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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. A2312270107/1/1 [See rule 58(1)] Pass No. A2312270107/1/1
TRANSIT PASS TRANSIT PASS
FOR MINOR MINERALS FOR MINOR MINERALS

1. Book No. : --- Date & Time : 27-Dec-2023 03:12:25 PM - 27-Dec-2023 06:27:00 PM 1. Book No. : --- Date & Time : 27-Dec-2023 03:12:25 PM - 27-Dec-2023 06:27:00 PM

2. Circle Mining Office : BERHAMPUR 2. Circle Mining Office : BERHAMPUR


3. Name of the Quarry/Lease/Source of Auction : UPPALADA SAND BED 3. Name of the Quarry/Lease/Source of Auction : UPPALADA SAND BED
4. Name of the Licensee/Lessee/Permit 4. Name of the Licensee/Lessee/Permit
: K.YUGANDER RAO : K.YUGANDER RAO
Holder/Auction Holder/Auction Purchaser Holder/Auction Holder/Auction Purchaser

5. Destination : LACHHANA , RAMAGIRI Route : JEERANGO 5. Destination : LACHHANA , RAMAGIRI Route : JEERANGO

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) : 3.00 Cum 8. Quantity Permitted (Cum/Tonnes) : 3.00 Cum
9. Measurement of Mineral in Carrier (in meter) : OD20B7845 9. Measurement of Mineral in Carrier (in meter) : OD20B7845

Length Breadth Height Length Breadth Height


NA NA NA NA NA NA

10. Cubic Content (Cum) : 3.00 10. Cubic Content (Cum) : 3.00

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 carrier Signature of the Signature of the Signature of the Signature of the
Issuing with date Driver with date checking staff with date person Issuing with carrier Driver with checking staff with
date date date
Signature of the person receiving Signature of Inspector
at the destination with date I/C with date & time Signature of the person receiving Signature of Inspector
at the destination with date I/C with date & time
Office Seal
Office Seal

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