APPENDIX _ I (See paragraph - 6) FORM 1

(D Basic Information:

Sl.No. Item Details I Name of the pro.iect/s: Kanchanpur Stone Quarry- I

2 SL. No. in the schedule

J. Proposed capacity I areal lenglhl tonnage to be 3,274 m' road metal annually from handled/command areallease arealnumber of 2.08 Acres 10.84 hectares from Wells to be drilled. Kanchanpur stone quarry-1 at Champua Tahasil in the district of Keonihar of State.

4. New/Expan s i on/Modern i zati on New

5. Existing Capacity Area etc. 3,.27 4 m' Approximately

6. Category of Project i.e.' A' or'B' 82 Category

7. Does it attract the general condition? [f yes, No Please specify. 8. Does it attract the specific condition? lf 'yes, No Please specify. 9. Location Kanchanpur village of Champua Tahasil of Keonihar District. Odisha Plot/Survey/Khasra No. Village- Kanchanpur Khata No-95, Plot No-20, Area-2.08A cres/ 0. 84 hectares, Kissam -Patharabani, Free Govt. non forest Land vill Kanchanpur Tehsil Champua District Keonihar State Odisha 10. Nearest railway station/airport along with Railway-Bileipada,, 20 Kms from the Distance in kms. site, Airport- Bhubaneswar 280 kms l1 Nearest Town, city, District Headquarters Champua Town in Keonjhar District. Along with distance in kms. Head Quarter is Keonjhar,60 kms from the oroposed area

12. Vi I lage Panchayats, Zilla Pari shad, M un i ci pal Kanchanpur GP, Corporation, Local body (complete postal Zillaparisad Zone - 13 Address with telephone nos. to be given) t3. Name of the applicant Smt. Swagatika Rout.

14. Registered Address Smt. Swagatika Rout At- Baneikala,PS- Dist -Keonihar, Odisha. It Address fbr correspondence: As Above -Strn Name S*ug-utlt u n"r1 D.srg*tlo@ O**t - Address nr nf,.,* Pi" C"d. NA Lt"rrl NA Telephone No. 09437042399 Fax No. NA

16. Details of Alternative Sites examined, if any. V i I lage-D i strict-State Location of these sites should be shown on a l.No Alternate Use topo sheet. 2. 3.

17. Interlinked Projects No

18. Whether separate application of interlinked No Project has been submitted? 19. If yes, date of submisston NA

20. If no, reason NA

21 Whether the proposal involves approval / clearance NA under: if yes, Details of the same and their status to be given. (a) The Forest (Conservation) Act, 1980? (b) The Wildlife (Protection) Act,1972 (c) The C.R.Z. Notification,l99l?

22. Whether there is any Government Order/ Policy It is Govt.non forest Land and lease relevant/ relating to the site? allotment order of the Tahasildar is enclosed. 23. Forest land involved (hectares) No Forest Land

24. Whether there is any litigation pending against the No 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 Droposed proiect. Activity 1. Construction, operation or decommissioning of the Pro.icct involving actions which will cause physical changes in the locality (topography, land use, changes water bodies, etc.)

Details thereof (with approximate quantities /rates, wherever possible) with sourcc of information data Sl.No. Ifi formation/C hecklist Yes/No confirmation l.l Permanent or temporary Yes Land [Jse Plan Conceptual iphange in land use, land Period(in period(in Ha) cover or topography Ha) including increase in Ouarry 0.34 r 0.341 intensity of land use Waste Dump Nil Nil (with respect to local StackYard/Processing Nil Nit land use plan) unit Road Nil Nil Site Service Nil Nil Sub grade Stack Nit Nil Total and Utilization 0.34 r 0.341 Safety Zone 0. r25 0.125 Undisturbed area 0.374 0.374 Total 0.840 0.840

1.2 Clearance of existing No land, vegetation and buildines? 1.3 Creation of new land No uses? 1.4 Pre-construction No investigations e.g. bore houses. soil testing? 1.5 Construction works? No 1.6 Demolition works? No t.7 Temporary sites used for No construction works or housing of construction workers? 1.8 Above ground buildings, No structures or earthworks including linear structures, cut and fill or excavations 1.9 Underground works No including mining or tunneling? l.l0 Reclamation works? No 1.1I Dredeine? No l.t2 Offshore structures? No l.l 3 Production and No manufacturi ng processes? l.l4 Facilities for storage of No soods or materials? I .15 Facilities for treatment or No d$posal of solid waste or liquid effluents? l.l6 Facilities for long term No housing of operational tirorkers? t.t7 New road, rail or sea No traffic during construction or ooeration? 1.18 New road, rail, air No waterborne or other transport infrastructure including new or altered routes and stations, ports, airports etc? l.l9 Closure or diversion of No existing transport routes or infrastructure leading to changes in traffic movements? t.20 New or diverted No transmission lines or nioelines? t.2l Impoundment, No damming, culverting, realignment or other changes to the hydrology of watercourses or aouifers? 1.22 Stream crossinss? No t.23 Abstraction or transfers No of water from ground or surface waters? 1.24 Changes in water bodies No or the land surface affecting drainage or run- offl t.25 Transport of personnel or No materials for construction, operation or decommissionine? t.26 Lons-term dismantline or No decommissioning restoration works? Ongoing activity during No decommissioning which could have an impact on the environment? I4flux of people to an area in either temporarily or permanentl Introduction of alien

Loss of native specles or ic diversi Anv other actions?

