APPENDIX I (See Paragraph-6) FORM 1M Note : If space provided against any parameter is inadequate,Kindly upload supporting document under 'Additional Attachments if any'  at the last part of the Form 1M. Please note that all such Annexures must be part of single pdf document. (I)Basic Informations S.No. Item Details (i). Name of the Mining Lease site SHIVNI 2 SAND GHAT (ii). Location / site (GPS Co-ordinate) 20 40 12.19 N 78 53 11.06 E Annexure-GPS file       (iii). Type of Lease Indivisual Area Size of the Mining Lease (in ha.) 0.82 ha. (iv). Capacity of the Mining Lease (TPA) 11537 (v). Period of Mining Lease 1 (vi). Expected cost of the Project 38 (vii). Have you hired Consultant/Registered Qualified Person(RQP) for preparing document? Yes Accreditation No. 1518/SA036  Name of Consultant/RQP P SHUKLA Address ETCPL NAGPUR Mobile No. 9225230146 Landline No. 3202777 Email Id ENVIROTECHNOCONSULT@GMAIL.COM (II) Environmental Sensitivity S.No Areas Distance in kilometer / Details 1. (i).  Nearest rail or road bridge over the concerned river,rivulet,nallah etc. in kms.  2.744 km 2. (ii). Nearest Infrastructural along with distance in kms  8.5 km (iii). Nearest Railway Line along with distance in kms  15.2 km (iv). Nearest National Highway along with distance in kms  3.782 km (v). Nearest State Highway along with distance in kms  2.193 km (vi). Nearest Major District Road along with distance in kms  4.798 km (vii). Nearest Any Other Road along with distance in kms  0.831 km (viii). Nearest Electric transmission line pole or tower distance in kms  11 km (ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  7.114 km (x). Nearest In-take for drinking water pump house distance in kms  1.6 km (xi). Nearest In-take for Irrigation canal pumps distance in kms  1.6 km 3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value BOR WILDLIFE SANCTUARY 36.5 KM NW 4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests NO WRETLAND, PACH MADHI BIOSPHERE SATPURA RANGE RIVER VENA 5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration BOR WILDLIFE SANCTUARY 36.5 KM NW 6. Inland, coastal, marine or underground waters VENA RIVER COASTAL AREA 550 KM W MARINE WATER 535KM W 7. State, National boundaries 89 KM N 8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas TADOBA RD 3.782 9. Defence installations PULGAON OFC 51 KM W 10. Densely populated or built-up area, distance from nearest human habitation SHIVNI 1.028 KM NE 11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) SAMUDRAPUR 8.5 KM SE 12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) VENA RIVER 13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) NOT WITHIN 5 KM AREA 14. Areas susceptible to natural hazard which could cause the project to present environmental problems (earthquakes, subsidence, landslides, erosion, flooding or extreme or adverse climatic conditions) NO SAND GHAT IS AT SAFE ZONE 15. Is proposed mining site located over or near fissure/fracture for ground water recharge? No 16. Whether the proposal involves approval or clearance under the following Regulations or Acts namely? (a). The Forest (Conservation) Act,1980? No (b). The Wildlife (Protection) Act,1972? No (c). The Coastal Regulation Zone (C.R.Z) notification,2011? No 17. Is forest land involved (ha)? No 18. Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up? No 19. New/Expansion/Modernization New Proposal Number DIA/MH/MIN/19320/2018 File Number DIA/MH/MIN/19320/2018 Date of Apply EC 01 Dec 2018

Details of State of the project
S.No.	State Name	District Name	Tehsil Name
(1.)	Maharashtra	Wardha	Samudrapur

(III)

EC Attachments

1 Uploaded PFR (Pre Feasibility Report) File Annexure-PFR file 2 Uploaded Approved Mining Plan File Annexure-Approved Mining Plan file 3 Uploaded District survey report Annexure-District Survey Report 4 Uploaded Cover Letter Annexure-Cover Letter Uploaded Additional attachments, if any S.No. Attached File Date of Submission (1.) WARDHA EIA 01 Dec 2018

(IV)	Undertaking
	The aforesaid application and documents furnished here with are true to my knowledge.

(IV).(i)

Name PROJECT PROPONENT Designation PROJECT PROPONENT Company PROJECT PROPONENT Address 68, mahakali nagar nagpur