Application for Prior TOR (Form – 1 & Form- 2) For Road Metal Mine over an Extent of 6.912 Hectares, in Sy. No.285/A1, of Ananthavaram village,Thullur Mandal, Guntur District, ______

Submitted To State Expert Appraisal Committee (SEAC), State Environmental Impact Assessment Authority, A.P.

Submitted By ______Ms Sri Shirdi Sai Stone Crusher D.No.612/1,612/5,Vijaya Cotton Centre Near Nallapadu Canal, Nallapadu (V), Guntur Dist.

FORM 1

(I) Basic Information

Sl.No. Item Details 1. Name of the project/s 6.912 Ha. Of Road Metal Mine of Ms SRI SHIRDI SAI STONE CRUSHER 2. S.No. in the schedule 1 (a) 3. Proposed capacity /area/length/tonnage to be 6.912 Ha. Of Road Metal Mine with a handled/command area/lease area/number of proposed production of 25,000 Cum/year wells to be drilled. of Road Metal 4. New/Expansion/Modernization Existing -Violation 5. Existing Capacity/Area etc. 6.912 Ha 6. Category of Project i.e. ‘A’ or ‘B’ B2 7. Does it attract the general condition? If yes, No please specify. 8. Does it attract the specific condition? If yes, No please specify. 9. Location Plot/Survey/Khasra No. Sy. No’s. 285/A1, Village Ananthavaram village, Tehsil Thullur Mandal, District Guntur District. State Andhra Pradesh. 10. Nearest railway station/airport along with The nearest Railway station is located at distance in kms. at a distance of 17.5km from the applied area 11. Nearest Town, city, district Headquarters along Guntur Town is located at a distance of 11 with distance in kms. km from the applied area 12. Village Panchayats, Zilla Parishad, Municipal Smt N.PADMAVATHI Corporation, Local body (complete postal Proprietor addresses with telephone nos. to be given) Ms Sri Shirdi Sai Stone Crusher W/o N.V.Nageswar Rao Gayatri Nagar, A.P. Cell:9885216654 13. Name of the applicant Ms Sri Shirdi Sai Stone Crusher 14. Registered Address Smt N.PADMAVATHI Proprietor Ms Sri Shirdi Sai Stone Crusher W/o N.V.Nageswar Rao Gayatri Nagar,Vijayawada A.P. Cell:9885216654 15. Address for correspondence: Smt N.PADMAVATHI Name Proprietor Designation (Owner/Partner /CEO) Ms Sri Shirdi Sai Stone Crusher Pin code W/o N.V.Nageswar Rao E-mail Gayatri Nagar,Vijayawada A.P. Telephone No. Cell:9885216654 Fax No. 16. Details of Alternative Sites examined, if any. Village-District-State Location of these sites should be shown on a topo 1 Not Applicable sheet. 2 3 17. Interlinked Projects Nil 18. Whether separate application of interlinked Not Applicable project has been submitted? 19. If yes, date of submission Nil 20. If no, reason This a mining project and not having any interlinked projects 21. Whether the proposal involves approval/clearance Not Applicable under: if yes, details of the same and their status to be given. i. The Forest (Conservation) Act, 1980? ii. The Wildlife (Protection) Act, 1972? iii. The C.R.Z. Notification, 1991? 22. Whether there is any Government Order/Policy Govt. Proceedings copy is submitted along relevant /relating to the site? with EMP report 23. Forest land involved (hectares) NO

24. Whether there is any litigation pending against No litigation about the project the project and/or land in which the project is propose to be set up? a) Name of the Court b) Case No. c) Orders/directions of the Court, if any and its relevance with the proposed project.

(II) Activity

1. Construction, operation or decommissioning of the Project involving actions, which will cause physical changes in the locality (topography, land use, changes in water bodies, etc.) Details thereof (with approximate quantities /rates, wherever possible) S.No. Information/Checklist confirmation Yes/No with source of information data 1.1 Permanent or temporary change in land use, Yes The Quarry operations envisaged for land cover or topography including increase the proposed plan period & during the in intensity of land use (with respect to tenure of the lease period involves local land use plan) change in land use/topography covering an extent of 6.912 Ha. The proposed permanent/temporary change in land use or land cover for the ensuring Plan period is given in Mining Plan. 1.2 Clearance of existing land, vegetation and No There will be clearance of existing buildings? vegetation wherever required. However, as the existing vegetation density in the mine lease is only about 0.4, no heavy clearance of vegetation will be required. There are no existing buildings in the lease area and hence no proposal of clearance of existing buildings is made 1.3 Creation of new land uses? Yes The proposed Quarry activities will result in change/creation of new land use. The waste lands in this part of the region will be judiciously & scientifically explored & systematically worked so as to create a good Quarry methodology for proper utilization of the minerals. 1.4 Pre-construction investigations e.g. bore Yes The area has been studied for houses, soil testing? estimation of Road Metal reserves by Geological Mapping. Accordingly reserves have been calculated & Mine Plan Prepared & approved by Department of Mines & Geology vide Lr No:2274/MP/RM/GNT/2017 Dt:28.06.2017. 1.5 Construction works? No Since this is a Existing quarry, construction/erection of temporary structures for mines office, rest shelter, first aid station, sanitation etc., are there in non-mineralized areas of Quarry lease. 1.6 Demolition works? No No demolition works involved

1.7 Temporary sites used for construction works No No major housing for construction or housing of construction workers? workers is envisages at the mines 1.8 Above ground buildings, structures or No Nil earthworks including linear structures, cut and fill or excavations 1.9 Underground works including mining or No Nil tunneling? 1.10 Reclamation works? Yes As the Quarry activities are expected to continue further & only a small portion of the lease area is exposed for Quarry, proposed reclamation programme involves only Afforestation works and other Environmental Protection measures. 1.11 Dredging? No Nil

1.12 Offshore structures? No Nil

1.13 Production and manufacturing processes? Yes About 25,000 Cum/Year of Road Metal will be extraction by operations such as drilling, Wire Saw Cutting, loading and unloading 1.14 Facilities for storage of goods or materials? No Not applicable – The Road Metal is transported directly to requirements of the user industry/buyers for shipment. 1.15 Facilities for treatment or disposal of solid Yes There will be no liquid effluent waste or liquid effluents? generated from the proposed Quarry activities. Hence no treatment is proposed. Externally dumps are to be stabilized with afforestation. The quarry pit shall also help in storage/ collection of rain water. 1.16 Facilities for long term housing of No Nil operational workers? 1.17 New road, rail or sea traffic during Yes Haul roads and approach roads are construction or operation? there .No new rail network or sea route is proposed for the mining project. 1.18 New road, rail, air waterborne or other Yes Approach road is there transport infrastructure including new or altered routes and stations, ports, airports No other major road, rail, air or etc? waterborne transport network is envisaged for the mining project. 1.19 Closure or diversion of existing transport No No such diversions are envisaged. routes or infrastructure leading to changes in traffic movements? 1.20 New or diverted transmission lines or No No such diversions are envisaged. pipelines? 1.21 Impoundment, damming, culverting, No No such diversions are envisaged. realignment or other changes to the hydrology of watercourses or aquifers? 1.22 Stream crossings? No No streams exist 1.23 Abstraction or transfers of water form No Part of the water required for the ground or surface waters? mining activities will be sourced from Near by Village 1.24 Changes in water bodies or the land surface No The rainwater constitutes the drainage affecting drainage or run-off? system of the area. Except this no other perennial watercourses exist in this area. 1.25 Transport of personnel or materials for Yes The mined out minerals will be construction, operation or decommissioning? transported to consumers by trucks directly manually. 1.26 Long-term dismantling or decommissioning No No dismantling works are envisaged. or restoration works? 1.27 Ongoing activity during decommissioning Yes Temporary change in land use pattern which could have an impact on the occurs. The existing scanty vegetative environment? land will be converted into lush green cover. 1.28 Influx of people to an area in either No No major influx is envisaged due to temporarily or permanently? the mining project, as the total manpower required during operational stage will be only 29 including labour & will be met from the local area only. 1.29 Introduction of alien species? No Not envisaged 1.30 Loss of native species or genetic diversity? No Not envisaged 1.31 Any other actions? No ---

2. Use of Natural resources for construction or operation of the Project (such as land, water, materials or energy, especially any resources which are non- renewable or in short supply): Details thereof (with approximate quantities /rates, wherever S.No. Information/checklist confirmation Yes/No possible) with source of information data 2.1 Land especially undeveloped or Yes Present Lease area is Road Metal agricultural land (ha) deposit area, it is a govt land (6.912 Hect) 2.2 Water (expected source & competing Yes Total water requirement of the users) unit: KLD mining operations including dust suppression is about 6.0 KLD and majority of this is proposed to be met from the bore well. 2.3 Minerals (MT) No Nil 2.4 Construction material – stone, aggregates, Yes The construction material sand / soil (expected source – MT) required for the project shall be sourced locally. However, no major constructional material requirement is envisaged 2.5 Forests and timber (source – MT) No Nil 2.6 Energy including electricity and fuels Yes This is a semi mechanized open cast (source, competing users) Unit: fuel (MT), mining with by using jackhammer energy (MW) drilling & wire saw cutting & low explosive blasting. Hence, energy and fuels consumption is required. Approximately 1.0 KLD of Diesel is required. 2.7 Any other natural resources (use No -- appropriate standard units)

3. Use, storage, transport, handling or production of substances or materials, which could be harmful to human health or the environment or raise concerns about actual or perceived risks to human health.

