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-4 a c a A nalytical <br /> ENVIRDNMENTAL SCIENCES <br /> Chain of Custody and Cooler Receipt Form for 2214240 Page 3 of 5 <br /> Ace, RC# Tltle: ENV-FRM-SACR-0030 CA Regulated Soil Notification <br /> _ _ <br /> I ist+Yxueuls ____ <br /> Effective Eate:06/03/2022 <br /> USDA/APHIS regulates material with organic matter,including soil,from specific counties that have invasive <br /> species,pests,or plant diseases present in the county. In order to process your project,we need to <br /> determine if special handling applies to your project. <br /> Any soils received without this completed form cannot be received or processed until the site address is <br /> confirmed. <br /> Receipt of Soils from California: <br /> Are samples soil or other regulated material? <br /> Yes ❑ NO If nD,matrix description; <br /> i. County <br /> ❑ Alameda ❑ Contra Costa ❑ Del Norte ❑ Humboldt ❑ Lake <br /> ❑ Los Angeles 11,2 ❑ Marin ❑ Mendocino ❑ Monterey ❑ Napa <br /> ❑ Orange 1 ❑ Riverside' ❑ San Bernardino 1 ❑ San Francisco ❑ San Mateo <br /> ❑ Santa Clara 2 ❑ Santa Cruz ❑ Solano Cl Sonoma ❑ Trinity <br /> Other(specify): i <br /> (if soy's are from one of the 19 counties specified above,the site address is required.) <br /> Site Address: <br /> Firr Ant'and fruit Flys gLwantires may be partial county quarantines'hc slu address must be Oecked a„vainst APHIS lnteractim maps;o <br /> determine H the situ Ix within x'�e quarantine a rca. <br /> To be completed by Pace National: Client- <br /> Lab <br /> lientLab ID(if applicable): <br /> Are Samples Regulated? R No ❑ Yes <br /> Regulated for? ❑ Phytophthora Rarnorum ❑ Fire Ants ❑ Fruit Flies" <br /> Amount of soil received: grams <br /> Received on: <br /> Will any analysis be done at another lab? ❑ Yes ❑ No <br /> If yes,complete the following for each lab that will receive the regulated samp3es: <br /> Receiving lab notified soils are regulated?Shipment <br /> Receiving Lab Amount shipped sent with receiving lab's Compliance Agreement? <br /> W 6 Yes (initial/date) <br /> g Yes (initial J date) <br /> g Yes (initial/date) <br /> y g Yes (initial/date) <br /> •Soils cannot he transfe-rmd to another destination without either a Ma S"or PFQ 540 fora.Contact APHIS before prceeeding. <br /> Initial/date after a copy of form has been sent to Luis Q uendo,USDA APHIS PPQ <br /> Qualtrax JD:71192 Page 1 of 1 <br /> The t•e.culrr in chis report apply m rhe samples anali'cd in accordance with the chum of euwo,ly docamenl. 77nieunalrlieul wpu,7 inns[he reptztduced in in rnrirety. <br /> All results listed in this report are rot the exclusive use of the submitting party. Pace Analytical assumes no responsibility rot reportalteration,separation,detachment or third party interpretation. <br /> ReportID: 1001318187 4100 Atlas Court Bakersfield, CA 93308 (661)327-4911 FAX(661)327-1918 www.pacelabs.com Page 6 of 79 <br />