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Form-4

APPLICATION FOR AMENDMENT IN ENVIRONMENTAL CLEARANCE

(To be filled up by User Agency)

1.	Details of Project

Proposal No. : SIA/OR/MIN/300249/2023
(a) Name of the project : Proposal for Amendment of Replenishment Study Report to EC of Brahmani River Sananahangara Sand Quarry of 4.57Ha.(Khata No.-635 & Plot No.-2757) of lessee Sumanta Kumar Mohanty
(b) Name of Company / Organisation. : MANISHANKAR MINERALS PRIVATE LIMITED
(c) Registered Address. : Flat No.-2E, Block-A, Singhania Tower, Joda, Dist.-Keonjhar Orissa 758034
(d) Legal Status of the Company. : Private
(e) Joint Venture (Yes/No) : No

2.	Address for the Correspondence

(a) Name of the Applicant. : Sumanta Kumar Mohanty
(b) Designation (Owner/Partner/CEO) : No
(c) Address :-
       State : Orissa
       District : Kendujhar
       Town / Village : No
(d) Pin Code : 758034
(e) Email : manishankarmineralquarry@gmail.com
(f) Telephone no : No
(g) Fax no : No
(h) Mobile no : 9439820871
(i) Contact Person. : Sumanta Kumar Mohanty
(j) Website (if any) : No

3.	Category of the Project/Activity as per Schedule of EIA Notification,2006

(a). Major Activity. : 1(a) Mining of minerals

      Minor Activity : No
      Major Sub Activity. : No
      Minor Sub Activity : No
(b). Category : B2
      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 : Khata No-635 and Plot No-275
(b) Village : Sananahangara
(c) Tehsil : Dharmasala
(d) District : Jajpur
(e) State : Orissa
(f) Pin Code : 755008
(g) Bounded Latitudes (North) : Yes
        From : Degree:20, Minutes : 41, Seconds :34
        To    : Degree:20, Minutes : 41, Seconds :41
(h) Bounded Longitudes (East) : Yes
        From : Degree:86, Minutes : 13, Seconds :52
        To    : Degree:86, Minutes : 14, Seconds :01
(i) Survey of India Topo Sheet No : F45U2, F45U6

5	Details of Environmental Clearance

(a) Project Name : Proposal for Amendment of Replenishment Study Report to EC of Brahmani River Sananahangara Sand Quarry of 4.57Ha.(Khata No.-635 & Plot No.-2757) of lessee Sumanta Kumar Mohanty
(b) MoEF&CC / SEIAA File No : SIA/OR/MIN/279400/2022
(c) Date of issue of EC : 26/07/2022 (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) : Amendment in Configuration/ Amendments in Clearance condition/ Other(specify) : Compliance to the st

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
1	Sand	9500 cum upto 1m depth for 2nd year mining period	Others	Road

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
1	manual method	76823cum mineable reserve as per pre-monsoon reple	78778cum as per post-monsoon replenishment study	78778 cum mineable reserve as per post-monsoon stu	2.54% replenishment percentage as compared to the post-monsoon and pre-monsoon study.

10	Reasons for Amendment

Reasons for Amendment : Compliance to the stipulated condition mentioned in the Amendment to EC of Brahmani river sananahangara sand quarry bearing file no.-SIA/OR/MIN/279400/2022 and in point no-9.1 & 9.2 on page-3 of EC grant letter.

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
1	SIA/OR/MIN/279400/2022	9500cum upto 1m depth for 2nd year mining period.	9500 cum for 3rd year of mining period.	78778cum of mineable reserve has been estimated in

12	Details of EIA Consultant

Have you hired Consultant for preparing document (Yes/No) ? : No
(i)Reason for not engaging the Consultant : N/A

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
NIL

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 : Sumanta Kumar Mohanty (c)Designation: No (d)Company: MANISHANKAR MINERALS PRIVATE LIMITED (e)Address: Flat No.-2E, Block-A, Singhania Tower, Joda, Dist.-Keonjhar Orissa 758034