Details thereof (with approximate quantities/rates, wherever S.No. Information/Checklist confirmation Yes/No possible) with source of information data 3.1 Use of substances or materials, which are No No major storage of fuel oils hazardous (as per MSIHC rules) to human health or the environment (flora, fauna, and water supplies) 3.2 Changes in occurrence of disease or affect No Not envisaged disease vectors (e.g. insect or water borne diseases) 3.3 Affect the welfare of people e.g. by Yes Living standards of the surrounding, changing living conditions? villagers will improved due to availability of better infrastructure, health care and educational facilities. 3.4 Vulnerable groups of people who could be No Not envisaged affected by the project e.g. hospital patients, children, the elderly etc., 3.5 Any other causes No --

4. Production of solid wastes during construction or operation or decommissioning (MT/month)

Details thereof (with approximate quantities/rates, wherever S.No. Information/Checklist confirmation Yes/No possible) with source of information data 4.1 Spoil, overburden or mine wastes No No solid or minerals waste from this mine 4.2 Municipal waste (domestic and or No No generation of municipal waste is commercial wastes) envisaged 4.3 Hazardous wastes (as per Hazardous Waste No No generation of hazardous waste is Management Rules) envisaged 4.4 Other industrial process wastes No No other major solid wastes are envisaged 4.5 Surplus product No Not envisaged

4.6 Sewage sludge or other sludge from No -- effluent treatment 4.7 Construction or demolition wastes No Not envisaged 4.8 Redundant machinery or equipment No Not envisaged 4.9 Contaminated soils or other materials No Not envisaged 4.10 Agricultural wastes No Not envisaged 4.11 Other solid wastes No Not envisaged

5. Release of pollutants or any hazardous, toxic or noxious substances to air (Kg/hr)

Details thereof (with approximate quantities/rates, wherever possible) S.No. Information/Checklist confirmation Yes/No with source of information data 5.1 Emissions from combustion of fossil fuels Yes The only source of emissions from from stationary or mobile sources combustion of fuels is from excavators, compressors & haulage vehicles i.e. Tractors/tippers. The emissions from the same are very minimum & hence insignificant to cause any adverse effects. 5.2 Emissions from production processes Yes Fugitive dust will only be generated from mining activities. Adequate control measures will be taken to control fugitive dust. 5.3 Emissions from materials handling Yes Fugitive dust will be generated from including storage or transport material handling activities. Dust Suppression by water sprinklers will be provided to prevent the fugitive dust emissions 5.4 Emissions from construction activities No No major construction activities are including plant and equipment envisaged 5.5 Dust or odours from handling of materials Yes Dust will be generated during including construction materials, sewage Excavation and transportation of and waste minerals and it will be controlled.

However, there is no possibility of any odor generation as there are no organic solvents / processes involved. 5.6 Emissions from incineration of waste No Not envisaged 5.7 Emissions from burning of waste in open No Not envisaged air (e.g. slash materials, construction debris) 5.8 Emissions from any other sources No Not envisaged

6. Generation of Noise and Vibration, and Emissions of Light and Heat:

Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of S.No. Information/Checklist confirmation information data with source of information data 6.1 From operation of equipment e.g. engines, Yes The Noise generation at the Mine ventilation plant, crushers site will be due to transportation vehicles and drilling, but the noise levels shall be within permissible limits. 6.2 From industrial or similar processes No Nil

6.3 From construction or demolition No Nil

6.4 From blasting or piling Yes Momentary noise due to drilling and vibration and building or structures lies at a distance of 1.4 Km from the mine lease area. 6.5 From construction or operational traffic No Not envisaged 6.6 From lighting or cooling systems No Not envisaged 6.7 From any other sources No Nil

7. Risks of contamination of land or water from releases of pollutants into the ground or into sewers, surface waters, groundwater, coastal waters or the sea:

Details thereof (with approximate quantities/rates, wherever S.No. Information/Checklist confirmation Yes/No possible) with source of information data 7.1 From handling, storage, use or spillage of Yes No major storages are envisaged and hazardous materials hence, no risk of contamination of land or contamination of land or water is envisaged. 7.2 From discharge of sewage or other No No wastewater generation is effluents to water or the land (expected envisaged from mining activities. mode and place of discharge) There will not be any external discharge or wastewater. 7.3 By deposition of pollutants emitted to air No Not envisaged into the land or into water 7.4 From any other sources No -- 7.5 Is there a risk of long term build up of Yes The water coming out from the waste pollutants in the environment from these dump ate can contain non toxic dust sources? particles and flows laminar and Waste dump can be a source of air born dust.

8. Risk of accidents during construction or operation of the Project, which could affect human health or the environment

Details thereof (with approximate quantities/rates, wherever possible) S.No. Information/Checklist confirmation Yes/No with source of information data 8.1 From explosions, spillages, fires etc from Yes Fires in diesel storage possible and storage, handling, use or production of HEMM fires, diesel spillage near hazardous substances machinery 8.2 From any other causes No -- 8.3 Could the project be affected by natural No The proposed project sits is a hillock disasters causing environmental damage area, hence, there is no possibility of (e.g. floods, earthquakes, landslides, site get affected by floods, cloud cloudburst etc)? bursts etc.

9. Factors which should be considered (such as consequential development) which could lead to environmental effects or the potential for cumulative impacts with other existing or planned activities in the locality Details thereof (with approximate quantities/rates, wherever S. No. Information/Checklist confirmation Yes/No possible) with source of information data 9.1 Lead to development of supporting. lities, ancillary development or development stimulated by the project which could have impact on the environment e.g.: Yes Supporting and ancillary development will take place. • Supporting infrastructure (roads, power supply, waste or waste water treatment, No No major developments envisaged. etc.)

• housing development No Not envisaged • extractive industries No Not envisaged • supply industries No Not envisaged • other

9.2 Lead to after-use of the site, which could No Nil have an impact on the environment 9.3 Set a precedent for later developments Yes Ancillary industries will be developed as a consequence. 9.4 Have cumulative effects due to proximity Yes Addition to existing environmental to other existing or planned projects with load in the form of air pollution & similar effects Noise due to cluster mines.

(III) Environmental Sensitivity

S.No. Areas Name/ Aerial distance (within 15 km.) Identity Proposed project location boundary 1 Areas protected under international No No protected areas exist in 10-km conventions, national or local legislation radius area for their ecological, landscape, cultural or other related value 2 Areas which are important or sensitive for Yes Ayyannvagu- 1.2 Km(S),Kottella ecological reasons - Wetlands, watercourses Vagu -3.9 Km (S),Viti Vagu -4.7 Km or other water bodies, coastal zone, (W),Mada Vagu -5.0 Km biospheres, mountains, forests (NW),Krishna River-6.0 Km (N);Kondaviti Vagu-8.3 Km (SE) 3 Areas used by protected, important or Yes Kariapudi RF -1.7 Km 9W);Pedda sensitive species of flora or fauna for Madduru R.F.3.3 Km (NS);Motadaka breeding, nesting, foraging, resting, over Rf-3.7 Km (SW);Nidumukkala RF -5.0 wintering, migration Km (S) 4 Inland, coastal, marine or underground No -- waters 5 State, National boundaries No -- 6 Routes or facilities used by the public for No access to recreation or other tourist, pilgrim areas 7 Defence installations No -- 8 Densely populated or built-up area Yes Ananthavaram is the nearest village located at a distance of 1.4 m from ML area 9 Areas occupied by sensitive man-made land Yes Hospitals & Schools and small temples uses (hospitals, schools, places of worship, are existing within 10 km radial community facilities) distance from the proposed mine area

10 Areas containing important, high quality or No -- scarce resources (ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals) 11 Areas already subjected to pollution or No -- environmental damage. (those where existing legal environmental standards are exceeded) 12 Areas susceptible to natural hazard which No The area is not known for these natural could cause the project to present hazards environmental problems(earthquakes, subsidence, landslides, erosion, flooding or extreme or adverse climatic conditions)

(IV).Proposed Terms of Reference for EIA studies:

