FORM - 1. Location/ Site alternatives under consideration : Block No. O : Contact Information :

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1 FORM - 1 I. Basic Information Name of project : Ajaysinh Bhupatsinh Suratia (Black Trap) Location/ Site alternatives under consideration : Block. O : Size of Project Lagu Survey. 17, Mahi River at Aklacha, Tal.: Thasara, Dist.: Kheda : Hq. Expected Cost of Project : 5 Lakhs Contact Information : Screening Capacity : B-2 Capacity corresponding to sectoral activity (such as production capacity for manufacturing, mining lease area and production capacity for mineral production, area for mineral exploration, length for linear transport infrastructure generation capacity for power generation etc.) S.. Information/Checklist confirmation Details 1. Name of the project/s Ajaysinh Bhupatsinh Suratia (Black Trap) 2. S.. in the schedule 1(a) MT/Year Capacity/ : 3. Block. O : Lagu Survey Proposed capacity/area/length/tonnage to be handled/command. 17, Mahi River at area/lease area/number of wells to be drilled Aklacha, Tal.: Thasara, Dist.: Kheda 4. New/Expansion/Modernization New 5. Existing Capacity/ Area ect MT/Year 6. Category of Project i.e. A or B B 7. Does it attract the general condition? If yes, please specify 8. Does it attract the specific condition? If yes, please specify Location Village Tehsil District State Nearest Railway station/airport along with distance in kms. AKLACHA THASARA KHEDA GUJARAT Thasara- 12

2 Nearest Town, City, District headquarters along with 11. distance kms. Thasara Village Panchayats, Zilla Parishad, Muncipal Aklacha, Tal.: Thasara, Dist.: Corporation, Local body (complete postal addresses with telephones nom. To be given) Kheda 13. Name of the applicant Ajaysinh Bhupatsinh Suratia 14. Registered address B-51,52 Suryakruti Apartment, Near of Diwalibag Society, Adajan, Surat Address for correspondence: Name Ajaysinh Bhupatsinh Suratia Designation (Owner/partner/CEO) Owner 15. Address B-51,52 Suryakruti Apartment, Near of Diwalibag Society, Adajan, Surat Pin code Telephone no Fax no. - Details of Alternative Sites examined, if any Location of 16. these sites should be shown on a Toposheet. 17. Interlinked Project Whether separate application of interlinked project has 18. been submitted. 19. If yes, Date of submission N.A 20. If no, reason N.A Whether the proposal involves approval/clearance under: if yes, details of the same and their status to be give. 21. (a) The Forest (Conservation)Act, 1980? (b) The Wildlife (Protection)Act, 1972? (c) The CRZ tification, 1991? Whether there is any Government Order/Policy relevant/ 22. relevant to the site? 23. Forest land involved (hectares) 24. Whether there is any litigation pending against the project and/or land in which the project is proposed tobe set up? (a) Name of the Court (b) Case. (c) Orders/ direction of the court, if any and its relevance with the proposed project.

3 (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.) S Information/Checklist confirmation Permanent or temporary change in land use, land cover or topography including increase in intensity of land use (with respect to local land use plan) Clearance of existing land, vegetation and buildings? / 1.3 Creation of new land uses? Pre-construction investigations e.g. bore houses, soil testing? Construction works? Demolition works? Temporary sites used for construction works or Housing of construction workers? Above ground buildings, structures or Earthworks including linear structures, cut and Fill or excavations Details thereof (with approximate quantities /rates, wherever possible) with source of information data The topography of the area is generally slopping and rocky. The permanent change in land use within the lease area due to mining. Sr.. A Particular Pre Operational phase Post operational Phase Mining Activity 1 Pits Old Dump Road &Building Plantation Infrastructure Top Soil Storage (Temporary) B Agriculture land C Remaining Virgin Govt. Waste Land Total The mining area is Govt. Waste Land. Mining lease area generally rocky and have poor vegetation and no buildings in the area. So no clearance will be required for existing land, vegetation, and building. In way of pitting & plantations. t Required t Required t Required requirement of Housing and other construction because The laborers deployed will be from nearby villages only. Mine excavation in the form of pits. 1.9 Underground works including mining or tunneling? 1.10 Reclamation works? Plantation t Required At the post Operational Phase During post operational phase about hect. Area is covered under Plantation 1.11 Dredging? t Required 1.12 Offshore structures? t Required 1.13 Production and manufacturing processes? t Required

