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Appendix A Bore Completion Report

In respect of resource consent number: granted to (consent holder) for the installation of a bore at (site address).

Bay of Plenty Regional Council bore number

Map reference NZMS 260 or GPS (NZ Map Grid) coordinates Easting

Northing

I certify that the bore has been constructed in accordance with NSZ 4411 Environmental Standard for Drilling of Soil and Rock and in accordance with the attached bore log and construction diagram.

Name of drilling company

Address

Phone Mobile

Name of authorised agent of drilling contractor

Number of bores drilled under the above consent

Checklist before submitting this report:

Have you completed (and attached where appropriate):

Please tick

I have sighted and understand the resource consent conditions. Bay of Plenty Regional Council Groundwater Drillers Log Form (for each bore drilled). Bore construction diagram (showing final location of the bore(s)). Accurate coordinates of the location of the bore(s). I certify that any additional bore(s) drilled under the above consent for non-production (e.g. investigation/monitoring bores) have been capped/sealed.

Signed______Date

A590665