FORM 1. 1 Name of the Project Pinakin Mangubhai Patel 2 S. number in schedule 8 (a)

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1 FORM 1 (I) Basic Information Item Details 1 Name of the Project Pinakin Mangubhai Patel 2 S. number in schedule 8 (a) 3 Proposed capacity/ area/ length/ tonnage to be handled/command area/lease area/number of well to be drilled Total Plot Area m 2 Balance Area of Plot m 2 Built-up Area m 2 4 New/expansion/modernization Expansion 5 Existing capacity/area etc m 2 6 Category of project i.e. A or B B Does it attract the general condition? If yes please specify Does it attract the specific condition? If yes please specify Location Plot/Survey/Khasra Village Tehsil District State Nearest railway station/airport along with distance in Kms. Nearest town, city, district headquarter along with distance in Kms. Village Panchayat, Zila Parishad, Municipal Corporation, local body (Complete postal address with telephone nos. to be given) Block.119/B, F.P.. 64/1, O.P.. 64/1, T.P.S.- 21 (Sarthana Simada), Moje-Sarthana,Dist- Surat. Block.119/B, F.P.. 64/1, O.P.. 64/1, T.P.S.- 21 (Sarthana Simada), Sarthana Surat Surat Gujarat Surat Railway Station is located 7.7 km and Airport is located 23.8 km. Project falls in Surat Municipal Corporation (SMC) T.P.S.. 21 (Sarthana Simada) Project falls in Surat Municipal Corporation (SMC) Limit 13 Name of the applicant Pinakin Mangubhai Patel /Rupeshkumar Mangubhai 14 Registered address 15 Address for correspondence 16 Name Designation Address 402,Sundram apt., Opp- Mudita Mithai,Beside Hill s Nursery school,palia Street, Nanpura, Surat 402,Sundram apt., Opp- Mudita Mithai,Beside Hill s Nursery school,palia Street, Nanpura, Surat Pinakin Mangubhai Patel Partner 402,Sundram apt., Opp- Mudita Mithai,Beside Hill s Nursery school,palia Street, Nanpura, Surat Pin code Kalpesh.goti@glepl.com Telephone / Fax - Details of alternative sites examined, if any. Location of these sites should be shown on a topo sheet Location of Site shown on Topo sheet is given in Annexure Interlinked Project t Applicable

2 18 Whether separate application for interlinked project has been submitted? t Applicable 19 If yes date of submission t Applicable 20 If no, reason Individual project Whether the proposal involves 21 approval/ clearance under: if yes, details of the same and their status to be given t Applicable The Forest (Conservation) Act, 1980 The Wildlife (Protection) Act, 1972 The CRZ tification Whether there is any Government order/policy relevant/ relating to site t Applicable 23 Forest Land involved? t Applicable 24 Whether there is any litigation pending against the project and / or land in which the project is propose to be set up Name of court Case no Order/directions of the court, if any and its relevance with the proposed project. litigation pending 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.,) (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.). 1.1 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) / Details thereof (with approximate quantities /rates, Open land converted in permanent construction structure. (With respect to local land use plan). The project will be developed as Pinakin Mangubhai Patel Commercial Building for (Total 109 nos shpos & Office, 5 screen Multiplex with total 1402 seats). 1.2 Clearance of existing land, vegetation and buildings? t Applicable 1.3 Creation of new land uses? The project will be developed as a Commercial Building namely Pinakin Mangubhai Patel The development will be in accordance with local development plan. 1.4 Pre-construction investigations e.g. bore houses, soil testing? Soil Sample was collected from the site. Copy of the same is enclose vide Annexure Construction works? Total Built-up Area m 2 There will be construction of Pinakin Mangubhai Patel Commercial Building for (Total 109 nos shpos & Office, 5 screen Multiplex with total 1402 seats). 1.6 Demolition works? t Applicable

3 1.7 Temporary sites used for construction works or housing of construction workers? 1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations About 30 construction workers & 10 Skilled workers including office staff will be working at the site. The workers will be hired from local population. Hence temporary housing is not required. There will be construction of B + G + 9 Floors 1.9 Underground works including t Applicable mining or tunneling? 1.10 Reclamation works? t Applicable 1.11 Dredging? t Applicable 1.12 Offshore structures? t Applicable 1.13 Production and manufacturing processes? 1.14 Facilities for storage of goods or materials? 1.15 Facilities for treatment or disposal of solid waste or liquid effluents? t Applicable Construction Phase: Minimum bulk material for construction will be bought as and when required and will be temporarily stored at site with proper arrangement of storage and under proper cover. Operation Phase: Solid Wastes: Solid waste generated in Project area will be mainly of domestic nature. The solid waste generated will be 0.10 MT/Day and it will be collected and disposed into MSW Disposal Site develop by Surat Municipal Corporation. Liquid Effluent: (Waste Water) The Waste Water (Domestic) generated will be 23 KLD of and it will be disposed into underground drained of Surat Municipal Corporation Facilities for long term housing of operational workers? 1.17 New road, rail or sea traffic during construction or operation? 1.18 New road, rail, air, waterborne or other transport infrastructure including new or altered routes and stations, ports, airports etc? 1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? 1.20 New or diverted transmission lines or pipelines? 1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? t Applicable t Applicable t Applicable t Applicable t Applicable t Applicable