4 1.14 Facilities for storage of goods or materials? In the store at project site Facilities for treatment or disposal of solid waste or liquid effluents? t Required 1.16 Facilities for long term housing of operational workers? t Required 1.17 New road, rail or sea traffic during construction operation? t Required New road, rail, air waterborne other 1.18 transport infrastructure including new or altered routes and station, ports, airports etc? Closure or diversion of existing transport 1.19 routes or infrastructure leading to changes t Required in traffic movement? 1.20 New or diverted transmission lines or pipelines? t Required Impoundment, damming, converting, 1.21 realignment or other changes to the t Required hydrology of water sources or aquifers? 1.22 Stream crossings? t Required Abstraction or transfers of water form ground or surface waters? Changes in water bodies or the land surface affecting drainage or run-off? Transport of personnel or materials for construction, operation or decommissioning? Long-term dismantling or decommissioning or restoration works? Ongoing activity during decommissioning which could have an impact on the environment? Influx of people to an area in either temporarily permanently? The existing mode of transportation will be used. new facility is required. There is no flowing water stream or lake as a surface water source in the core zone. Requirement of water in the area is mostly met from underground sources through tube wells and hand pumps. change in water bodies, drainage or runoff is anticipated. Road transportation for personnel will be arranged by lessee s vehicles and material will be transported by Tippers/dumpers. t Required t Required Temporarily about 20 people will get employment. Most of the people will be employed from nearby villages Introduction of alien species? t Required 1.30 Loss of native species or genetic diversity? Due to mining activity some grasses & shrubs will be removed Any other actions? t Required

5 (2) Use of nature resources for construction or operation of the Project (such as land, water, materials or energy, especially any resources which are on-renewable or in shorts supply): S.. Information/Checklist confirmation / Land especially undeveloped or agricultural land(ha) Water (expected source & competing users) unit: KLD Details thereof (with approximate quantities /rates, wherever possible) with source of information data Undeveloped Govt. waste Land Hand pump, Well/Tube well situated in nearby village & water tanker and no competing users. Detail of water requirements in KLD as given below: Dust Supperation 2.25 Drinking 1.50 Green belt 2.50 Total Minerals (MT) MT/Year 2.4 Construction material Stone aggregates/soil (Expected source MT) t Required 2.5 Forests and Timber (source MI) t Required Energy including electricity and fuels (source, competing users) Unit: fuel (MI), energy(mw) Any other natural resources (Use appropriate standard units) electricity is required. Fuel (HSD) will be obtained from authorized public fuel station. t Required (3) Use,storage, transport, handling or substances or materials, which could be harmful health or the environment or raise concerns about actual or perceived risks to human health. S.. Information/Checklist confirmation / Use of substances or materials, which are hazardous (as per MSIHC rules) to human health or the environment (flora, fauna and water supplies) Change in occurrence of affect disease vectors (e.g. insect or water borne diseases) 3.3 Affect the welfare of people e.g. changing living condition? Details thereof (with approximate quantities /rates, wherever possible) with source of information data such material is used t Required Mine management will look after the undeveloped area to improve the socio-economic level and enhance the skill of the local people. Persons will get employment. 3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. t Required 3.5 Any other causes t Required

6 (4) Production of solid wastes during construction or operation or decommissioning (MT/month) S.. Information/Checklist confirmation / 4.1 Spoil, Overburden or Wastes Details thereof (with approximate quantities /rates, wherever possible) with source of information data Total material will be used in the road, railway track construction etc. If soil encountered, soil will be stacked at separate site, and it will be simultaneously used for plantation. Municipal waste (domestic and or commercial 4.2 wastes) t Applicable Hazardous wastes (as per Hazardous Waste 4.3 Management Rules) t Applicable 4.4 Other industrial process wastes t Applicable 4.5 Surplus product t Applicable Sewage sludge or other sludge from effluent 4.6 treatment t Applicable 4.7 Construction or demolition wastes t Applicable 4.8 Redundant machinery or equipment t Applicable 4.9 Contaminated soils or other materials t Applicable 4.10 Agricultural wastes t Applicable 4.11 Other solid wastes t Applicable (5) Release of pollutants or any hazardous, toxic or noxious substances to air (Kg/hr) S Information/Checklist confirmation Emissions from combustion of fossil fuels from stationary or mobile sources / 5.2 Emissions from production processes Emissions from materials handling including storage or transport Emissions from construction activities including plant and equipment Dust or odours from handling of materials including construction materials, sewage and waste 5.6 Emissions from incineration of waste Details thereof (with approximate quantities /rates, wherever possible) with source of information data HSD (1.0 KLD) will be used in machineries during mining. Mostly mobile equipment s and their expected emission will be very less and will have less impact. The production process will involve excavation and loading which will generate emissions and will cause little impact. Dust emission from handling of material and transport, which will be very less and cause very less impact. t Applicable Only dust emission from handling of material, which will very less and not cause any negative impact. odor will develop. t Applicable Emissions from burning of waste in open t Applicable 5.7 air (e.g. slash materials, construction debris) 5.8 Emissions from any other sources t Applicable

