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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/AS/MIN/307964/2024
(a) Name of the project : Jatinga River Minor Mineral Unit-1 (Stone)
(b) Name of Company / Organisation. : DFO CACHAR
(c) Registered Address. : Sadarghat Road, Silchar Assam 788001
(d) Legal Status of the Company. : State Government
(e) Joint Venture (Yes/No) : No

2.	Address for the Correspondence

(a) Name of the Applicant. : Divisional Forest Officer Cachar
(b) Designation (Owner/Partner/CEO) : Deputy Conservator of Forests
(c) Address :-
       State : Assam
       District : Cachar
       Town / Village : No
(d) Pin Code : 788001
(e) Email : biswas1biswas555@gmail.com
(f) Telephone no : No
(g) Fax no : No
(h) Mobile no : 8133010999
(i) Contact Person. : Divisional Forest Officer
(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 : 1(a) Mining of minerals

      Major Sub Activity. : No
      Minor Sub Activity : Open Cast Mining
(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 : U.S.F. Land
(b) Village : Dhamcherra
(c) Tehsil : Udarbond
(d) District : Cachar
(e) State : Assam
(f) Pin Code : 788817
(g) Bounded Latitudes (North) : Yes
        From : Degree:24, Minutes : 59, Seconds :0836
        To    : Degree:25, Minutes : 00, Seconds :3560
(h) Bounded Longitudes (East) : Yes
        From : Degree:92, Minutes : 43, Seconds :0900
        To    : Degree:92, Minutes : 45, Seconds :0040
(i) Survey of India Topo Sheet No : 83 C 16

5	Details of Environmental Clearance

(a) Project Name : Jatinga River Minor Mineral Unit-1 (Stone)
(b) MoEF&CC / SEIAA File No : SEIAA.1314/2020/EC/19/1142
(c) Date of issue of EC : 09/10/2020 (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) : Required additional quantity for urgent public works

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	Stone	535	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	NA	NA	NA	NA	NA

10	Reasons for Amendment

Reasons for Amendment : Required additional quantity for urgent public works

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	SEIAA.1314/2020/EC/19/1142	107000 Cum per year	107000 Cum per year	Required additional quantity of 52781 Cum for one

12	Details of EIA Consultant

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

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 : No Data

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 : Divisional Forest Officer Cachar (c)Designation: Deputy Conservator of Forests (d)Company: DFO CACHAR (e)Address: Sadarghat Road, Silchar Assam 788001