1.1 Introduction M/s Sri Shirdi Sai Stone Crusher – Mine Owner of the 6.912 Ha. of Raod Metal Mine proposes to produce about 25000 Cum/Year minerals at S. No. 285/A1, Ananthavaram village, Thullur Mandal, Guntur District, Andhra Pradesh for which Environmental Impact Assessment studies are proposed. The EIA study includes determination of baseline conditions within 10-km radius study area from the boundary of the mining lease, assessment of the Impacts on the environment due to the proposed mining project and making recommendations on the preventive measures to be taken to minimize the impact on the environment to acceptable levels. A suitable post-study monitoring program will also be outlined. Preparation of Environment management plan will also be done. The Environmental Impact Assessment Study will consist of: 1) Baseline Data Generation: Assessment of the existing quality of the environment within the 10 km radius of the mine area, which includes ambient air, meteorology, surface and ground water, surface and subsurface soil, noise, aquatic and terrestrial life, human interface and socio economic as per the MoEF guidelines for Environmental Impact Assessment study. i) Ambient Air Quality: Ambient Air Quality will be monitored 24 hours per day

for PM2.5, PM10, SO2, & NOx at 8 stations within 10 km radius of the Mine once in twice per a week for 03 month iii) Meteorology: Micro meteorological data (wind speed and direction dry and wet bulb temperature and humidity) will be recorded at one weather station on the project site during the once in twice per a week for 03 month. iv) Water: Surface and ground water bodies: Representative samples will be drawn from the surface and ground water bodies at 8 stations within 10 km radius of the project site and analyzed for their physicochemical characteristics, bacteriological and biological parameters as per IS 2490/ IS 10500 specifications. v) Soil Analysis: Surface and sub-surface soil samples will be drawn from 8 stations within 10 km radius of the Mine site and analyzed for physico-chemical characteristics and micronutrients. vi) Ambient Noise Levels: Day and night noise levels will be monitored at 8 stations within 10 km radius of the Mine site. vii) Over Burden and Waste Management: The over burden and waste management will be situated and comprehensive measures will be suggested. viii) Socio – Economic: The project site will be surveyed by household survey for socio-economic aspects like demography, literacy, education and employment, public health and safety etc., within the 10 km radius of the proposed Mine. 2) The baseline data for various environmental attributes as listed above will be generated within the 10 km radius of the Mine area as per the MoEF guidelines to assess the baseline environmental status of the area. 3) Besides, the geological study of the mine and proposed pollution control system will be studied to evaluate its adequacy to comply with various statutory norms. The impacts due to the proposed mining activity will be super imposed on the surrounding environment to predict and evaluate the impacts. Prediction of impacts will be evaluated by using ISCST3 modeling. 4) The data from the secondary sources such as census dept., agricultural dept., industries dept., irrigation, mines and geology dept., town and country planning dept. etc. will be collected to estimate the socio economic status of the study area. 5) On the basis of the baseline environment data collected for the study area and the information collected from the other sources with respect to mine activity, the significant beneficial and adverse impacts of the environment will be identified and estimated. 6. Environment Management Plan A EIA Report based on one full season field data generation will be prepared for the purpose of getting Environmental clearance from MOEF, New Delhi. The Environment Management Plan (EMP) will include all the mitigation measures proposed under each significant environmental attribute. Further, a suitable greenbelt development plan for the project site will be include in the EMP report. 7. Post Study Monitoring Plan The Post Project Monitoring (PPM) plan will be prepared considering the following:  The proposed pollution control measures or air, wastewater and solid waste (hazardous/non-hazardous) disposal;  Waste minimization management, waste reuse and resource recovery;  The monitoring requirements for ensuring the statutory as well as process data is collected; and  The organizational/institutional set-up required for effective environment management plan implementation and post-project monitoring will be suggested also with the budgetary requirements.

“I hereby given undertaking that the data and information given in the application and enclosures are true to the best of my knowledge and belief and I am aware that if any part of the data and information submitted is found to be false or misleading at any stage, the project will be rejected and clearance give, if any to the project will be revoked at our risk and cost.

Signature of the applicant with Name and Full Address (Project Proponent /Authorised Signatory) Smt N.PADMAVATHI Proprietor Ms Sri Shirdi Sai Stone Crusher W/o N.V.Nageswar Rao Gayatri Nagar,Vijayawada A.P. Cell:9885216654

STANDAD TEMPLATE FOR EVALUATION OF ALL PROJECTS / ACTIVITIES:

S. No Information Required Information to be furnished by the Proponents 1 Name of the project or activity 6.912 Ha. ofRoad Metal Mine 2 Name of the organization / owner Ms Sri Shirdi Sai Stone Crusher 3 Address for communication Smt N.PADMAVATHI Proprietor Ms Sri Shirdi Sai Stone Crusher W/o N.V.Nageswar Rao Gayatri Nagar,Vijayawada A.P. 4 Telephone numbers Cell:9885216654 5 Email ID of the organization or contact person [email protected] 6 Location of the proposed project or activity Sy. No’s. 285/A1, Ananthavaram village, Thullur Mandal, Guntur District Andhra Pradesh. 7 Appraisal category (B2 or B1) B2 8 Nearest habitation and distance from the project or Ananthavaram village is the nearest activity habitation to this mine site located at a distance of 1.4 m from the mine area 9 Installed capacity / production capacities 25,000 Cum/Year of Road Metal 10 Specify the fuel (Coal/CNG/Biomass/Others) and No fuels are required for this mining quantity required operations 11 Details of land use / land cover The mine lease area is a Revenue Land The ML area is a hilly terrain. Total area of 6.912 Ha. Will be used for the mining purpose. 12 Occupancy, ownership of the land in which the Govt. Land activity is proposed: (Government land / Private land / Forest land /Revenue land /Temple land /leased land/ land belongs to other Department) 13 If it is a Forest land, the following details shall be NOT APPLICABLE furnished: (Whether it is a Reserved forest / Protected forest/Demarcated forest/ National Parks/Sanctuaries/any land in possession of Forest Department.) (The village map with Sy. No. indicating nearest forest boundary line from the site shall be enclosed)

14 Total investment of the project / activity 40 L a. Funds allocated for EMP 18 LAKHS 15 Brief description of the project with special reference EMP report enclosed to specific pollution and its control measures 16 Compliance report on the following : i. Status of compliance of the conditions and Not Applicable environmental safeguards stipulated in the earlier clearance letters. ii. Details of the court cases, if any, pending in any No such cases against the project Court of Law against the project as well as any directions passed by the Court relating to the project directly or indirectly. iii. Details of the notices, if any, given to the project NIL under Section 5 of the Environmental (Protection) Act, 1986 and Section 18 of the Air (Prevention & Control of Pollution) Act, 1981. 17 Whether the project attatracts the provisions laid under the OM date 16.11.2010 issued by MoE&F, GOI,w.r.t. violation of EIA notification,2006 and its Yea amendments there of ? (Yes/ No) Present stage and status of the project Existing Mine and present NOT working. 18 Name of the consultant T. MURALI KRISHNA M/s. GLOBAL ENVIRO LABS 2-2-1075/14/A, Tilaknagar ‘X’ Roads, Baghamberpet, Hyderabad – 13 pH: 040-65582886, 27407969, 9849039741

DECLARATION

(a) We, Ms SRI SHIRDI SAI STONE CRUSHER Mine Owners of 6.912 Ha. Of Road Metal Mine located in Sy. No: 285/A1, of Ananthavaram village, Thullur Mandal, Guntur District of Andhra Pradesh hereby declare that, our organization does not have conflict of interest with the Chairmen and members of SEAC, A.P. and SEIAA, A.P.

(b) We hereby declare that, T. MURALI KRISHNA, GLOBAL ENVIRO LABS are authorized to submit the application and to do all necessary correspondence for obtaining environmental clearance from State Level Environment Impact Assessment Authority (SEIAA), A.P. and to attend the meeting (s) of State level Expert Appraisal Committee (SEAC), A.P. to present our case and to clarify the points raised by the Members of SEAC and SEIAA.

(c) We hereby declare that M/s. Global Enviro Labs, 2-2-1075/14/A/1, Tilaknagar ‘X’ Roads, Baghamberpet, Hyderabad is/are authorized to assist all matters relating to the environmental matters.

(d) we here by declare that the information furnished above is true to best of my/our knowledge and I/we shall hold personal liability for any deliberate misrepresentation and or concealment of factual information. If the information furnished is found to be false, the EC issued to our organization can be withdrawn and I/we are liable for action as per rules applicable.

Date: 28/01/2019 Signature of the Applicant/ project proponent Place: THULLUR (Name and address of the Applicant) Smt N.PADMAVATHI Proprietor Ms Sri Shirdi Sai Stone Crusher W/o N.V.Nageswar Rao Gayatri Nagar,Vijayawada A.P. Cell:9885216654

FORM-2

APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE

1 Details of Project a. Name of the Project (s) 6.912 Ha. of Road Metal Mine (Ms Sri Shirdi Sai Stone Crusher, Sy. No: 285/A1 of Ananthavaram , Thulluru (M), Guntur District, Andhra Pradesh.) b. Name of the Company / Organization Ms Sri Shirdi Sai Stone Crusher c. Registered Address Smt N.PADMAVATHI Proprietor Ms Sri Shirdi Sai Stone Crusher W/o N.V.Nageswar Rao Gayatri Nagar,Vijayawada A.P. Cell:9885216654 d. Legal Status of the Company Proprietor e. Joint Venture (Yes/No) No If Yes, - (i) No. of JV Partners (Multiple Entries - Allowed) Name of the Share of the Address of the Email Id of Mobile No. of JV partner JV partner partner partner partner - - - - -

2 Address for the correspondence a. Name of the applicant N.PADMAVATHI b. Designation (Owner / Partner / CEO) Proprietor c. Address W/o N.V.Nageswar Rao Gayatri Nagar,Vijayawada A.P. d. Pin code -- e. e-mail [email protected] f. Telephone No Cell:9885216654 g. Fax No. --- 3 Category of the Project/ Activity as per Schedule of EIA Notification, 2006 a. Project / Activity 1 (a) l(a)(i) / l(a)(ii) / l (b) / l (c) / l (d) / 1 (e) / 2(a) / 2(b) / 3(a) / 3(b) / 4(a) / 4(b)(i) / 4(b) (ii) / 4(c) / 4(d) / 4(e) / 4(f) / 5(a) / 5(b) / 5(c) / 5(d) / 5(e) / 5(f) / 5(g) / 5(h) / 5(i) / 5(j) / 6(a) / 6(b) / 7(a) / 7(b)/ 7 (c) / 7 (d) I 7 (da) / 7 (e) / 7 (f) / 7 (g) / 7 (h) / 7 (i) / 8 (a) / 8 (b) b. Category (A/B1/B2) B2 If B1 or B2 - Reason for application at Central Level / State Does not qualify for B1 as total area level (in case of B2 projects) qualified is less than <100 Ha

