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2eAnalyticar <br /> I 3 05- /.0 <br />CA Regulated Soil Notification <br />USDA / APHIS regulates material with organic matter, including soil, from specific <br />counties that have invasive species, pests, or plant diseases present in the county. In <br />order to process your project, we need to determine if special handling applies to your <br />project. <br />Any soils received without this completed form cannot be received or processed until <br />the site address is confirmed. <br /> <br />Receipt of Soils from California: <br />Are samples soil or other regulated material? <br />Yes 0 No if no, matrix description: <br />County <br />Alameda 0 Contra Costa 0 Humboldt 0 Lake 0 Los Angeles* 0 Mann <br />Mendocino 0 Monterey 0 Napa 0 Orange* 0 Riverside* 0 San Francisco <br />San Mateo 0 Santa Clara 0 Santa Cruz 0 Solano 0 Sonoma 0 Trinity <br />Other (specify): hL..-•-• Cos-lv-4k3 <br />(If soils are from one of the 18 counties specified above, the site address is required.) <br /> <br />Site Address: <br />Fire Ant and •• Fruit Fly quarantines may be partial county quarantines. The site address must be checked against APHIS interactive maps to <br />determine if the site is within the quarantine area. <br /> <br />To be completed by Pace National: Client: <br />Lab ID (if applicable): <br /> <br />Are Samples Regulated? yNo 0 Yes <br />Regulated for? 0 Phytophthora Ramorum 0 Fire Ants 0 Fruit Flies** <br />Amount of soil received: - grams <br />Received on: <br /> <br />Will any analysis be done at another lab? 0 Yes 0 No <br />If yes, complete the following for each lab that will receive the regulated samples: <br /> <br />Receiving Lab Amount shipped <br />Receiving lab notified soils are regulated? Shipment <br />sent with receiving lab's Compliance Agreement? <br />Yes (initial / date) <br />Yes (initial / date) <br />Yes (initial / date) <br />Yes (initial / date) <br /> <br />* Soils cannot be transferred to another destination without a PPQ 530 form, Contact Jordan Krug at Jordan.d.krug@aphis.usda.goy. <br /> <br />Initial / date after a copy of form has been sent to Anthony Jackson, USDA APHIS PPQ <br /> <br />H:\QAQC\Public\Controlled Docs\DAV-31 CA Regulated Soil Notification.docx DAV-31 <br />Rev 2 <br />7/17/20