4 1.22 Stream crossings? t Applicable 1.23 Abstraction or transfers of water from ground or surface waters? Construction Phase: During construction phase water requirement 10.3 KLD will be met through the S.M.C. Operation Phase: During operational phase fresh water requirement of 25 KLD will be met by S.M.C Changes in water bodies or the land surface affecting drainage or run-off? 1.25 Transport of personnel or materials for construction, operation or decommissioning? 1.26 Long-term dismantling or decommissioning or restoration works? 1.27 Ongoing activity during decommissioning which could have an impact on the environment? 1.28 Influx of people to an area in either temporarily or permanently? t Applicable Transport of personnel and materials will be required for both construction and operation phases. t Applicable t Applicable During construction phase 40 workers will be employed temporarily. During the operational phase, there will be influx of more than 1000 s. people Introduction of alien species? t Applicable 1.30 Loss of native species or genetic t Applicable diversity? 1.31 Any other actions? t Applicable 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):. Information/checklist 2.1 Land especially undeveloped or agricultural land (ha) 2.2 Water (expected source & competing users) unit: kld / Details thereof (with approximate quantities /rates, t Applicable Water demand will be as follows: Construction phase Maximum Quantity: ( 10.3 KLD ) Source: Surat Municipal Corporation 2.3 Minerals (MT) t Applicable 2.4 Construction material stone, aggregates, sand / soil (expected source MT) Operation phase Maximum Quantity: (25 KLD) Source: Surat Municipal Corporation Construction materials such as stone, cement, sand, bricks, marble, paints, tiles, electric ware, sanitary ware, glass will be used. All the above materials will be purchased from the local market and from nearest approved quarries, as and when required. It will be stored temporarily at the site.

5 2.5 Forests and timber (source MT) t Applicable 2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT), energy (MW) 2.7 Any other natural resources (use appropriate standard units) Source: D.G.V.C.L Expected Demand : 3000 KW Back-up Power: D.G. Set: Total - 3 s. (125 KVA ) (D.G. set will be used In case of power failure or emergency) Fuel Used : Diesel Fuel requirement: Total 12 Liter/Hr. t Applicable 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 Use of substances or materials, which are 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 disease vectors (e.g. insect or water borne diseases) / Details thereof (with approximate quantities/rates, t Applicable 3.3 Affect the welfare of people e.g. by t Applicable changing living conditions? 3.4 Vulnerable groups of people who could be affected by the project e.g. t Applicable hospital patients, children, the elderly etc., 3.5 Any other causes t Applicable Suitable drainage and waste management measures will be adopted in both construction and operational phase, which will restrict stagnation of water or accumulation of waste. This will effectively restrict the reproduction and growth of disease vectors.

6 4. Production of solid wastes during construction or operation or decommissioning (MT/Month) SR.. / Details thereof (with approximate quantities/ rates, 4.1 Soil, overburden or mine wastes Excavated surplus earth will be refilled at low lying areas in the project premises and development of greenbelt. 4.2 Municipal waste (domestic and or commercial wastes) The municipal solid wastes generated during operation phase will consist of: Organic waste Waste vegetables and foods Inorganic waste Papers, cartons, Thermocol, plastics, polythene bags, Glass, etc. Solid waste storage location will be incorporated in the design itself. Adequate number of collection bins, separately for biodegradable and non-biodegradable waste will be provided as per Municipal Solid Waste (Management and Handling) Rule, Waste from such bins will be collected separately on daily basis. The Waste generated will be 0.10 MT/Day and it will be collected and disposed into MSW Disposal Site develop by Surat Municipal Corporation. Please Refer Vide Annexure Hazardous wastes (as per t Applicable Hazardous Waste Management Rules) 4.4 Other industrial process wastes t Applicable 4.5 Surplus product t Applicable 4.6 Sewage sludge or other sludge from effluent treatment t Applicable 4.7 Construction or demolition wastes The construction waste will consist of construction debris along with cement bags, Unusable steel scrap (small cut-pieces of steel), insulating and packaging materials etc. 4.8 Redundant machinery or equipment 4.9 Contaminated soils or other t Applicable materials 4.10 Agricultural wastes t Applicable 4.11 Other solid wastes t Applicable Cement bags, waste paper and cardboard packing material will be sold off to recyclers. Unusable steel scrap (small cut-pieces of steel) will also be collected at site and sold to recyclers. t Applicable