If Others - c. Please Specify - d. EAC concerned (for category A Projects only) - (Coal Mining / Non-coal Mining / Thermal / River Valley & Hydro / Industry- I / Industry-II / Infrastmcture-1 / Infrastructure-II / Nuclear & Defence / CRZ e. New / Expansion / Modernization / One Time Violation Capacity expansion (only for Coal Mining) / Expansion under Para 7(ii) / Modernization under Para 7(ii) / Change of Product Mix under Para 7(ii)) 4 Location of the Project a. Plot / Survey / Khasra No. 285/A1 b. Village Ananthavaram c. Tehsil Thulluru d. District Guntur e. State Andhra Pradesh f. Pin Code --- g. Bounded Latitudes (North) 16o 30’ 27.31 N 80o 25’ 9.89” E From 16o 30’ 27.24 N 80o 24’ 58.51” E To 16o 30’ 35.38 N 80o 25’ 2.78” E h. Bounded Longitudes (East) 16o 30’ 35.51 N 80o 25’ 3.88” E From 16o 30’ 36.90 N 80o 25’ 5.65” E To 16o 30’ 34.96 N 80o 25’ 8.02” E 16o 30’ 31.76 N 80o 25’ 9.43” E 16o 30’ 31.80 N 80o 25’ 10.46” E

i. Survey of Topo Sheet No. 56 M/5 j. Upload Topo Sheet File ( Upload pdf only) Uploaded in website k. Maximum Elevation Above Means Sea Level ( 18 m AMSL) The lowest RL 52 M is and the highest RL is 70 M The relief is 18 M l. Upload (kml) File (Upload kml only) Uploaded in website m. Distance of Nearest HFL from the project -- boundary within the study area n. Seismic Zone (Zone: 1 / 2 / 3 / 4 / 5) Zone II & III

5 Whether project is executed in multiple States (Yes I No)? If Yes No a. Number of States in which Project will be Not Applicable Executed (e.g. 1,2,3,4,5,6) b. Main State of the Project Not Applicable c. Other State (Multiple Entries Allowed) Not Applicable (If the project to be executed, does not belong to any state, then state category could be selected as Other) State District Tehsil Village

6 Details of Terms of Reference (ToR) a. Whether ToR is mandatory for submitting Yes application (Yes / No)? If Yes -- b. Date of issue of ToR / Standard ToR -- c. MoEF&CC / SEIAA File No. -- d. Upload ToR letter (PDF only) -- 7 Details of Public Consultation a. Whether The Project exempted from Public No Hearing (Yes / No)? If Yes , Reason It is B2 Category Project b. Supporting Document ( upload pdf only) -- c. Whether details of Public Hearing available Yes (Yes/No)? If No, -- d. Reason there of -- Supporting Document (upload pdf only) -- If Yes, -- e. Date of Advertisement of Public Hearing -- f. Copy of advertisement in English (Upload PDF -- only) g. Whether Public hearing was presided over by an -- officer of the rank of Additional District Magistrate or above (Yes/No)? If yes -- h. Designation of Presiding Officer (District -- Magistrate / District Collector / Deputy Commissioner / others - please specify) i. Copy of duly signed Proceedings of Public -- Hearing in English (Upload pdf only) j. Date of Public Hearing -- k. Venue of Public Hearing: -- Village -- Tehsil -- District -- State -- l. Distance of Public Hearing Venue from the -- Proposed Project (km) m. No. of people attended -- n. If the multiple public hearings conducted -- Pl give the details of each PH as per (e) to (o) -- above 8 Details of Project Configuration/ Product (Multiple Entries Allowed) a. Whether the project is New (Yes/No?) No (Existing) If yes, b. Project Configuration 6.912 Ha of Road metal Mine Plant / Equipment/ Facility Configuration Remarks if any Excavator-01 200 HP-1.2 Cum -- Tippers-03 60 HP -- Drilling Machine -01 3’’ -- Compressor -01 3HP -- Water Tanker-01 1000 Ltrs -- Loaders-02 3 Cum --

c. Product Product / Activity Quantity Unit Mode of Transport/ (Capacity / Area) Transmission of Product Cum /Year By Road and trucks will Road Metal 25000 be used for transport - Unit:- (Tons per Annum(TPA), Mega Watt(MW), Hectares(h a), Kilo Litre per Day(KLD), Tons Crushed per Day( TCD), Cubic Meter per Day, Kilometers(Km), Million Liters per Day(MLD), Others) - Mode of Transport/Transmission of Product (Road, Rail, Conveyor Belt, Pipe Conveyor, Arial Ropeway, combination of two or three modes, Others) 9 If Expansion / Modernization / One Time Capacity expansion ( only for Coal Mining) / Expansion under Clause 7(ii) / Modernization under Clause 7(ii) / Change of Product Mix under Clause 7(ii))) a. Details of environmental clearance granted No earlier (i) Date of issue of environmental clearance - (ii) MoEFCC / SEIAA File Number - (iii) Upload EC Letter - b. Details of certified report on compliance of earlier environmental clearance conditions (i) Details of Regional Office of MoEFCC / Zonal - Office of CPCB / SPCB / UTPCC from which certified report on compliance of earlier environmental clearance conditions obtained (ii) Letter No - (iii) Status of Compliance - (iv) Certified report on compliance of earlier - environmental conditions (Including Monitoring Report) ( Upload pdf only) clearance (v) Date of site visit - c. Details of Consent to Operate - (i) Whether Consent to operate obtained No (Yes/No)? If yes, - (ii) Upload Copies of all Consent to operate - obtained since inception (Upload pdf only) (iii) Date of issue - (iv) Valid up to - (v) File No. - (vi) Application No. - (vii) Upload Copies of all Consent to operate - obtained since inception (Upload pdf only) d. Details of Capacity Expansion (Multiple Not Applicable Entries Allowed)

Product / Activity Quantity Quantity To Unit Mode of Transport / (Capacity / Area) from Transmission of Product

- Unit:- (Tons per Annum(TPA), Mega Watt(MW), Hectares(h a), Kilo Litre per Day(KLD), Tons Crushed per Day( TCD), Cubic Meter per Day, Kilometers(Km), Million Liters per Day(MLD), Others) - Mode of Transport/Transmission of Product (Road, Rail, Conveyor Belt, Pipe Conveyor, Arial Ropeway, combination of two or three modes, Others e. Details of Configuration (Multiple Entries Allowed) - Not Applicable

Plant / Existing Proposed Final Remarks Equipment / Configuration Configuration configuration if any Facility after expansion

10 Project Cost a. Total Cost of the Project at current price level Rs 40 Lakhs (in Lakhs) b. Funds Allocated for Environment Management Rs 18.0 Lakhs (Capital) (in Lakhs) c. Funds Allocated Towards ESC (Entrepreneur Rs 1.5 Lakhs Social Responsibility) (in Lakhs) d. Funds Allocated for Environment Management Rs 18.13 Lakhs Plan (EMP) (Recurring per Annum) (in Lakhs) 11 Whether project attracts the General Condition No specified in the Schedule of EIA Notification (Yes/No)? [provide name of WL/CPA/ESA/Inter- state boundary/ International boundary and distance from the project If Yes - a. Protected Area Notified Under the Wild - Life(Protection) Act, 1972 b. Critically Polluted Areas as identified by the - Central Pollution Control Board from Time to Time c. Notified Eco-Sensitive Areas - d. Inter-State Boundaries and International - Boundaries 12 Whether projects attract the Specific Condition No specified in the Schedule of EIA Notification (Yes/No)? If Yes a. If any Industrial Estate I Complex I Export processing Zones / Special Economic Zones I Biotech Parks / Leather Complex with homogeneous type of industries such as Items 4(d), 4(f), 5(e), 5(f), or those Industrial estates with pre-defined set of activities (not necessarily homogeneous, obtains prior environmental clearance, individual industries including proposed industrial housing within such estates / complexes will not be required to take prior environmental clearance, so long as the Terms and Conditions for the industrial estate/complex are complied with (Such estates/complexes must have a clearly identified management with the legal responsibility of ensuring adherence to the Terms and Conditions of prior environmental clearance, who may be held responsible for violation of the same throughout the life of the complex/estate - 13 Raw Material/ Fuel Requirement (Multiple Entries Allowed) – Raw Material not required because of it is a Mining of Road metal Project but for machinery running fuel is required a. Details of Raw Material / Fuel Requirement Raw Quantity Unit Source (in case of Mode of Distance of Source Type of Linkage Material/ per Import, please Transport from Project Site (Linkage Fuel Fuel Annum specify country meters ( In case of Supply Agreement / and Name of the import, distance e-auction/ MoU/ port from which from the port from LOA/ Captive/ Open Raw Material/ Fuel which the raw market/ Others) is received) material/ fuel is received 250000 Near By Petrol Diesel KL -- Road Open Market (app) Bunks In case of expansion proposals, total requirement of raw material / fuel shall be given - Unit:- (Tons per Annum(TPA), Mega Watt(MW), Hectares( ha), Kilo Lit re per Day ( KLD) Tons Crushed per Day(TCD), Cubic Meter per Day, Kilometers(Km), Million Liters per Day(MLD), Others). - Mode of Transport/Transmission of Product (Road, Rail, Conveyor Belt, Pipe Conveyor, Arial Ropeway, combination of two or three modes, Others). 14 Baseline Data (Air/ Water/ Noise/ Soil/ Ground water table/ Others) - Not Applicable a. Period of Base Line Data Collection - From (DD/MM/YYYY) - To (DD/MM/YYYY) - b. Season (Sumner / Pre-monsoon I Post- - monsoon / Winter) c. No. of Ambient Air Quality (AAQ) - Monitoring Locations d. Details of AAQ Monitoring (Multiple Entries - Allowed) Criteria Pollutants Unit Maximum Minimum 98 Percentile Prescribed Value Value Value Standard ------Criteria Pollutants: - (PM10, PM2.5, S02, NOx, Others parameters specific to sector) - Unit: - (Micro Gram per Meter Cube, Nano Gram per Meter Cube, Mili Gram per Meter Cube, NA) e. No. of Ground Water Monitoring Locations Not Applicable (Multiple Entries Allowed) f. Details of Ground Water Monitoring Not Applicable Criteria Pollutants Unit Maximum Minimum 98 Percentile Prescribed Value Value Value Standard ------Criteria Pollutants: - (pH, TSS, TDs, Total Hardness, Chlorides, Fluoride, Heavy Metals, other parameters specific to the sector) - Unit:- (mg/l, NA) g. No. of Surface Water Monitoring Locations Not Applicable h. Details of Ground Water Monitoring (Multiple Not Applicable Entries Allowed) Criteria Pollutants Unit Maximum Minimum 98 Percentile Prescribed Value Value Value Standard ------Parameter :- (pH, DO, BOD, COD, others parameters specific to the sector) - Unit :- (mg/1, NA) i. No. of Ambient Noise Monitoring Locations Not Applicable j. Details of Noise Monitoring (Multiple Entries Not Applicable Allowed)

