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E4 I Groundwater Permit -1 <br /> 2.Tax identification Number <br /> i <br /> MONITORING WELL DATA REPORT <br /> ft 2019 OCT MONTHLY <br /> !: <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 /> AL 672 FMOUTH ROAD/RTE. 28 <br /> do not use the <br /> return key, b.Street Address <br /> MASH PEE MA 102649 <br /> i' 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 WHITEWATER <br /> a.Date Sampled(mm/dd/yyyy) b.Laboratory Name <br /> LAURA JOHNSON <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 Oct Monthly T <br /> All forms for submittal have been completed. <br /> 2. This is the last selection. <br /> 3. I_Delete the selected form. <br /> gdpols 2015-09-15.doc•rev. 09/15/15 Groundwater Permit Daily Log Sheet• Page 1 of I <br />