7 5. Release of pollutants or any hazardous, toxic or noxious substances to air (kg/hr). 5.1 Emissions from combustion of fossil fuels from stationary or mobile sources 5.2 Emissions from production processes 5.3 Emissions from materials handling including storage or transport 5.4 Emissions from construction activities including plant and equipment 5.5 Dust or odours from handling of materials including construction materials, sewage and waste / Details thereof (with approximate quantities/rates, t Applicable t Applicable At the time of transportation, dust will be generated. This will be restricted to the construction phase and to the construction site only. At the time of transportation & construction, dust will be generated. Manually Water sprinkling will be carried out to minimize dust suppression. Construction Phase: Dust will be generated during construction activity. Hence Vertical Curtails & Water sprinkling will be carried out to minimize dust suppression. On site sanitation facilities (Septic Tank/Soak Pit) will be provided during the construction phase. 5.6 Emissions from incineration of waste t Applicable 5.7 Emissions from burning of waste in t Applicable open air (e.g. slash materials, construction debris) 5.8 Emissions from any other sources t Applicable The construction waste will consist Cement bags, waste paper, cardboard packing material and Unusable steel scrap (small cut-pieces of steel) will be sold off to recyclers. Temporary Solid waste storage will be provided at site and recycle material will be sold to recyclers. Operation Phase: During the operational phase, sewage will be disposed into underground drainage line of Surat Municipal Corporation.

8 6. Generation of ise and Vibration, and Emissions of Light and Heat:. 6.1 From operation of equipment e.g. engines, ventilation plant, crushers / Details thereof (with approximate quantities/rates, During construction, the machinery used for construction will be of high standard of reputed make and will adhere to International standards. These standards itself take care of noise pollution control/ vibration control and air emission control. Hence, insignificant impacts due to construction machinery are envisaged. 6.2 From industrial or similar processes t Applicable 6.3 From construction or demolition Due to various construction activities, there will be short term noise impacts in the immediate vicinity of the project site. 6.4 From blasting or piling t Applicable 6.5 From construction or operational traffic During construction noise will be generated due to construction activity but it will be for short term only. During operation phase noise will be generated due to traffic. 6.6 From lighting or cooling systems CFL Lighting shall be provided on internal roads, Fences/Boundaries of the building 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 waters or the sea:. 7.1 From handling, storage, use or spillage of hazardous materials 7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) 7.3 By deposition of pollutants emitted to air into the land or into water / Details thereof (with approximate quantities/ rates, t Applicable Sewage will be collected in Septic Tank / Sock Pit and disposed into underground drainage line of Surat Municipal Corporation with prior permission t Applicable 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

9 8. Risk of accidents during construction or operation of the Project, which could affect human health or the environment. 8.1 From explosions, spillages, fires etc from storage, handling, use or production of hazardous substances / Details thereof (with approximate quantities/ rates, Portable Fire Extinguishers shall be provided at site during construction. Fire Extinguishers i.e. (D.C.P.), Hose Real, Wet Riser, Yard Hydrant, Automatic Sprinkler System, Manually Operated Electric Fire Alarm System, Automatic detection and alarm system will be install for the operational phase. 8.2 From any other causes During the Construction phase possibility of accidents may be fall from height, scaffolds, temporary stairs, cutting and welding, electrical fitting etc 8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? During the Operation phase possibility of accidents may be electrical fire. The Buildings Design for as per earthquake zone III. 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. 9.1 Lead to development of supporting. facilities, ancillary 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 Others 9.2 Lead to after-use of the site, which could have an impact on the environment 9.3 Set a precedent for later developments 9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects / Details thereof (with approximate quantities/ rates, Supporting infrastructure will be developed like road, water supply network, power etc. Increase in demand for housing Increase in demand in industrial facilities Increase in demand in supply industries Increase in demand for commercial and recreational facilities Negligible increase in traffic and there will be positive impact on socio- economic environment. The project will lead to development of a Commercial shop. As Above

10 (III) Environmental Sensitivity. Areas 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 reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests 3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration 4 Inland, coastal, marine or underground waters Name/ Identity Aerial distance (within 15 km.) from Proposed project location boundary t Applicable Tapi River is 942 m. t Applicable t Applicable 5 State, National boundaries t Applicable 6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas Railway Station is 7.7 km. Surat Airport is 23.8 km. 7 Defense installations t Applicable 8 Densely populated or built-up area -- 9 Areas occupied by sensitive manmade land uses (hospitals, schools, places of worship, community facilities) 10 Areas containing important, high quality or scarce resources (ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals) 11 Areas already subjected to pollution or environmental damage. (those where existing legal environmental standards are exceeded) 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) National Highway. 8 is 6.8 km. hospital, Surat is located 650 m t Applicable t Applicable The Buildings Design for as per earthquake zone III.

11 I hereby given undertake 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 given, if any project will be revoked at our risk and cost. Date: 15/03/2018 Place: Surat Signature of the applicant With name and full address Pinakin Mangubhai Patel Block.119/B, F.P.. 64/1, O.P.. 64/1, T.P.S.- 21 (Sarthana Simada), Dist- Surat. (IV). Proposed Terms of Reference for EIA studies t Applicable.

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