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 Mining appln of Mr.Sandeep S. Choursiya,Gut No.186/1,Gunjkheda stone quarry proposal (ii). Location / site (GPS Co-ordinate) 20°44'3.95"N, 78°20'38.76"E Annexure-GPS file       (iii). Type of Lease Indivisual Area Size of the Mining Lease (in ha.) 2.00 ha. (iv). Capacity of the Mining Lease (TPA) 81244 (v). Period of Mining Lease 5 (vi). Expected cost of the Project 30 (vii). Have you hired Consultant/Registered Qualified Person(RQP) for preparing document? Yes Accreditation No. 1518/RA0036  Name of Consultant/RQP Prashil Shukla Address Enviro Techno consult Pvt Ltd.,Nagpur Mobile No. 9225230146 Landline No. 32027888 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.  0.567 km 2. (ii). Nearest Infrastructural along with distance in kms  2.8 km (iii). Nearest Railway Line along with distance in kms  0.536 km (iv). Nearest National Highway along with distance in kms  16.66 km (v). Nearest State Highway along with distance in kms  0.902 km (vi). Nearest Major District Road along with distance in kms  2.209 km (vii). Nearest Any Other Road along with distance in kms  0.492 km (viii). Nearest Electric transmission line pole or tower distance in kms  18 km (ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  1.706 km (x). Nearest In-take for drinking water pump house distance in kms  1.706 km (xi). Nearest In-take for Irrigation canal pumps distance in kms  1.613 km 3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value Bhor Reserve Forest -38 Km NE 4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Water Body –Gunjkheda-1.2 km NW,Wardha river-3.324 Km W Coastal Area 580 Km, ,Marine Water -575 Km West 5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Bhor Reserve Forest -38 Km NE 6. Inland, coastal, marine or underground waters Water Body –Gunjkheda-1.2 km NW,Wardha river-3.324 Km W Coastal Area 580 Km, ,Marine Water -575 Km West 7. State, National boundaries 83 Km N 8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Pulgaon sevagram Rd – 0.902 km SE 9. Defence installations Pulgaon -2.8 km SW 10. Densely populated or built-up area, distance from nearest human habitation Gunjkheda -2.3 km W 11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) 2.8 Km Pulgaon SW 12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Water Body –Gunjkheda-1.2 km NW,Wardha river-3.324 Km W Coastal Area 580 Km, ,Marine Water -575 Km West,quarry is agriculture area with single crop system, Fishing at Water Body 1.5 Km NE, Minerals quarry Basalt 13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) NO 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. Stone quarry is at safe distances from natural hazards like earthquake prone area, subsidence, landslide, erosion, flooding prone area 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/19335/2018 File Number DIA/MH/MIN/19335/2018 Date of Apply EC 01 Dec 2018

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

(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 NIL

(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