7 (6) Generation of ise Vibration and Emissions of Light and Heart: S.. Information/Checklist confirmation / 6.1 From operation of equipment e.g. engines, ventilation plant, crushers Details thereof (with approximate quantities /rates, wherever possible) with source of information data ise from operation of drill machine & dumpers/tippers. 6.2 From industrial or similar processes t Applicable 6.3 From construction or demolition t Applicable From blasting or pilling From construction or operation traffic From lighting cooling systems Blasting in small scale will be done so noise will be momentary. There will be vibrations from blasting but no long term impact on nearby area will be anticipated. During operational stage running of dumpers/tippers will produce very less noise, which will not cause any impact. t Applicable 6.7 From any other sources t Applicable (7) Risks of contamination of land or water from releases of pollutants into the ground or into sewers, surface waters, groundwater, coastal water or the sea: S.. Information/Checklist confirmation / Details thereof (with approximate quantities /rates, wherever possible) with source of information data From handling storage, use or spillage of hazardous materials From discharge of sewage or other effluents to water or the land (expected and place of discharge) By deposition of pollutants emitted to air into the land or into water Explosives will be procured /supplied by license contractor on the day of working and will be handled and used by persons certified under MMR Only waste water discharged to land will be from septic tanks. Dust settling on land is expected to be very low and will be non-toxic. 7.4 From any other sources t Applicable 7.5 Is there a risk of long term build up of pollutants in the environment from these sources? t Applicable

8 (8) Risk of accidents during construction or operation of the Project, which could affect human health the environment S Information/Checklist confirmation From explosions, spillages, fires etc. from storage, handling use or production of hazardous substances From any other causes Could the project be affected by natural disasters causing environment damage (e.g. floods, earthquakes, landslides, cloudburst etc)? / Details thereof (with approximate quantities /rates, wherever possible) with source of information data Hazardous substance will be only explosive for which there are separate laws which will be strictly followed. The risks of accidents are envisaged due to the operation of equipment s, failure of mine pit etc. Pits slope & Bench slope will be kept at as per rules. loose stone or debris will be allowed to remain near the edges of excavation and along the sites of haul road. However, good safety practices will be adopted at the site. All precautionary measures will be adopted and use of protective equipment s will be mandatory. However, to meet the minor incidences and accidents first aid measures at site will be provided. t Applicable (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 S Information/Checklist confirmation Lead to development of supporting laities, ancillary development or development stimulated by the 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 Lead to after use of the site, which could have an impact on the environment / 9.3 Set a precedent for later developments Details thereof (with approximate quantities /rates, wherever possible) with source of information data Proposed project will result in further growth of the surrounding area by increasing direct and indirect employment opportunities in the region. All supporting temporary infrastructure will be developed. Temporary Office, rest shelter, first aid station will be constructed. The top mined out benches will be converted into green belt which will have positive impact on environment. Mined out area will ultimately be fenced properly all around its periphery to prevent any entry into the area.

9 9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects A number of small mines in surrounding area have either restarted or increases combined environmental impacts, particularly due to increased road traffic for materials transport/ dispatch. Mitigation measures to control environment pollution in mine are carried out to minimize the impact. (iii) Environmental Sensitivity Sr.. Areas Name/ Identity Arial distance (within 15 km) Proposed project location boundary 1 Areas protected under international conventions, national or local legislation for their ecological, landscape, cultural or t Applicable other related value 2 Areas which are important or sensitive for ecological reasons Wetlands, watercourses or other water bodies t Applicable coastal zone, biospheres, mountains, forests 3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over t Applicable wintering, migration 4 Inland, coastal, marine or underground waters t Applicable 5 State, National boundaries t Applicable Routes or facilities used by the public for access to t Applicable 6 recreation or other tourist, pilgrim areas 7 Defense installations t Applicable 8 Densely populated or built-up areas t Applicable 9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of workshop, community t Applicable facilities) 10 Areas containing important, high quality or scarce resources (ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals) t Applicable 11 Areas already subjected to pollution or environmental damage. (those where existing legal environmental standards are exceeded) t Applicable 12 Areas susceptible to natural hazard which could cause the project to present environmental problems (earthquakes, subsidence, landslides. Erosion, flooding or extreme or adverse climatic conditions) t Applicable

10 (IV) Proposed Terms of Reference for EIA studies: NOT APPLICABLE I hereby given undertaking that the data and information given in the application and enclosures are the best of my knowledge 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. Date: 01/12/2014 Signature of the applicant Place: SURAT. Ajaysinh Bhupatsinh Suratia. B 51-52, Suryakruti Apprtment, Near Diwali bag society, Adajan, SURAT (Project Proponent/Authorize Signatory) te: (1) The projects involving clearance under Coastal Regulation Zone tification 1991 shall submit with the application a CRZ map duly demarcated by one of the authorized agencies, showing the project activities, w.r.t CRZ (at the stage of TOR) and the recommendation of the state coastal zone management authority (at the stage of EC). Simultaneous action shall also be taken to obtain the requisite clearance under the provision of the CRZ tification 1991 for the activities to be located in the CRZ. (2) The projects to be located within 10 Kms of the National Parks, Sanctuaries, Biosphere Reserves, Migratory Corridors of Wild Animals, the project proponent shall submit the map duly authenticated by Chief Wildlife Warden showing these features vis-a-vis the project location and the recommendation or comments of the Chief Wildlife Warden thereon (at the stage of EC). (3) All correspondence with the Ministry of Environmental and Forest and State level Expert appraisal Committee (SEAC) C/O Gujarat Pollution Control Board including submission of application for TOR/EC, subsequent clarifications as may be required from time to time, participation in the EAC meeting on behalf of the project proponent shall be made by the authorized signatory only. The authorized signatory should also submit a document in support of his claim of being an authorized signatory for the specific project.

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