5 Annexer-III

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ANNEXURE - III

Format For Maintaining Records Of Right Way Permissions Granted for fuel station
( To be maintaned sepparately for every NH )
1 Name Of State Gujarat
2 Name of Agency Hindustan Petroleum Corporation Ltd.
3.Name of NHAI PIU Project Director,PIU Gandhidham
4 NH Number NH-27

Left Or Right
Side on NH Any Deviation
Date of Date of Date of last
Location ( towards Section and Kind Of from Most
Sr No Signing of Validity of Inspection Remarks
( Chainage In Mtr ) increasing Reach Srevice Name of Standred
Agreement Agreement of Site
chainage/km Licensee and norms
direction contact address
Km.632+735 (Between Right hand side Palanpur- Fuel Hindustan
Km.632+710 to Km.632+760) Swaroopganj of station Petroleum
NH-27 Corporation Ltd,
Ahmedabad
Retail Region,
Petroleum
House, Behind
1 Memnagar Fire
Station, P.O Box
No 4032,
Navrangpura,
Ahmedabad,
Gujarat.

For Hindustan Petroleum Corporation Ltd-


PLACE-

DATE-
.

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