Parameter Unit Maximum value Minimum Prescribed value Standard ------Parameter:- (Leq(Day), Leq(Night)) - Unit:- (A-weighted decibels(dB(A)) k No. of Soil Monitoring Locations (Multiple Entries Allowed) Parameter Unit Maximum Value Minimum 98 Percentile Value Value ------Parameter:- (pH, N(Nitrogen), P(Phosphorus), K(Potassium), Electric Conductivity) - Unit: - (Millisiemens per Centimeter, Milligram per Litre, Percent, Centimeter per Second, Milliequivalents per 100 Gram, Milligram per Kilogram, Parts per Million, Kilogram per hectare, Others) l Ground Water Table i Range of Water Table Pre-Monsoon Season (Meters Below Ground Level (m bgl)): From 25-m To 30-m ii Range of Water Table Post-Monsoon Season (Meters Below Ground Level (m bgl)): From 30 -m To 40 -m iii Whether Ground Water Intersection will be there No (Yes / No)? If Yes, - (i) Upload Copy of Central Ground Water Authority - Letter ( Upload pdf only) (ii) Letter No. - (iii) Date of issue - 15 Details of Water Requirement (During Operation) (Multiple Entries Allowed) 06 KLD a. Details Distance Quantity in Method of water Source from Mode of Transport KLD withdrawal Source Water from 06 Tube wells/Others - Water Tanker nearby villages - Source: Surface/ Ground Water/ Sea/ Others – Ground Water - Mode of Transportation: Pipeline / canal / Others – Tankers - Method of water withdrawal: Barrage / Weir / Intake well / Jackwell / Tube well / Open well / Others – Tube Well/Others b. Upload Copy of Permission from Competent Authority (Upload pdf only) c. Letter No. - d. Date of issue - e. Permitted quantity - f. Whether Desalination is proposed (Yes/ No) - If Yes, - (i) Desalination capacity (KLD) - (ii) Quality of Brine (KLD) - (iii) Mode of Disposal of brine - 16 Waste Water Management (During Operation) Type/ Quantity Treatme Treatmen Mode Quantity of Quantity of Source of waste nt t Method of Treated Water Discharged water Capacity Dispos Used/ in Water (Kilo generated (Kilo al Recycling/ Litre per Day (Kilo Litre Litre per Reuse (Kilo per Day) Day) Litre per Day) Domestic 1.0 - - Septic - - wastewater tank followe d by Soak pit

a. Total Waste Water Generation 1.0 KLD b. Total Discharged Water Nil c. Total Reused Water Nil 17 Solid Waste Generation Management (Multiple Entries Allowed) Item Quantity Unit Distance from site Mode of Mode of per annum Transport Disposal Rock Mass/ ------Over Burden Waste - Item:- (Industrial waste, Municipal Solid waste, Fly ash, Bottom Ash, Hazardous waste (as per Hazardous and Other Waste Management Rules 2016), E Waste, Bio-Medical waste, Construction & Demolition waste, Plastic Waste, Others) - Unit:- (Tons, Kiloliter) - Mode of Disposal:- (Treatment, Storage and Disposal Facility(TSDF), Authorized Recyclers, Landfill, Sanitary Landfills, Others) 18 Air Quality Impact Prediction (Multiple Entries Allowed) Not Applicable Criteria Unit Baseline Minimum Incremental Total GLC Prescribed Pollutants Concentration value Concentration Standard

- Parameter:- (PM10, PM, S02, NOx, Others parameters specific to the sector) - Unit:- (Microgram per Meter Cube, NA)

19 Power Requirement – Not Required a. Quantity (Kilo Volt Amps (KVA)) - b. Source - c. Upload Copy of Agreement (Upload pdf only) - d. Stand by Arrangement (Details of DG Sets) -- e. Stack Height (in m) -- 20 Land Ownership Pattern (Prior to the project proposal) in Ha a. Forest land -- b. Private Land -- c. Government Land 6.912 Ha d. Revenue Land -- e. Other Land -- Total land 6.912 Ha. 21 Present Land Use breakup in Ha a. Agriculture Are -- b. Waste/Barren Area 6.912 Ha c. Grazing / Community Area -- d. Surface Water bodies -- e. Settlements -- f. Industrial -- g. Forest -- h. Mangroves -- i. Marine area -- j. Others (Specify) -- Total 6.912 Ha 22 Land requirement for various activities (Multiple entries allowed) in Ha Type of land use At the beginning of At the end of the During the scheme period scheme period Conceptual (Ha.) (Ha.) Period (Ha.) Mining 0.5753 2.3076 6.1100 Roads - 0.0100 0.0100 Green Belt Area - - - Total Land 0.5753 2.3176 6.1200 Degradation Area which will 6.3367 4.5944 0.7920 remain untouched Total 6.9120 6.9120 6.9120

Activity / Facility / Plant / Others include: Main Plant, Township, Greenbelt, Ash pond, Quarry area, OB dump Area, Safety zone, Tailing pond, Landfill, Water reservoir, Desalination plant, Area for solid waste management, Built-up area, others 23 Ecological and Environmental Sensitivity (Within 10 Km):- WLS-Wild Life Species; NPA Notified Protected Area: ESAs-Eco Sensitive Areas: ESZs- Eco Sensitive Zones) a. Details of Ecological Sensitivity Not Applicable Details of Ecological Name Distance from the Remarks Sensitivity Project (Km)

- Details of Ecological Sensitivity: - (Critically Polluted Area, WLS, NPA, ESAs, ESZs, Corridors, Wildlife Corridors)

