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Document Name: Document Revised:24Apr2017 / Soil Checklist Page 1 of 1 Document No.: Issuing Authority: F-DAV-C-028-Rev.02 Pace Davis Quality Office SOIL CHE �� , Client: tit(�"� � � Work Order: ' ` Initials/Date: I'oa, Are samples soil or other egulated material? ❑ Yes ❑ No If no,matrix description: Sample Origin(circi one): FOREIGN (including non-continental U.S.) DOMESTIC If Foreign,list Cou oforigin: (regulated,proceed to Requirements) C D NM NY OR— Indicate County of Origin � -�� lj�}Lcc ki- Site add must be confirmed against quarantine areas in these states.If unknown,contact PM. Project canna received until this is determined. If Domestic, circle State o sa pies from a rantine zone? ❑ Yes VNo (If No,pr ed with receipt,som es are not regulated,If yes,proceed to depth question.) Origin: -- ------- -- _.._.....- ----- ---- ----- ---- ----- AL AR FL GA LA MS NC OK SC TN TX VA (Regulated,proceed to depth question) ❑ NO E OF THE ABOVE (Proceed to receipt,samples are not regulated.) Are any samples from a d pth of<6 ft? ❑ Yes ❑ No ❑ Not indicated Is sub analysis requested? ❑ Yes ❑ No (f No to both questions,proceed to receipt,samples are not regulated.) REQUIREMEN ACTION COMPLETED Domestic soils from a depth offeet are Were samples segregated by depth<or>6 feet? YES NO N/A exempt from classification as reg lated soil per California APHIS/USDA guidelines. If samples are to be subcontracted outside of California,treat sub samples as regulated soil. I Were there any signs of breakage or leakage(check for broken glass YES NO Samples must be double contain d to prevent and/or loose soil in the cooler)? accidental release. Anything thawmes into If YES,were ice and melt water sterilized by adding enough bleach to YES NO N/A contact with loose soil must be tr�eated as achieve a 10%concentration and sitting for>30 minutes before disposing. - c regulated. If YES,was any broken glass and/or loose soil placed in the USDA o Regulated soil drum or Regulated satellite container? YES NO N/A o E Samples most be segregated and ored in were samples placed in a designated container and cooler? YES NO designated bins and coolers. Yellow stickers identify regulated oil samples. Did yellow stickers get placed on all sample containers? YES NO Equipment and supplies that hav come into Were the cooler(s)and/or countertop(s)decontaminated using a fresh contact with samples must be det ntaminated 10%bleach solution? Were gloves,disposable lab supplies or shipping YES NO or disposed of property. materials disposed of in the SR USDA Regulated satellite container? To Be Completed by PM/P for Regulated Soils: Sample Analysis to be conducted at(circle all that apply): Davis Subcontract Lab Name of Subcontract Lab(s): REQUIREMENT ACTION COMPLETED USDA/APHIS rep must be int rmed by email when Notification to Anthony Jackson,USDA APHIS regulated soils are received ano prior to shipping to PPQ indicated on California Regulated Soil Notification YES NO any subcontract lab,including R Pace Labs- form. Sub shipments must include a�alid copy of the Is a copy of all needed paperwork included with the COC? receiving lab's permit along wi In all required forms. (SR cannot ship samples until all necessary paperwork is YES NO N/A compiled.) Comments: Project Manager Signatur Date: '"' g s�' �' �•� ;":rte ii �;1 wss JAN 18 2018 ENVIRONVE"JTAL H566111*26 DLR„i I i.`�,iENT