APPENDIX – I (See paragraph – 6) FORM 1 (I) Basic ... - Seiaacg.org

6 Routes or facilities used by the public for Not applicableaccess N 0to recreation or other tourist, pilgrima r e a s7 Defence installationsNoNot applicable8 Densely populated or built-up area Not applicableNo9 Areas occupied by sensitive man-made Not applicableland uses (hospitals, schools, places ofworship, community facilities)No10 Areas containing important, high quality Not applicableor scarce resources(ground water resources, surfaceNoresources, forestry, agriculture, fisheries,tourism, minerals)11 Areas already subjected to pollution or Not applicableenvironmental damage. (those where Noexisting legal environmental standardsare exceeded)12 Areas susceptible to natural hazard which Not applicablecould cause the project to presentenvironmental problems(earthquakes, subsidence, landslides, Noerosion, floodingor extreme or adverse climaticconditions)(IV) Proposed Terms of Reference for EIA studiesI here by given undertaking that the data and information given in the application andenclosure are true to the best of my knowledge and belief and I am aware that if any part of the dataand information submitted is found to be false or misleading at any stage, the project will be rejectedand clearance give, if any to the project will be revoked at our risk and cost.Date: 8/11/2012Place: RAIPURSignature of the applicantWith Name and Full Address(Project proponent I Authorised Signatory Name– AKSHAY KUMAR SHRIVASTAVAVillage Post- Nardha Block-Arang , Dist-Raipur(C.G.) Pin - 493111Permanent Address- C-43,VIP Estate, Khamardih,Shankar Nagar, Raipur (C.G) 49200112