b. Whether NBWL recommendation is required No (Yes/No)? If yes - Upload NBWL recommendation in PDF - c. Details of Environmental Sensitivity - Details of Name Distance from Remarks Environmental the Project Sensitivity (Km) Forests Kariapudi RF 1. 3.3 Km (NS) -- Pedda Madduru R.F. 7 Km (W) Motadaka RF 3.7 Km (SW) Nidumukkala RF 5.0 Km (S) - Details of Environmental Sensitivity:- (Forest, Archaeological Sites, Defense Installations, Others) d. Whether NOC / Permission from the competent No authority is required (Yes/No)? If yes - Upload NoC / Permission from the competent - authority in PDF 24 Forest Land 1 Whether any Forest Land involved (Yes/No)? No forest land is involved If yes a. Forests Clearance Status (ln-Principle(Stage-1) - Approval Obtained / Final (Stage-II) Approval Obtained / Forest Clearance Under Process(Stage-1) / Forest Clearance Under Process(Stage-11) / Application for Forest Clearance yet to be Submitted) If In-Principle (Stage-I) Approval Obtained, - (i) MoEFCC file number - (ii) Date of In Principle (Stage-I) approval - (iii) Area diverted - (iv) Upload FC Letter (Upload pdf only and - attach it as Annexure-FC letter) If Final (Stage-II) Approval Obtained, - (i) MoEFCC file number - (ii) Date of Final Approval - (iii) Date of In-Principle Approval - (iv) Area diverted - (v) Upload FC Letter (Upload pd/ only and - attach it as Annexure-FC letter) If Forest Clearance under process (Stage-I), - (i) MoEFCC file number - (ii) Area applied - If Forest Clearance under process (Stage-II), - (i) MoEFCC file number - (ii) Area applied - b. Legal Status of Forest Land (Reserved, - Protected, Private, Village, Others) If Others, - Please Specify Others - 25 Tree Cutting, if any a. No. of Trees Cut for the Project (if Forestland No not involved) b. Details of Tree Cutting and Planting of Trees No ( Upload pd/ Only) 26 Land Acquisition Status Not Applicable a. Acquired Land - b. Land yet to be acquired - c. Status of Land acquisition if not acquired - 27 Rehabilitation and Resettlement (R&R) a. No. of Villages No b. No. of Households - c. No. of PDFs (Project Displaced Families) - d. No. of PAFs (Project Affected Families) - e. Funds Allocated for R&R - f. Status of R&R (Completed / In-progress / Yet to - start) 28 Whether there is Presence of Schedule-I Species (Yes/No)? If yes, No a. Details of Schedule-I Species - b. Whether conservation plan for Schedule-I - Species has been prepared (Yes/ No)? If yes, - (i) Upload conservation plan (Upload only PDF) - (ii) Fund Provision made - (iii) Period of Implementation - c. Whether conservation plan for Schedule-I - Species has been approved by competent authority (Yes/ No)? (i) Upload copy of approval (Upload PDF Only) - (ii) Letter No. - (iii) Date of issue - (iv) Recommendations if any - 29 Whether there is Presence of Water Bodies in Core Area (Yes/No)? If yes, No a. Details of Water Bodies in Core Area - b. Whether there is Diversion required (Yes/No)? No If yes, - c. Details of diversion required - d. Details of study conducted - e. Whether permission has been obtained from - competent authority (Yes/No)? (i) Upload copy of permission (Upload PDF - Only) (ii) Letter No. - (iii) Date of issue - (iv) Recommendations if any - 30 Whether there is Presence of Water Bodies in Buffer Area (Yes/No)? If yes, Yes a. Details of Water Bodies in Buffer Area Ayyannvagu- 1.2 Km(S),Kottella Vagu -3.9 Km (S),Viti Vagu -4.7 Km (W),Mada Vagu - 5.0 Km (NW),Krishna River-6.0 Km (N);Kondaviti Vagu-8.3 Km (SE) b. Direction of Water Bodies in Buffer Area (North NW & SE / South / East / West / North East/ North West/ South East/ South West) c. Distance of Water Bodies in Buffer Area (kilo 1.2 Km meters) 31 Manpower Requirement a. Permanent employment during construction - b. Permanent employment during operation - c. Temporary employment during construction - d. Temporary employment during operation - e. No. of working days 250 f. Total manpower 29 32 Green Belt in Ha a. In case of new projects - i. Total Area of Green Belt 0.25 Ha ii. Percentage of Total Project Area 10 % iii. No. of Plants to be Planted 500 plants per annum iv. Funds Allocated for Plantation 150000/- v. Upload Green Belt Plan (Upload PDF Only) Uploaded in Website (EMP Report) b. In case of expansion / modernization / change in Not Applicable product mix etc. i. Description Existing Proposed Total Total Area of Green Belt Percentage of Total Project Area No. of Plants

ii. Upload Green Belt Plan (Upload PDF Only) Attached (EMP Report) 33 Project Benefit (Multiple entry allowed) Type of Project Benefits Details of Project Benefit Improvement In Physical Infrastructure This project will improve the overall physical infrastructure in this area Rain water harvesting will be done for groundwater recharging that will improve the ground water table in the area. Improvement In Social Infrastructure Social Benefits Like Drinking Water, Health Care Measures and Educational Facilities Employment Potential The surrounding villagers will get employment (Project benefits shall include environmental, social and others) 34 Whether the Project/ Activity attract the provisions No of CRZ (Yes/No)? If yes, - 1 Project Details - a. CRZ Classification: (C RZ I (A), CRZ - I(B), CRZ II, CRZ III , C RZ IV(A), CRZ IV(B ) ) b. Location type : (Non-Eroding Coast, Low - and Medium Eroding Coast, High Eroding Coast) c. Details of Mangroves Land Involved, if - Any d. Area of Mangroves Land (hectare) - e. EIA (Terrestrial) Studies: (Carried Out, - Not Carrie d Out) If Carried Out, - 1) Summary Details of EI A - (Terrestrial) Studies 2) Upload Recommendation made in - EIAs (Upload pdf only) 3) Period of Study from (EIA - Terrestrial) 4) Period of Study to (EIA Terrestrial) - If Not Carried out - Give Reason - f. E IA (Marine) Studies : (Carried Out, Not - Carried Out) If carried out - 1) Summary Details of EIA (Marine) - Studies 2) Upload Recommendation made in E - IAs 3) Period of Study from (EIA Marine) - 4) Period of Study to (EIA Marine) - If Not Carried out - Give Reason - g. Disaster Management Plan/National Oil - Spill Disaster Contingency Plan (if Applicable) 2. Description of the Project Under No Consideration a. Type of Project: (Resort/ Buildings/civic - amenities, Coastal Roads/Roads on Stilt, Pipelines from Thermal power Blow Down, Marine Disposal of Treated Effluent, Facility for Storage of Goods/Chemicals, Offshore structures, Desalination Plant, Mining of Rare Earth/ Atomic Minerals, Sewage Treatment Plants, Lighthouse, Wind Mills, Other) If Resort/Buildings/civic amenities, - 1) Agency Name for Preparing CRZ Maps 2) Total Area/Built-up Area (hectare ) 3) Height of Structure 4) FSI Ratio 5) The governing Town Planning Rules/Regulations 6) Details of Provision of Car Parking Area If Coastal Roads/Roads on stilt, - 1) Agency Name for Preparing CRZ Maps 2) Area of Land Reclamation 3) Estimated Quantity of Muck/Earth for Reclamation 4) Carrying Capacity of Traffic If Pipelines from Thermal Power Blow - Down, 1) Agency Name for Preparing CRZ Maps 2) Length of Pipeline 3) Length Traversing CRZ Area 4) Depth of Excavation 5) Width of Excavation 6) Length of Pipeline from Seashore to Deep Sea 7) Depth of Outfall Point from Surface of Sea Water 8) Temperature of effluent above Ambient at Disposal Point If Marine Disposal of Treated Effluent, 1) Agency Name for Preparing CRZ - Maps 2) Location of Intake/Outfall - 3) Depth of Outfall Point - 4) Length of Pipeline - 5) Length Traversing CRZ Area - 6) Depth of Excavation - 7) Width of Excavation - 8) Length of Pipeline from Seashore to - Deep Sea/Creek 9) Depth of Outfall Point from Surface - of Sea Water 10) Depth of Water at Disposal Point - 11) Type of Disposal - If Facility for Storage of Goods/Chemicals, 1) Agency Name for Preparing CRZ - Maps 2) Name and Type of Chemical - 3) End us e of the Chemical - 4) No. of Tanks for Storage - 5) Capacity of tanks - If offshore structures, 1) Agency Name for Preparing CRZ - Maps 2) Exploration or Development - 3) Depth of Sea Bed - 4) No. of Rigs/Platform - 5) Details of Group Gathering Stations - If Desalination Plant, 1) Agency Name for Preparing CRZ - Maps 2) Capacity of Desalination - 3) Total Brine Generation - 4) Temperature of Effluent above - Ambient at Disposal Point 5) Ambient Salinity - 6) Disposal Point - If Mining of Rare Earth/Atomic Minerals, 1) Agency Name for Preparing CRZ - Maps 2) Capacity of Mining - 3) Volume/ Area to be mined - 4) Type of Mineral to be Extracted - 5) End use of the Mineral - If Sewage Treatment Plants, 1) Agency Name for Preparing CRZ - Maps 2) Capacity - 3) Total Area of Construction - 4) Compliance of effluent parameters - as laid down by CPCB /SPCB/other authorized agency 5) Whether discharge is in sea - water/creek? If yes, Distance of Marine Outfall Point - from Shore/from the tidal river bank Depth of Outfall Point from Sea - Water Surface Depth of Sea at Outfall Point - If Lighthouse, 1) Agency Name for Preparing CRZ - Maps 2) Total Area of Construction - 3) Height of the Structure - If Wind Mills, 1) Agency Name for Preparing CRZ - Maps 2) Capacity (MW) - 3) Transmission Lines: (Overhead, - Underground) 4) Diameter of Windmill - 5) Length of Blade - 6) Speed of Rotation - 7) Height of the Structure - If others, 1) Agency Name for Pre paring CRZ - Maps 2) Please Specify with salient - features 3) Upload relevant Document - (Upload pdf only) 3. Distance of Project (In Meters) from No LTL/HTL to be Stated a. Clause of CRZ Notification Under which - the Project is a Permissible/Regulated Activity b. Whether CRZ Map Indicating HTL, LTL - Demarcation in 1:4000 Scales Prepared? (Yes/No) If yes, - 1) Distance of Project (in meters) - from HTL to be Stated 2) Upload Maps(kml File) - 3) Distance of Project (in meters) - from L TL to be Stated 4) Upload Maps (kml File) - c. Whether Project Layout Superimposed on CRZ Map 1:4000 Scales?: (Yes/No) If yes, 1) Upload Maps (kml File) d. Whether CRZ Map 1:25000 Covering 7 km Radius Around Project Site Prepared? (Yes/No) If yes, 1) Upload Maps (kml File) e. Whether CRZ Map Indicating CRZ- - I,II,III and IV Including Other Notified ESAs Prepared? : (Yes/No) If yes, - 1) Upload Maps (kml File) - f. NOC from State Pollution Control - Boards Obtained: (Yes/No) If yes, - 1) Upload Copy of NOC (Upload pdf - only) g. Details of Rain Water Harvesting System - 4. Recommendation of State Coastal Zone No Management Authority a. Upload Copy of CZMA (Upload pdf - Only) b. State the Conditions Imposed - c. Social and Environmental Issues and - Mitigations Measures Suggested Including but not Limited to R&R, Water, Air, Hazardous Wastes, Ecological aspects, etc. (Brief Details to be Provided) 35 Sector Specific Details I Whether the proposal is mining of minerals (coal / non-coal) project (Yes/No)? If yes, Yes

