have been made as per the instruction received.
5.29/04/2024(1) Where is your reply of EDS i.e “You have applied for EC amendment, since your unit is falling in CEPI area so as per OM date 05-7-2022 of MoEF&CC you have to apply at Central Level”. Please apply at Central level for EC amendment.
 
Additional Detail Sought:   NIL
14. Undertaking
(a): 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. In addition to above, I hereby give undertaking that no activity / construction / expansion has since been taken up. (b)Name : Tushar R Patel (c)Designation: Partner (d)Company: M/S. OM SHIV INDUSTRIES (e)Address: Plot no.6606, GIDC Estate Ankleshwar, Dist: Bharuch, Gujarat Gujarat 393002