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USDA REGULATED SOIL CHECKLIST To Be Completed by SR Staff: WO: 10521947 Date: i 14?. t 2 Initials: Sample Origin (circle one): DOMESTIC QUARANTINED FOREIGN (Note: soil samples from Hawaii, Guam, Puerto Rico and the US Virgin Islands are considered to be of a Foreign Source) If Domestic, circle State of Origin: AL A CA L GA LA MS NC NM NY OK OR SC TN TX VA (Includes: IFA, SOD, Golden Nematode, Kornai Bunt and Witchwe List County: &L!n (USDA Permit/Compliance Agreement authorizes movement of samples from these domestic regulated zones) If Quarantined, circle State of Origin: FL ID TX CA List County: (Includes Fruit Fly, Giant African Snail and Pale Cyst Nematode) (Movement is not authorized for Pale Cyst Nematode (ID or Giant African Snail (FL), remaining quarantines require additional paperwork) If Foreign, list Country of Origin: (Movement from some Canadian Providences is not allowed. Refer to CS -232 Regulated Soil Flow Chart) REQUIREMENT Document Name: Document Revised: 13Feb2018 Analytical Regulated Soil Checklist Page 1 of 2 Document No.: Issuing Authority: YES NO N/A F-MN-Q-338-Rev.06 Pace Minnesota Quality Office USDA REGULATED SOIL CHECKLIST To Be Completed by SR Staff: WO: 10521947 Date: i 14?. t 2 Initials: Sample Origin (circle one): DOMESTIC QUARANTINED FOREIGN (Note: soil samples from Hawaii, Guam, Puerto Rico and the US Virgin Islands are considered to be of a Foreign Source) If Domestic, circle State of Origin: AL A CA L GA LA MS NC NM NY OK OR SC TN TX VA (Includes: IFA, SOD, Golden Nematode, Kornai Bunt and Witchwe List County: &L!n (USDA Permit/Compliance Agreement authorizes movement of samples from these domestic regulated zones) If Quarantined, circle State of Origin: FL ID TX CA List County: (Includes Fruit Fly, Giant African Snail and Pale Cyst Nematode) (Movement is not authorized for Pale Cyst Nematode (ID or Giant African Snail (FL), remaining quarantines require additional paperwork) If Foreign, list Country of Origin: (Movement from some Canadian Providences is not allowed. Refer to CS -232 Regulated Soil Flow Chart) REQUIREMENT ACTION COMPLETED PPQ-530 Paperwork must be included for Scan PPQ-530 to the corresponding Project folder on the x drive. SS NO any samples from counties with a Fruit Fly containers? YES NO N/A Quarantine in TX. Refer to MN -S063 If PPQ-530 is not present, contact the Waste Coordinator and do YES NO through MN -S065 not continue processing samples. Samples from ID may not be moved from If samples originated in a quarantined zone, contact the Waste YES NO N/A the quarantined region. Refer to MN -S055 Coordinator and do not continue processing samples. If NO, ice and melt water can be disposed of by normal process (down the drain). Samples from Giant African Snail If samples originated in a quarantined zone, contact the Waste Samples must be double contained to Quarantine in FL may not be moved from Coordinator and do not continue processing samples. YES NO the quarantined region. Refer to MN -5068 Any broken glass and/or loose soil are to be bagged and placed in a USDA Regulated satellite REQUIREMENT ACTION MPLETED "Special Handling" stickers are to be placed Did "special handling" stickers get placed on all sample SS NO on all samples. containers? Samples must be segregated and stored in Were samples placed in a designated cooler, containers and YES NO designated bins, shelves and coolers. shelves? Were there any signs of breakage or leakage (check for broken YES NO glassand/uricose soil -in -the cooler). If NO, ice and melt water can be disposed of by normal process (down the drain). If YES, were ice and melt water separated from the cooler and Samples must be double contained to disposed of properly? YES NO N/A prevent accidental release. Any broken glass and/or loose soil are to be bagged and placed in a USDA Regulated satellite container or active drum (see Waste Coordinator). Ice and melt water should be baked at a temperature range of 121-154°F for 2 hours and then cooled before going down the drain. Equipment and supplies that have come Was the cooler(s) and/or countertop(s) decontaminated using into contact samples must be either a fresh 10% bleach solution or 70% ethanol? (Gloves and YES NO decontaminated. other lab supplies will be bagged and placed in the USDA Regulated satellite container or active drum). Comments: Page 21 of 22