ORIGINAL COPY DUPLICATE COPY

GOVERNMENT OF ODISHA
GOVERNMENT OF ODISHA
DEPARTMENT OF STEEL & MINES
DEPARTMENT OF STEEL & MINES
FORM-Y
FORM-Y
[See rule 58(1)] Pass No. A2402230297/1/1
[See rule 58(1)] Pass No. A2402230297/1/1
TRANSIT PASS
TRANSIT PASS
FOR MINOR MINERALS
FOR MINOR MINERALS

1. Book No. : --- Date & Time : 28-Feb-2024 07:08:37 PM - 29-Feb-2024 01:38:00 AM
1. Book No. : --- Date & Time : 28-Feb-2024 07:08:37 PM - 29-Feb-2024 01:38:00 AM

2. Circle Mining Office : BALANGIR 2.

Circle Mining Office : BALANGIR
3.
Name of the Quarry/Lease/Source of 3. Name of the Quarry/Lease/Source of
Auction : BADYANATH SAND QUARRY : BADYANATH SAND QUARRY
Auction
4.
Name of the Licensee/Lessee/Permit 4. Name of the Licensee/Lessee/Permit
: SRI SINGDHA PUJHARI : SRI SINGDHA PUJHARI
Holder/Auction Holder/Auction Purchaser Holder/Auction Holder/Auction Purchaser

5. Destination : Prakash Singh , Sambalpur Route : Arjunpur 5. Destination : Prakash Singh , Sambalpur Route : Arjunpur

6. Minor Mineral : SAND 6. Minor Mineral : SAND

7. Permit No. : NA Date : NA 7. Permit No. : NA Date : NA

8. Quantity Permitted (Cum/Tonnes) : 16.00 Cum 8. Quantity Permitted (Cum/Tonnes) : 16.00 Cum

9. Measurement of Mineral in Carrier (in meter) : OD15F9966 9. Measurement of Mineral in Carrier (in meter) : OD15F9966

Length Breadth Height Length Breadth Height

NA NA NA NA NA NA

10. Cubic Content (Cum) : 16.00 10. Cubic Content (Cum) : 16.00

11. Weight of the Vehicle (Tonnes) Gross : NA Tare : NA 11. Weight of the Vehicle (Tonnes) Gross : NA Tare : NA
12. Weight of the Mineral : NA 12. Weight of the Mineral : NA

Signature of the person

Signature of the Signature of the Signature of the Signature of the Signature of the
Issuing with date
carrier Driver with checking staff with person Issuing with carrier Driver with checking staff with
date date date date date

Signature of the person receiving

Signature of Inspector Signature of the person receiving Signature of Inspector
at the destination with date
I/C with date & time at the destination with date I/C with date & time

Office Seal Office Seal