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{ Groundwater Permit <br /> 1 . MONITORING WELL DATA REPORT 2 Tax identification Number <br /> 2019 QUARTERLY 4 <br /> 3. Sampling Month&Frequency <br /> A. Facility Information <br /> Importaht: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 /> MASHPEE MA 02649 <br /> F .. C.City d.State e.Zip Code <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 /> 10/1/2019 RI ANALYTICAL <br /> a.Date Sampled(mm/dd/yyyy) b.Laboratory Name <br /> DAWNE SMART <br /> c.Analysis Performed By(Name) <br /> B. Form Selection <br /> 1.Please select Form Type and Sampling Month&Frequency <br /> Monitoring Well Data Report-2019 Quarterly 4 <br /> r. All forms for submittal have been completed. <br /> 2. � This is the last selection. <br /> 3. Delete the selected form. <br /> gdpols 2015-09-15:doc•rev. 09/15/15 Groundwater Permit Daily Log Sheet• Page 1 of 1 <br />