SRI KUNCHAM MOHAN House No. 7-39, Kodakandla Village & Mandal, Janagaon District – 506 222 Mobile No. +91 94410 05352, +91 98854 14184 To The Member Secretary, State Level Environmental Impact Assessment Authority (SEIAA), TS O/o. Telangana State Pollution Control Board, A-3, Industrial Estate, Sanath Nagar, Hyderabad – 500 018. Respected Sir, Sub: Submission of Form-I, Form-2, Standard Template, PFR, Environment Management Plan and Quarry Plan as part of Environmental Clearance documentation for proposed Rough Stone & Road Metal quarry by Sri Kuncham Mohan – reg. Refer to the above mentioned subject; we here with submitting Form-I, Form-2, Standard Template, PFR, Environment Management Plan and Quarry Plan for the proposed Rough Stone & Road Metal quarry in an area of 2.0 ha located in Survey No. 104/1, Chennapuram Village, Nagaram Mandal, Suryapet District, Telangana State. We request you to kindly process our application for grant of Environmental clearance at the earliest and acknowledge the receipt of the same. Thanking you, Yours Sincerely, Sri Kuncham Mohan STANDARD 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 Sri Kuncham Mohan – Rough Stone & Road Metal Quarry 2 Name of the organization/owner. Sri Kuncham Mohan 3 Address for communication Sri Kuncham Mohan House No. 7-39, Kodakandla Village & Mandal, Janagaon District – 506 222 Mobile No. +91 94410 05352. 4 Telephone numbers Mobile No. 94410 05352. 5 Email ID of the organization or contact person 6 Location of the Proposed project or Survey No. 104/1, Chennapuram activity Village, Nagaram Mandal, Suryapet District, Telangana State. 7 Appraisal Category (B2 or B1) B2 8 Nearest habitation and distance from the The nearest village is Nagaram located project or activity at a distance of 2.7 km from the quarry lease area in SW direction 9 Installed capacity / Production Capacities Quarry lease area is 2.00 ha with semi mechanized opencast quarry for Rough Stone & Road Metal is 57380 m3/annum 10 Specify the Fuel (Coal / CNG / NA biomass/Others) and quantity required 11 Details of Land use/Land Cover The proposed quarry lease area consists of rocky hill area with topo relief in NW direction 12 Occupancy, ownership of the land in Government Land. which the activity is proposed: In principle of quarry lease application (Government land / Private land / Forest notice issued by Deputy Director of land /Revenue land /Temple land /leased Mines and Geology, Hyderabad vide land/ land belongs to other Department) notice no. 3328/QL/SRPT/2018 dated 30.10.2018 for a period of 15 Years. Quarry Plan was scrutinized by the Deputy Director of Mines and Geology, Hyderabad vide letter no. 3526/QP/SRPT/2018 dated 08.01.2019. 13 If it is a Forest land, the following details No. shall be 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. Rs. 30 Lakhs a. Funds allocated for EMP (capital cost Capital Cost - Rs. 4.83 Lakhs and recurring cost per annum) Recurring cost - Rs. 2.57 Lakhs/year 15 Brief description of the project with Semi mechanized opencast quarrying special reference to specific pollution and by drilling and blasting its control measures. 16 Compliance report on the following : Status of compliance of the conditions No environmental clearance is obtained and environmental safeguards stipulated earlier. in the earlier clearance letters. Details of the court cases, if any, pending -NA- in any Court of Law against the project as well as any directions passed by the Court relating to the project directly or indirectly. Details of the notices, if any, given to the No notice is received under EP Act. project 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 attracts the No (Q. L. Area is 2.83 ha) provisions laid under the OM dt. 16.11.2010 issued by the MoEF & CC, GOI, w.r.t. violation of EIA Notification, 2006 and its amendments there of? (Yes / No) Present stage and status of the Project : Fresh 18 Name of the Consultant: M/s. Team Labs and Consultants, B115- 117 & 509, Aditya Enclave, Ameerpet, Hyderabad - 500 038 DECLARATION a) I Sri Kuncham Mohan residing at H. No. 7-39, Kodakandla Village & Mandal, Janagaon District – 506 222. Hereby declare that I/We/ our organization does not /do not have conflict of interest with the Chairman and members of SEAC and SEIAA. b) I hereby declare that I (Sri Kuncham Mohan) am the authorized signatory of our company is authorized to submit the application and to do all necessary correspondence for obtaining environmental clearance from State Level Environment Impact Assessment Authority (SEIAA), Telangana and to attend the meeting (s) of State level Expert Appraisal Committee (SEAC), Telangana to present our case and to clarify the points raised by the Members of SEAC and SEIAA. c) I/We hereby declare that M/s. Team Labs and Consultants, B-115 & 509, Annapurna Block, Aditya Enclave, Ameerpet, Hyderabad -500038 is/are authorized to assist all matters relating to the environmental matters. d) I/we hereby 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 Place Signature of the Applicant/ project proponent (Name and address of the Applicant) Sri Kuncham Mohan House No. 7-39, Kodakandla Village & Mandal, Janagaon District – 506 222 Mobile No. +91 94410 05352. Sri Kuncham Mohan H. No. 7-39, Kodakandla Village & Mandal, Janagaon District – 506 222 Mobile No. +91 94410 05352 To The Member Secretary, State Level Environmental Impact Assessment Authority, A-3, Industrial Estate, Sanatnagar, Hyderabad - 500018. Telangana State Sir, Sub: Intimation of the Authorized Signatory- Reg. Ref: Amendments to EIA-2006 notification issued vide S.O.3067 (E) dt. 01.12.2009 by MoE&F, GOI. With reference to above, it is to inform that I (Sri Kuncham Mohan) am the authorized signatory to make all necessary correspondence with the SEAC, Telangana & SEIAA, Telangana for obtaining the Environmental Clearance for the proposed Rough Stone & Road metal quarry lease area of 2.00 ha located in Survey No. 104/1, Chennapuram Village, Nagaram Mandal, Suryapet District, Telangana State. Thanking You, Yours faithfully, Sri Kuncham Mohan.