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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/307571/2023
(a) Name of the project : Proposal for modification of Environmental Clearance for Dhubalpada Sand Quarry over an area of 10.00 Acres or 4.046 Hectares in village Dhubalpada under Patnagarh tahasil of Balangir district.
(b) Name of Company / Organisation. : PREMANANDA PRADHAN
(c) Registered Address. : Sri Premananda Padhan, At- Santipada, Po- Ranjendra College, Balangir Orissa 767001
(d) Legal Status of the Company. : Individual
(e) Joint Venture (Yes/No) : No

2.	Address for the Correspondence

(a) Name of the Applicant. : PREMANANDA PADHAN
(b) Designation (Owner/Partner/CEO) : Lessee
(c) Address :-
       State : Orissa
       District : Balangir
       Town / Village : No
(d) Pin Code : 767001
(e) Email : premanandapadhan98@gmail.com
(f) Telephone no : No
(g) Fax no : No
(h) Mobile no : 9438268493
(i) Contact Person. : PREMANANDAPADHAN
(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-155, Plot no-112, Kissam-Jore
(b) Village : Dhubalpada
(c) Tehsil : Patnagarh
(d) District : Balangir
(e) State : Orissa
(f) Pin Code : 767048
(g) Bounded Latitudes (North) : Yes
        From : Degree:20, Minutes : 43, Seconds :13
        To    : Degree:20, Minutes : 43, Seconds :30
(h) Bounded Longitudes (East) : Yes
        From : Degree:83, Minutes : 13, Seconds :29
        To    : Degree:83, Minutes : 13, Seconds :41
(i) Survey of India Topo Sheet No : 64P/2

5	Details of Environmental Clearance

(a) Project Name : Proposal for modification of Environmental Clearance for Dhubalpada Sand Quarry over an area of 10.00 Acres or 4.046 Hectares in village Dhubalpada under Patnagarh tahasil of Balangir district.
(b) MoEF&CC / SEIAA File No : SEIAA-1116/12-2020
(c) Date of issue of EC : 26/03/2021 (d) Uploaded EC letter :

6	Details of Consent to Operate

(i) Whether Consent to operate obtained (Yes/No) ? : Yes (ii) Uploaded copies of all Consent to operate obtained since inception:

(iii)Date of issue : 29/01/2022
(iv)Valid Upto: 31/03/2026
(v)File No : 1947
(vi)Application No : 3660941 (vii)Uploaded copy of Consent to operate valid as on Date:

7	Amendment Sought for

Amendment in Configuration/ Amendments in Clearance condition/ Other (specify) : Modification of EC as per submission of annual replenishment study report.

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/4.046 Hects.	8.57	Cubic meter per Day	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	Dhubalpada Sand Quarry	1800cum	1800cum	1800cum	Production per annum

10	Reasons for Amendment

Reasons for Amendment : Submission of annual replenishment Study report.

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	Transfer EC no-4507/SEIAA	Transfer EC File no-SIA/OR/MIN/270347/2022	dated-11.05.2022	Dhubalpada Sand Quarry

12	Details of EIA Consultant

Have you hired Consultant for preparing document (Yes/No) ? : No
(i)Reason for not engaging the Consultant : Quarry is coming under B2 Category Project.

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.	21/12/2023	1). The project proponent ask to submit KML file of the proposed lease area and send it to SEIAA, Odisha Email-info.seiaaodisha@gmail.com 2). The PP also required to submit compliance of EC conditions with mentioning year-wise production details.
2.	03/01/2024	The corrections have been made as per the instruction received.

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 : PREMANANDA PADHAN (c)Designation: Lessee (d)Company: PREMANANDA PRADHAN (e)Address: Sri Premananda Padhan, At- Santipada, Po- Ranjendra College, Balangir Orissa 767001