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Groundwater Permit 2.Tax identification Number � <br /> I DISCHARGE MONITORING REPORT <br /> 2019 OCT MONTHLY <br /> 3. Sampling Month&Frequency <br /> I' <br /> A. Facility Information <br /> lmportant: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- 672 FALMOUTH ROAD/RTE.28 <br /> do not use the <br /> return key. b.Street Address <br /> MASHPEE MA 02649 . <br /> Ir 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 Oct Monthly <br /> All forms for submittal have been completed. <br /> 2. This is the last'selection. <br /> J. E.Delete the selected form. <br /> gdpols 2015-09-15.doc• rev. 09/15/15 Groundwater Permit Daily Log Sheet• Page 1 of 1 <br />