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CI'rAT;ON CIRCUITS INC. �- 9 3 `' 78 45 3 , <br /> 209-46.6-4000 1950 WEST FREMONT STREVT <br /> STOCKTONt CA 95203 <br /> PRE-TREATMENT PROGRAM - CUSTODY TAG <br /> Test Requirementss ( ) - pH (EPA 150 . 1 ) . <br /> ( ) - Trace metals, Total (EPA 200. 71) . f ' cJ <br /> ( ) - Cyanide, Total (EPA 9010) . <br /> ( ) - Total Toxic Organics. <br /> (X - Other: _ 1 r't <br /> Sample Types (� - Grab.s� tL <br /> ( ) - 24 Hours Composite. <br /> ( ) - City Split. <br /> ( ) - at Point of Discharge <br /> ( ) - Other: <br /> Sample Collection Periods From. . . . . `/ <br /> Sample Collection Time : ,7'��� • : • • To. . . a;/ e!� !!,, <br /> (Date ) . . . . . ( Time) ,. . )Y. . . . . . . <br /> Preservative Addeds ( ) - Nitric Acid <br /> ( ) - Sulfuric Acid BY ( Init. ) : . . . . . . . . . <br /> Dates . . . . . . . . . . . , <br /> Sodium/Potassium Hydroxide <br /> CONTAINER / Time Date <br /> LOT NUMBER. �6�L— / Sampl s ( Sign t�e ) , <br /> rttrrr--- 1 1 <br /> Y <br /> ------------------------------- L <br /> ----------------- -- ' -4-----= <br /> . Re 'nqui h � s ignature) ; Time ; Date � e -- - f--- ' <br /> _ Y = (Signature ) ; <br /> - _-------q------- , -6-lT i��M_1 2_ 2 3 - <br /> Relin ished Bys (Si nature -------- <br /> ' Date ace ved Bys (Signature ) <br /> , <br /> ------------ --------------- <br /> Relinquished Sy . (Signature) ; Time ; Date ; Received By : (Signature ) <br /> . Relinquished Sys (Signature) : <br /> ---------------------------------Time------------------ <br /> ----- ' <br /> Date ,Received Bys (Signature ) ; <br /> =aasaiis!ltaaassalasaasaiasa!!!lasa!!slsisailsa silissaaslalsssa!!salsaeoeaa�== <br /> In House WESTON Result <br /> Result Sample Nos . , . . . . . . . . . . . . . . . <br /> PH <br /> ------------N---_ <br /> Cu, total (mg/1 ) <br /> -------------------- <br /> Pb, total (mg/1 ) 1 7 <br /> -------------------- ----------- <br /> Other (mg/1 ) <br />