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1 ----;,-cc Anr71ytica1 <br /> ENVIRDNMENTAL SCIENCES <br /> Chain of Custody and Cooler Receipt Form for 2215185 Page 2 of 3 <br /> QC#-Title: ENV-FRM-SACR-0030 CA Regulated Soil Notification <br /> = 7CC <br /> Effective Date:06/30/2022 <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 sa es so+I or other regulated material? <br /> Ye5 ❑ No If na,rra;rix description- . . <br /> County <br /> ❑ Alameda 0 Contra Costa ❑ Del Norte ❑ Humboldt ❑ Lake <br /> ❑ Los Angeles 1 ❑ Marin ❑ Mendocino ❑ Monterey ❑ Napa <br /> ❑ Oranges ❑ Riverside' ❑ San Francisco ❑ San Mateo <br /> ❑ Santa Clara` (2 Santa rue ❑ Sol r)o f El Sonoma ❑ Trinity <br /> Other{specify}: r–� �'/ iL �� <br /> (if sons ore from one of the counties specified above,the site address is required.) <br /> Site Address: <br /> F*-T Ant'and Fru'r,Fly:quarantines may be part°al county qua2ntinas Ttie site address�n�s[be ch?t.e0 against APHIS interani�e map>to <br /> dererm'riv if the sile is with-.,n the quarartne area. <br /> To be completed by Pace National: client: <br /> Lab ID(if applicable) <br /> Are Samples Regulated? 2--ml ❑ Yes <br /> Regulated for? ❑ Phytophthora Ramorum ❑ Fire Ants ❑ Fruit Flies" <br /> Amount of soil received: grams <br /> Received on: <br /> ;rdill any analysis be done at another lab? ❑ Yes ❑ No <br /> If yes,complete the following for each lab that will receive the regulated samples; <br /> Receiving lab notified soils are regulated?Shipment <br /> Receiving Lab Amount shipped sent with receiving lab's Compliance Agreement? <br /> g Yes (initial/date) <br /> g Ye5 _y,,.„_.•._.�,�_ —_ (initial/date) <br /> g Yes (initial/date) <br /> g Yes (initial/date) <br /> 5*S L�nnct be tri nsfr.rred to-.-lother destination wil'aout either a P'0530or PPQStD!o'rn. Cemact ANIS before proceeding. <br /> Initial/date after e cepa of form has been sent to Luis Oquundo,USDA APHIS PPQ <br /> Qualtrax ID:71192 Page t of 1 <br /> 1 he results in this report upply to the samples uurih_ed in uccordonce with the chmi)rf c•u.ytody document.This unulvucul report illim be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting party. Pace Analytical assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> Report ID: 1001323091 4100 Atlas Court Bakersfield, CA 93308 (661)327-4911 FAX(661)327-1918 www.pacelabs.com Page 4 of 23 <br />