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 Sl.No. Information/checklist confi rmation Yes/Ir{o approximate quantities /rates, wherever possible) with source of information data

2.1 Land especially undeveloped or agricultural Yes Kanchanpur Stone quarry-l is of land (ha) 0.84 hectares Scheduled for Ouarrv Purpose. 2.2 Water (expected source & competing users) Yes I.68KLD unit: KLD 2.3 Minerals (MT) Yes Approximately 55,552 m' of road metal (Geological Resources) is available in the area mention above. 2.4 Construction material - stone, aggregates, Yes Stone sand / soil (expected source - MT) 2.5 Forests and timber (source - MT) No 2.6 Energy including electricity and fuels No (source, competing users) Unit: fuel (MT), enersv (MW) 2.7 Any other natural resources (use appropriate No 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, SI.No. lsformation/Checklist confi rmation Yes/No wherever possible) with source of information data 3,t ]r" of -trb.t*ffi-r* N; azardous (as per MSIHC rules) to human balth or the environment (flora, fauna, and rater supplies)

3.2 lhanges in occurrence of disease or alfect No isease vectors (e.g. insect or water borne iseases) -t.J \ffect the welfare of people e.g. by changing No iving conditions? 3.4 Vulnerable groups of people who could be No lffected by the project e.g. hospital patients, :hildren, the elderly etc., 3.5 {ny other causes

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

Details thereof (with approximate quantities /rates, Sl.No. Information/Checklist confi rmation Yes/No wherever possible) with source of information data 4.1 Spoil, overburden or mine wastes No 4.2 Municipal waste (domestic and or commercial No wastes) 4.3 Hazardous wastes (as per Hazardous Waste No Management Rules) 4.4 Other industrial process wastes No 4.5 Surplus product No 4.6 Sewage sludge or other sludge from effluent No treatment 4.7 Construction or demolition wastes No 4.8 Redundant machinerv or equipment No 4.9 Contaminated soils or other materials No 4. l0 Asricultural wastes No 4.1I Other solid wastes No 5. Release of pollutants or an1, hazardous, toxic or noxious substances to air (Kg/hr)

Details thereof (with approximate quantities /rates, lnformation/Checklist confi rmation wherever possible) with source { of information data Emissions from combustion of fossil fuels from stationary or mobile sources

missions from production Emissions from materials handling including No e or trans Emissions from construction activities N" includins nlant and equinmerrt Dust or odors from handling of materials N" including construction materials, sewage and waste Emissions from incineration of waste Emissions from burning of waste in open air (e.g. slash materials, construction debris) Emissions from anv other sources

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

Yes/lllo Details thereof (with approximate quantities /rates, wherever possible) with source Sl.No. Information/Checklist confi rmation of information data with source of information data

6.1 From operation of equipment e.g. No engines, ventilation plant, crushers

6.2 From industrial or similar processes No

6.3 From construction or demolition No

6.4 From blasting or piling No

6.5 From construction or operational traffic No

6.6 From lighting or cooling systems No

6.7 From any other sources No 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 quantities /rates, 4 approximate Sl.No. Information/C hecklist confi rma tion Yes/No wherever possible) with source of information data 7.1 From handling, storage, use or spillage of No hazardous materials 7.2 From discharge of sewage or other effluents to No ilater or the land (expected mode and place of lischarge) 7.3 By deposition of pollutants emitted to air No 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 No pollutants in the environment from these sources?

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, Sl.No. Information/Checklist confi rmation Yes/I.{o wherever possible) with source of information data

8.1 From explosions, spillages, fires etc from No storage, handling, use or production of hazardous substances 8.2 From any other causes No 8.3 Could the project be affected by natural No disasters causing environmental damage (e.g. floods,earthquakes, landslides, Cloudburst etc)? g. 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, 5 Sl. No. lnformation/C hecklist confi rma tion Yes/No wherever possible) with source of information data 9.1 Lead to development of supporting. lities, No ihncillary development or development stimulated by the project which could have impact on the environment e.g.: ' Supporting infrastructure (roads, power supply, waste or waste water treatment, etc.) . housing development . extractive industries ' suPPlY industries . other 9.2 Lead to after-use of the site, which could No havean impact on the environment 9.3 Set a precedent for later developments No 9.4 Have cumulative effects due to proximity to No other existing or planned projects with similar effects

(UD Environmental SensitivitY

Sl.No. Areas Name/ Aerial distance (within Identity 15 km.) Proposed project Iocation boundary No 1 Areas protected under international conventions, national or local legislation for their ecological, landscape. cultural or other related value 2 Areas which are important or sensitive for ecological No reasons - Wetlands, watercourses or other water bodies. coastal zone, biospheres, mountains, forests a J Areas used by protected, important or sensitive No species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration 4 Inland. coastal, marine or underground waters No 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 No

9 Areas occupied by sensitive man-nrade N

(v) Proposed Terms of Reference for EIA studies

I hereby given undertaking that the data and information given in the application and enclosure are true to the best of my knowledge and believe 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 given, if any to the project will be revoked at our risk and cost.

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