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Groundwater Permit - __ _- - <br /> Tax identification Number <br /> DISCHARGE MONITORING REPORT <br /> I�.. 2019 QUARTERLY 4 <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 /> LM 672 FAOUTH ROAD/RTE.28 <br /> do not use the <br /> return key. b.Street Address <br /> MASHPEE 15A 02649 <br /> iF 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 /> 10/2/2019 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 /> Discharge Monitoring Report-2019 Quarterly 4 <br /> All forms for submittal have been completed. <br /> 2. 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 />