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s Groundwater Permit -DAILY LOG SHEET Tax identification Number- ----_-- -- - _ <br /> ti 2. <br /> I; 2019 NOV DAILY <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 /> 67 <br /> do not use the 2 FALMOUTH ROAD/RTE.28 <br /> return key. b.Street Address <br /> MASHPEE IMA 102649 <br /> C.City d.State e.Zip Code <br /> `i <br /> 2, Contact information: <br /> TANA P1 <br /> f MYLES OSTROFF <br /> a•Name of Facility Contact Person <br /> 6174311097 myles@chartweb.com <br /> b.Telephone Number c,e-mail address <br /> 3. Sampling information: <br /> 11/30/2019 WHITEWATER <br /> a.Date Sampled(mm/dd/yyyy) b,Laboratory Name <br /> LAURAJOHNSON <br /> c.Analysis Performed By(Name) <br /> B. Form Selection <br /> 1. Please select Form Type and Sampling Month&Frequency <br /> Daily Log Sheet-2019 Nov Daily T <br /> r All forms for submittal have been completed. <br /> 2, r This is the last selection. <br /> 3. Delete the selected form, <br /> i <br /> gdpols 2015-09-15.doc•rev.09/15/15 Groundwater Permit Daily Log Sheet•Page 1 of 1 <br />