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Groundwater Permit <br /> 2.Tax ideritfication Number <br /> j If�lf DAILY LOG SHEET <br /> ! 2019 OCT DAILY <br /> 3. Sampling Month&Frequency <br /> A. Facility Information <br /> fmportant:When <br /> filling out forms on 1. Facility name,address: <br /> the computer, use ISOUTH CAPE VILLAGE <br /> only the tab key to a.Name <br /> move your cursor- 672 FALMOUTH ROAD/RTE. 28 <br /> do not use the <br /> return key. b.Street Address <br /> MASHP_EE 19A 102649 <br /> !f C.City d.State e.Zip Cade <br /> 2. Contact information: <br /> +' ( 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 /> 10/31/2019 JWHITE WATER <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 Oct Daily <br /> r All forms for submittal have been completed. <br /> 2. E This is the last selection. <br /> 3. r Delete the selected form. <br /> gdpols 2015-09-15.doc• rev. 09/15/15 Groundwater Permit Daily Log Sheet• Page 1 of 1 <br />