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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/308017/2024
(a) Name of the project : Ramla Sand Quarry over an area of 3.00 acres or 1.214 hectares in village Ramla under Champua Tahasil in Keonjhar District, Odisha.
(b) Name of Company / Organisation. : SUPRAVA NAYAK
(c) Registered Address. : Mining Officer Cum Competent Authority Champua Subdivision O/o the Deputy Director o Mines, Keonjhar Circle keonjhar 758001 Orissa 758001
(d) Legal Status of the Company. : Individual
(e) Joint Venture (Yes/No) : No

2.	Address for the Correspondence

(a) Name of the Applicant. : SUPRAVA NAYAK
(b) Designation (Owner/Partner/CEO) : No
(c) Address :-
       State : Orissa
       District : Kendujhar
       Town / Village : No
(d) Pin Code : 758001
(e) Email : mo.champua.keonjhar@gmail.com
(f) Telephone no : No
(g) Fax no : No
(h) Mobile no : 9438558811
(i) Contact Person. : SUPRAVA NAYAK
(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 : Mouza-Ramla, Khata No-261, Plot No-1371/1, Kissam-Nadi
(b) Village : Ramla
(c) Tehsil : Champua
(d) District : Kendujhar
(e) State : Orissa
(f) Pin Code : 758041
(g) Bounded Latitudes (North) : Yes
        From : Degree:22, Minutes : 02, Seconds :22
        To    : Degree:22, Minutes : 02, Seconds :27
(h) Bounded Longitudes (East) : Yes
        From : Degree:85, Minutes : 40, Seconds :4
        To    : Degree:85, Minutes : 40, Seconds :12
(i) Survey of India Topo Sheet No : F45H12

5	Details of Environmental Clearance

(a) Project Name : Ramla Sand Quarry over an area of 3.00 acres or 1.214 hectares in village Ramla under Champua Tahasil in Keonjhar District, Odisha.
(b) MoEF&CC / SEIAA File No : SEIAA-1639/04-2021
(c) Date of issue of EC : 22/09/2021 (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) : Cum

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/1.214HA	5Cum	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	Ramla Sand Quarry	1200Cum	4027Cum	4027Cum	As per Replenishment Study Report

10	Reasons for Amendment

Reasons for Amendment : Submission of 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	Ramla Sand Quarry over an area of 3.00 acres or 1.214 hectares in village Ramla under Champua Tahasi	SEIAA-1639/04-2021	2806/SEIAA, Dated-22.09.2021	Amendment of EC

12	Details of EIA Consultant

Have you hired Consultant for preparing document (Yes/No) ? : No
(i)Reason for not engaging the Consultant : It is 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.	08/01/2024	1).The project proponent(PP) ask to submit the KML file of the lease area and send to SEIAA, Odisha email-info.seiaaodisha@gmail.com 2). The PP also submit compliance of EC condition with mentioning year-wise production details. 3). The EC is issued in favour of Tahasildar and now amendment of EC application applied by Mining Officer. Hence, the ask to submit circular that the Mining Officer is the Authorized officer instead of Tahasildar.

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 : SUPRAVA NAYAK (c)Designation: No (d)Company: SUPRAVA NAYAK (e)Address: Mining Officer Cum Competent Authority Champua Subdivision O/o the Deputy Director o Mines, Keonjhar Circle keonjhar 758001 Orissa 758001