1 No. of Mineral to be Mined (Multiple Entries Allowed) Minerals To be Mined Major or Minor Mineral Road Metal Minor Mineral

2 Mine Capacity in ROM (Run of Mine) 25000 Cum/Annum of Road Metal 3 Upload 500 meters Cluster Certificate from State Uploaded in Website Mines and Geology in case of minor minerals (Upload pdf Only) 4 Mining Plan a. Approval Letter No. 2274/MP/RM/GNT/2017 b. Date of Approval Dt:28.06.2017 c. Uploaded in website Uploaded in website

d. Approved by Deputy Director Mines And Approved by Deputy Director Mines And Geology, Geology. e. If Others, - Please specify - f. Approved Mining Lease Area 6.912 Ha g. Approved Capacity 25000 Cum/Annum of Road Metal 5 Technical Details a. Total Geological Reserves (Million Ton) Road Metal- 6,37,970 Cum (1594925 MT) b. Mineable Reserves (Million Ton) Road Metal -595490 Cum (1488725 MT) c. Extractable Reserves (Million Ton) Road Metal- 595490 Cum (1488725 MT) d. Percent of Extraction (%) Road Metal-100 % e. Grade of Coal / Ore / Mineral - f. Stripping Ratio - g. Category of Gaseousness (Only for Coal - Mining, Others may write Not applicable) h. Average Gradient(Degree) - i. Maximum Thickness of Seams(meters) - (Only for Coal Mining, Others may write Not applicable) j. Mining Method (Opencast / Underground Open Cast Semi Mechanized / Mixed (Opencast + Underground) / Adit k. Life of Mine (Years) 23.82 or 24 Years 6 Details of beneficiation (including crushing/ screening/others) a. Whether it is proposed to install Crusher No within the mining lease area (Yes/No)? If yes, - b. No. of Crusher - c. Details of Crusher (Multiple entries - allowed) Crusher ID Capacity (in TPH) Remarks

d. Whether it is proposed to install No beneficiation plant / Coal washery within the mining lease area (Yes/No)? If yes, - e. Beneficiation / washing Technology - f. Capacity - 7 Details of Seams if applicable Not Applicable a. No. of seams - b. Thickness of seams to be worked on - c. Maximum Thickness of Seams(meters) - (if not Applicable, may Write NA) 8 Details of Mining Lease a. Details of Mining Lease Road Metal Mine b. Upload Letter of Intent (Upload pdf only) Uploaded in Website c. Date of Execution of Mining Lease with 6284/Q4/1997 dated 30.06.1999 Reference Number d. Validity of Mining Lease 20 e. Upload Copy of Executed Lease deed - valid as on Date (Upload pdf only) f. Earlier Renewals (Multiple Entries Not Applicable Allowed) Uploaded Copy of Earlier Lease Date of Renewal

9 OB (Over Burden) Management (Only if No Mining Method: Opencast) a. Details of External Dumps - i) No. of OB Dumps - ii) Total Area (in Hectare) - iii) Height (in meter) - iv) Quantity (in Million Cubic meter) - v) No. of year back fill up - b. Details of Internal Dump i) No. of lnternal Dumps Nil ii) Total Area (in Hectare) -- iii) Height (in meter) -- iv) Quantity (in Million Cubic meter) -- 10 Details of Topsoil Management No a. Quantity of Topsoil excavated during - the entire life of the mine (in Million Cubic meter) b. Quantity of Topsoil proposed for - utilization for reclamation during the entire life of the mine(in Million Cubic meter) c. Quantity of Topsoil proposed for - utilization for other activities during the entire life of the mine (in Million Cubic meter) 11 Detail of Final Mine Void (Only if Mining - Method: Opencast) a. Area (in Hectare) 6.912 Ha b. Depth (in meter) 18 m from the top of the hill c. Volume (in Million Cubic meter) - 12 Details of Quarry (Only if Mining Method: Opencast) a. Final Void of (hectare) 6.912 Ha b. At a Depth of (meter which is proposed - to be converted into a Water Body.) c. Total Quarry Area (ha) 6.912 Ha 13 Details of Transportation - a. In Pit/Underground to Surface - b. Surface to Siding/Loading The excavated material will be loaded into the Trucks. c. Transportation I Conveyor Details Material will be supplied to the customers through Tippers 14 Details of Land Usage (Pre-Mining) - Land Use Within ML Outside ML Area Total Area (Hectare) (Hectare) Agriculture Land Forest Land Waste Land 6.912 - 6.912 Grazing Land Surface Water Bodies Settlements Others(Specify)

15 Details of Transportation a. InPit/Underground to Surface b. Surface to Siding/Loading The excavated material will be loaded into the Trucks. c. Transportation I Conveyor Details Material will be supplied to the customers through Trucks /tractors 16 Details of Land Usage (Pre-Mining) Land Use Within ML Area Outside ML Total (Hectare) Area (Hectare) Agriculture Land Forest Land Waste Land 6.912 - 6.912 Grazing Land Surface Water Bodies Settlements Others(Specify)

17 Details of Land Usage (Post-Mining) -- Land Use Plantation Water Body Public Use Others Excavation I quarry Top Soil Storage External OB dumps Internal OB dumps Roads Built Up Area(Colony/Office) Green Belt Virgin Area Other Total

18 Details of Reclamation (Only if Mining Method: There is no reclamation process Opencast) Total Afforestation Plan shall be proposed in this plan period. Implemented Covering of Mining. This will include: a. External OB Dump (in hectare) - b. Internal Dump (in hectare) Nil c. Quarry (in hectare) 6.912 d. Safety Zone (in hectare) 0.15 e. Final Void of (hectare) - f. At a Depth of (meter which is proposed to - be converted into a Water Body.) g. Density of Tree Plantation per ha (in no.) 500 h. Others in ha (such as Excavation Area along - ML Boundary, along Roads and Infrastructure, Embankment Area and in Township Located i. Total afforestation plant (in hectare) 0.25 19 Status of Progressive Mining Closure Plan (For Expansion Projects only) – Not Applicable

a. Implementation of Various Activities as per - Approved Progressive Mine Closure Plan (in Bar Chart) (pdf) (Upload pdf only) b. Any Deviation from the Approved - Progressive Mine Closure Plan c. Total Area Excavated (in hectare) 6.912 d. Total Area Backfilled after Excavation (in - hectare) e. Total Area Reclaimed (in hectare) - 20 Actual Coal Ore Production vis-a-vis sanctioned Not Applicable capacity Since inception (Multiple Entries Allowed). Financial Sanctioned Sanctioned Sanctioned Actual Excess Year Capacity as capacity as capacity as Production Production per per CTO per Beyond the EC (MTPA) approved EC/ Mining Plan CTO / Mining Plan Sanctioned Capacity (MTPA)

II Whether proposal is for Thermal Project (including captive No power plant and Waste Heat Recovery Plant) (Yes/No)? If Yes, 1 Specifications of the Plant a. Technology proposed (Supercritical, Sub- Critical, CFBC, AFBC,PFBC, IGCC, Incineration, Pyrolysis, Gasification, Bio- methanation, Others) b. Plant Load Factor (%) c. Station Heat Rate (Kcal/Kwh) d. Steam Rate/Flow Rate e. Boiler Temperature f. Boiler Pressure g. Type of Stack (Single flue /Bi-flue /Tri-Flue) h. No. of Stacks Stack ID Stack Stack Exit velocity Exit height (m) Diameter at of stack gas temperature of exit (m) (m/s) stack gas(Deg. centigrade)

2 Details of fuel linkage (please specify if multiple Not Applicable linkages are involved) a. Type of linkage (Linkage/ Fuel Supply Agreement / e-auction / MoU /LOA / Captive / Open market / Others) b. Quantity of linkage granted c. Date of Linkage d. Duration of linkage 3 Details of Transportation of fuel Not Applicable Details/Mode Distance (km)) Quantity (TPA) Rail Road Pipeline Conveyor Other mode (Please specify)

