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(— PaceAnalytical' <br /> s <br /> CA Regulated Soil Notification <br /> USDA/APHIS regulates material with organic matter, including soil, from(specific <br /> M counties that have invasive species, pests, or plant diseases present in thQ county. In <br /> J 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 /> Receipt of Soils from California: <br /> Are samples soil or other regulated material? <br /> ❑ Yes NO If no,matrix description: <br /> County <br /> ❑ Alameda ❑ Contra Costa ❑ Humboldt ❑ Lake ❑ Los Angeles"1 ❑ Marin <br /> ❑ Mendocino ❑ Monterey ❑ Napa ❑ Orange' ❑ Riverside' Y' San Francisco <br /> ❑ San Mateo ❑ Santa Clara ❑ Santa Cruz ❑ Solana ❑ Sonoma I❑ irinity <br /> Other(specify):---- <br /> (if soils are from one of the 18 counties specified above, the site address is uired.) <br /> Site Address: SA-rte ^ <br /> •Fire Ant and"Fruit Fly quarantines maybe partial county quarantines. The Alladdressmust be checked gainst APHIS Interactive maps to <br /> ! determine if the site Is within the quarantine area. <br /> To be completed by Pace National: Client: UU _ <br /> Lab ID(if applicable): _.. <br /> Are Samples Regulated? K-No ❑ Yes <br /> Regulated for? ❑ Phytophthora Ramorum ❑ 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 sampl i es: <br /> Receiving lab notified soils are reulated?Shipment <br /> Receiving Lab Amount shipped sent with receiving lab's Compliance Agreement? <br /> g Yes (initial/date) <br /> g Yes (initial date) <br /> g Yes (initial date) <br /> I g Yes _ (initialll/date) <br /> '•Soils cannot betransferred to another destination without either a PPQ 530or PPQ5401orm. ContactAP IS before p'oce, ,. <br /> Initial/date after a copy of form has been sent to Luis Oquendo, USDA APHIS PPQ <br /> i <br /> i <br /> i <br /> H:\DAQC\Public\Controlled Docs\DAV-31 CA Regulated Soil Notification.docx DAV-31 <br /> Rev 4 <br /> 2/8/2021 <br />