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SOIL CHE Client: wpM � f Work Order: �� Initials/Date: I voU / ! Are samples soil or other egulated material? ❑ Yes ❑ No I If no, matrix description: Document Name: Document Revised: 24Apr201 Domestic soils from a depth of 4 feet are Soil Checklist Page 1 of 1 site add must be confirmed against quarantine areas in these states. If unlmown, contact PM. project cannoV, received until this is erefield. Document No.: Issuing Authority: circle State o F-DAV-C-028-Rev.02 Pace Davis Quality Office SOIL CHE Client: wpM � f Work Order: �� Initials/Date: I voU / ! Are samples soil or other egulated material? ❑ Yes ❑ No I If no, matrix description: Sample Origin (circ) one): FOREIGN (including non -continental US.) DOMESTIC If Foreign, list Cou ofOrigin: (regulated, proceed to Requirements) Domestic soils from a depth of 4 feet are i161)D NM NY OR— Indicate County of Origin l ``�� 4t -� 6i YES NO N/A site add must be confirmed against quarantine areas in these states. If unlmown, contact PM. project cannoV, received until this is erefield. If Domestic, sa pies from a rantine zone? ❑ Yes VNo circle State o form. Origin:r**,� (If No, pro ed with receipt, so mp es are not regulated, If yes, proceed to depth question.)-_-_,-_.__ Ar- Is a copy of all needed paperwork included with the COC? ---- -- ----- _._.....— -- ---- AL AR FL GA LA MS NC OK SC TN TX VA (Regulated, proceed to depth questwn),,M�i`t YES NO ___--�—�-i ❑ NONE OF THE ABOVE (Proceed to receipt samples are not regulated.) Are any samples from a clpth of < 6 ft? ❑ Yes ❑ No ❑ Not indicated Is sub analysis requested I ❑ Yes ❑ No (If No to both questions, proceed to receipt samples are not regulated.) REQUIREMEINITACTION ACTION COMPLETED Domestic soils from a depth of 4 feet are Were samples segregated by depth < or > 6 feet? YES NO N/A exempt from classificat on as re ulated soil per PPQ indicated on Califomia Regulated Soil Notification California APHIS /USDA guidelin If samples are to be subcontracted outside of California, treat sub samples as regulated soil. form. Were there any signs of breakage or leakage (check for broken glass Sub shipments must include valid copy of the Is a copy of all needed paperwork included with the COC? YES NO Samples must be double contai d to prevent and/or loose soil in the cooler)? If YES, were ice and melt water sterilized by adding enough bleach to YES NO N/A accidental release. Anything tha comes into contact with loose soil must be t eated as achieve a 10% concentration and sitting for>_ 30 minutes before disposing. regulated. If YES, was any broken glass and/or loose soil placed in the USDA YES NO N/A Regulated soil drum or Regulated satellite container? Samples must be segregated and stored in Were samples placed in a designated container and cooler? YES NO designated bins and coolers. Yellow stickers identify regulated soil 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 de 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/I`C for Regulated Soils: Sample Analysis to be con ucted at (circle all that apply): Davis Subcontract Lab Name of Subcontract Lab(s): REQUIREMENT ACTION COMPLETED USDA / APHIS rep must be in rmed by email when Notification to Anthony Jackson, USDA APHIS regulated soils are received ai id prior to shipping to PPQ indicated on Califomia Regulated Soil Notification YES NO any subcontract lab, includinE IR Pace Labs. form. Sub shipments must include valid copy of the Is a copy of all needed paperwork included with the COC? receiving lab's permit along ith all required forms. (SR cannot ship samples until all necessary paperwork is YES NO N/A compiled.) Comments: Project Manager Date: rN Page 24 of 26