4 Details of Fuel Characteristics Not Applicable a. Gross Calorific Value (Kcal/Kg) b. Ash content (%) c. Sulphur Content (%) d. Moisture (%) e. Mercury (mg/kg) f. Fixed Carbon (%) g. Volatile Matter (%) 5 Details of Cooling system Not Applicable a. Type of cooling system: Air cooled/Water cooled b. Type of draft: Natural draft/Forced draft c. Type of air circulation: Parallel flow/ Counter flow d. Cycles of Cooling (COC): e. Water requirement for cooling (m3/day): f. Boiler blow down temperature: Whether proposal is for River Valley & Hydroelectric Project (Yes/No)? If Yes, 1 Sub Sector: (Multipurpose Project I Hydroelectric - Project I Irrigation project) 2 Name of the River - 3 Whether Cumulative Impact Assessment and Carrying - Capacity Study of River Basin Carried Out? (Yes/No) If Yes a. Status of Cumulative Impact Assessment and Carrying Capacity Study of River Basin: (Recommended / Not Recommended,) If Recommended b. Details of Cumulative Impact Assessment and Carrying Capacity Study of River Basin c. Upload Relevant Document (Upload pdf only) 4 Type of Project: (Construction of Darn Barrage / Run - of the River / Lift Irrigation Scheme) 5 Darn Height (meter) if applicable - 6 Darn Length (meter) if applicable - 7 Total Submergence Area (hectare) - 8 Details of Gross Command Area (GCA) (hectare) - 9 Details of lrrigable Command Area (ICA) (hectare) - 10 Details of Culturable Command Area (CCA) (hectare) - 11 Total Command Area (hectare) - 12 Powerhouse Installed Capacity - a. Type of Powerhouse: (Underground / Surface) b. Capacity (megawatts) c. No. of Tunnels d. No. of Units e. Bank of River: (Left /Right / Both) 13 Generation of Electricity Annually - a. Quantity of Generation of Electricity Annually (in Giga Watt Hours (GWh)) b. Water availability at various percentages Percentage Water availability Dependable year Remarks (Cusecs) At50% At75% At90%

c. Machine Availability (%) d. Cost of Electricity Generation (in INR) e. Internal Rate of Return (%) f. Year of achievement of Internal Rate of Return 14 Catchment Area Treatment Plan (Upload PDF) - 15 Muck Management Plan - a. Upload Muck Management Plan in PDF b. Total Excavation Muck (Cubic Meter) c. Utilized for Construction (Cubic Meter) d. No. of Muck Disposal sites e. Total Muck Disposal Area (Ha) 16 Fishery Development and Management Plan - a. Upload Fishery Development and Management Plan in PDF b. No. of Fingerlings c. No. of Fish Species d. Name of the umbrella Fish Species (Scientific Name) 17 Status of Environmental Flow - Season Average Inflow (in Percent of Flow Million Cubic Meter) Lean Non-Lean Monsoon Non-Monsoon

18 Free Flow Stretch (km) - 19 Approval of Central Water Commission - a. Approval Reference No. b. Date of Approval c. Upload Copy of Approval (Upload pdf only) 20 Approval of Central Electricity Authority - a. Approval Reference No. b. Date of Approval c. Upload Copy of Approval (Upload pdf only) 21 Details of Coffer Dam ( upstream) if applicable - a. Quantity of the material (m3) b. Length of the dam (m) c. Quantity of muck to be used (m3) d. Quantity of borrow material to be used (m3) e. Decommissioning plan (upload in PDF) 22 Details of Coffer Dam ( downstream) if applicable - a. Quantity of the material (m3) b. Length of the dam (m) c. Quantity of muck to be used (m3) d. Quantity of borrow material to be used (m3) e. Decommissioning plan (upload in PDF) IV Whether the proposal is Infrastructure projects (Yes/No) No If Yes, 1 Details of Building Construction - a. Maximum Height of the Building (Meters) b. Total No. of Flats to be Build c. No. of Buildings d. Total plot area (sqm) e. Total built up area (sqm) 2. Foreshore Facilities And/or Marine Disposal - a. Whether Project Involves Foreshore Activities and/or marine - Disposal (Yes/No)? If Yes, b. Upload Shoreline Study (Upload pdf only) c. Type of Cargo d. Quantity of Cargo e. Control Measures of Cargo f. Dust Control Measures g. Quantum h. Quantity of Dredging (Cubic meter per day) i. Type of Dredging (Capital, Maintenance) j. Disposal of Dredge Material k. Details of Outfall Diffusers l. No. of Dilution Expected m. Distance at which the outlet will Reach Ambient Parameters n. Details of Monitoring at outfall o. Copy of NoC from PCB in case of Marine Disposal (Upload pdf only) 3 Rain Water Harvesting - a. No. of Storage b. Capacity c. No. of Recharge Pits d. Capacity 4. Parking - a. Details of 4-Wheeler/ 2-Wheeler Parking 5. Energy Saving Measures - a. Source/Mode b. Percentage c. Quantity 6. Other Details - a. Details of impact on Water Bodies and Drainage patters of catchment area, if any b. Details of Traffic Density Impact Assessment and Modelling Sh1dy (Upload pdf Only). c. In case of Underground Tunnel projects below the Forest Land -Subsidence Impact Studv report (Upload pdf Only) 7. Type of Industries to be established with Industrial Estate as per their - category A/B S. No Type of lndustry No. of Units Category A/B

8. Length of the alignment in case of highway projects - 9. Details Bridges/ROB/Interchanges, Flyovers, Vehicle Underpass and - Pedestrian Underpass (in case of Highway Projects) a. Total No. of Bridges b. Total No. of ROB c. Total No. of Interchanges d. Total No. of Flyovers e. Total No. of Vehicle Underpass f. Total No of Pedestrian Underpass g. Details of other utilities rail and road corridors 36 Details of Court Cases if any None a. Whether there is any Court Cases pending against the project and/or land in which the project is proposed to be set up (Yes/No)? If Yes, b. Name of the Court (Districts Court / High Court / NGT / Tribunals / Supreme Court of India) If name of Court: (Districts Court, High Court, NGT, Tribunals) c. Name of the Sub-court d. d. Case No. e. e. Orders I Directions of the court, if any and its relevance with the proposed project f. Case Details g. Upload Court Order if any (Upload pdf Only) 37 Details of direction issued under Environment (Protection) Act I Air (Prevention & Control of Pollution)) Act I Water (Prevention & Control of Pollution) Act – Not Applicable a. Whether any direction issued under Environment (Protection) Act I Air - (Prevention & Control of Pollution)) Act I Water (Prevention & Control of Pollution) Act (Yes/No)? If Yes, b. Details of directions issued under Environment (Protection) Act I Air - (Prevention & Control of Pollution)) Act I Water (Prevention & Control of Pollution) Act c. Upload copy of directions issued under Environment (Protection) Act I - Air (Prevention & Control of Pollution)) Act I Water (Prevention & Control of Pollution) Act d. Compliance status of the directions - 38. Details of EIA Consultant a. Have you hired Consultant for preparing document Yes (Yes/No)? If No, - (i) Reason for not engaging the Consultant - If Yes, - (i) Accreditation No. 76 (ii) Name of the EIA Consultant M/s. Global Enviro Labs (iii) Address 2-2—1075/14/A/1, Tilaknagar ‘X’ Roads, Baghamberpet, Hyderabad (iv) Mobile No. 9849039741 (v) Landline No. 040-27407969 (vi) E-mail Id (vii) Category of Accreditation (Eligible for Category A / Category A Eligible for Category B) (viii) Sector of Accreditation 1(a) (i) (ix) Validity of Accreditation - (x) Upload Certificate of Accreditation certified by Uploaded in Website. QCI/NABET (Upload pdf) 39. Documents to be attached I If Project Type is New / Expansion / Modernization / one-time capacity expansion for coal mine 2: a. Upload Copy of EIA/EMP Report Uploaded in Website b. Upload Copy of Risk Assessment Report Uploaded in Website c. Upload Copy of Feasibility Report/ Detailed Project Uploaded in Website Report(DPR) /Detailed Engineering Report /Detailed Conceptual Plan / Approved Mining Plan (in case of Mining proposals) ( Upload pd( only) d. Upload Copy of Final Layout Plan (Upload pdf only) Uploaded in Website e. Upload Cover Letter (Upload pdf only and attach it as Uploaded in Website Annexure-document of cover letter f. Upload a copy of documents in suppo1t of the Uploaded in Website competence/authority of the person making this application to make application on behalf of the User Agency (Upload pdf ( only and attach it as Annexure-authorization) g. Upload copy of District Survey Repo1t (for mining of Uploaded in Website minor minerals only) h. Upload copy of Replenishment Study Report & Baseline Not Applicable Survey data (for river sand mining proposals only) i. Upload Additional File, if any ( Upload pdf only) - II If Project Type is other than New / Expansion / Modernization / Not Applicable one-time capacity expansion for coal mining a. Upload Copy of Feasibility Report /Detailed Project Report(DPR) /Detailed Engineering Report /Detailed Conceptual Plan (Upload pdF( only) b. Upload Copy of Final Layout Plan (Upload pdf only) c. Upload Cover Letter (Upload pdf only and attach it as Annexure-document of Cover letter) d. Upload a copy of documents in support of the competence /authority of the person making this application to make application on behalf of the User Agency (Upload odf only and attach it as Annexure-authorization) e. Upload Additional File, if any (Upload pdf only) f. Upload Updated Form 1 (Upload pdf only) 40 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 I construction I expansion has since been taken up

Signature

b. Name Smt N.PADMAVATHI c Designation Proprietor d Company Ms Sri Shirdi Sai Stone Crusher e address W/o N.V.Nageswar Rao Gayatri Nagar,Vijayawada A.P. Cell:9885216654