Form-4

APPLICATION FOR AMENDMENT IN ENVIRONMENTAL CLEARANCE

(To be filled up by User Agency)
1. Details of Project
 
 Proposal No. : SIA/OR/MIN/307954/2024  
 (a) Name of the project : Proposal for modification of Fasad Sand Quarry over an area of 12.355 Acre or 5.00 Hectares in village Fasad under Agalpur tahasil of Balangir district.  
 (b) Name of Company / Organisation. : MR GANGA SHANKAR SAHU  
 (c) Registered Address. : At/Po- Salebhata, Dist.-Balangir At-Fasad, Tahasil-Agalpur, Dist-Balangir Orissa 767022  
 (d) Legal Status of the Company. : Individual  
 (e) Joint Venture (Yes/No) : No
2. Address for the Correspondence
 
 (a) Name of the Applicant. : GANGA SHANKAR SAHU  
 (b) Designation (Owner/Partner/CEO) : OWNER  
 (c) Address :-  
        State : Orissa  
        District : Balangir  
        Town / Village : No  
 (d) Pin Code : 767021  
 (e) Email : sahugangashankar3@gmail.com  
 (f) Telephone no : No  
 (g) Fax no : No  
 (h) Mobile no : 9438268493  
 (i) Contact Person. : GANGA  
 (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-93, Plot no-2, Kissam-Nadi  
 (b) Village : Fasad  
 (c) Tehsil : Balangir  
 (d) District : Balangir  
 (e) State : Orissa  
 (f) Pin Code : 767022  
 (g) Bounded Latitudes (North) : Yes  
         From : Degree:20, Minutes : 58, Seconds :57  
         To    : Degree:20, Minutes : 59, Seconds :07  
 (h) Bounded Longitudes (East) : Yes  
         From : Degree:83, Minutes : 29, Seconds :46  
         To    : Degree:83, Minutes : 30, Seconds :02  
 (i) Survey of India Topo Sheet No : 64P/5, 64P/9,64O/8,64O/12
5 Details of Environmental Clearance
 
 (a) Project Name : Proposal for modification of Fasad Sand Quarry over an area of 12.355 Acre or 5.00 Hectares in village Fasad under Agalpur tahasil of Balangir district.  
 (b) MoEF&CC / SEIAA File No : 239156/77-MINB2/11-2021  
 (c) Date of issue of EC : 18/02/2022   (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 : 05/07/2023  
 (iv)Valid Upto: 31/03/2025  
 (v)File No : 1780  
 (vi)Application No : 4838499   (vii)Uploaded copy of Consent to operate valid as on Date:
7 Amendment Sought for
 
 Amendment in Configuration/ Amendments in Clearance condition/ Other (specify) : Ammendment configuration as per Annual Replenishment Report request to approve 7000cum as per EC con
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
1Sand/ 5.00 Hects.38.09Cubic meter per DayRoad
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
1Fasad Sand Quarry7000cum7000cum7000cumProduction 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
1EC no-EC22B001OR159069EC File no-239156/77-MINB2/11-2021Dated-18/02/2022Fasad 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
1.05/01/2024The documents attached in sl. no. 13(a) is not opening please uploaded addendum to EIA/EMP Report again. Also, submit signed copy of Replenishment study report by consultant/RQP who prepared it and from lessee forwarded through lease granting Authority.
2.10/01/2024The 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 : GANGA SHANKAR SAHU (c)Designation: OWNER (d)Company: MR GANGA SHANKAR SAHU (e)Address: At/Po- Salebhata, Dist.-Balangir At-Fasad, Tahasil-Agalpur, Dist-Balangir Orissa 767022