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;.1 Groundwater Permit <br /> �r • 2.Tax Identification Number- <br /> I�14 DISCHARGE MONITORING REPORT <br /> l 2019 NOV MONTHLY <br /> 3. Sampling Month&Frequency <br /> A. Facility Information <br /> Important:When <br /> filling out forms on 1.Facility name,address: <br /> the computer,use SOUTH CAPE VILLAGE <br /> only the tab key to a.Name <br /> move your cursor- <br /> do not use the <br /> 672 FALMOUTH ROAD/RTE.28 <br /> return key. b•Street Address <br /> MASH PEE IMA 02649 <br /> C.City d.State e.Zip Code <br /> l <br /> 2. Contact information: <br /> MYLES OSTROFF <br /> a.Name of Facility Contact Person <br /> 6 Jmyles@chartweb.com <br /> b,Telephone Number c.a-mall address <br /> 3. Sampling information: <br /> 11/7/2019 IRI ANALYTICAL <br /> a.Date Sampled(mm/dd/yyyy) b.Laboratory Name <br /> PAUL PERROTTI <br /> c.Analysis Performed By(Name) <br /> B. Form Selection <br /> 1. Please select Form Type and Sampling Month&Frequency <br /> Discharge Monitoring Report-2019 Nov Monthly <br /> i <br /> r All forms for submittal have been completed. <br /> 2. -This is the last selection, <br /> 3. r- Delete the selected form. <br /> I <br /> i <br /> E <br /> gdpols 2015-09-15,doc•rev.09/15/15 Groundwater Permit Daily Log Sheet- Page 1 of 1 <br />