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' -PaceAnal�G'eal' �JC.���G�� <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 /> Receipt of Soils from California: <br /> Are samples soil or other regulated material? "" /� "L 1 <br /> ❑ Yes I�NO If no,matrix description:,�c%4J,5))""� 4- c•Iy <br /> County �— <br /> ❑ Alameda ❑ Contra Costa ❑ Del Norte ❑ Humboldt ❑ Lake <br /> ❑ Los Angeles* ❑ Marin ❑ Mendocino ❑ Monterey ❑ Napa <br /> ❑ Orange* ❑ Riverside* ❑ San Francisco ❑ San Mateo ❑ Santa Clara ** <br /> ❑ Santa Cruz ❑ So6no ❑ Sonoma ❑ Trinity <br /> Other(specify):!i, <br /> L <br /> (if soils are from one of th19 counties specified above, the site address is required.) <br /> Site Address: <br /> 'Fire Ant and•'Fruit Fly quarantineslmay 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 /> To be completed b Pace National:nal: Client: V <br /> Are Samples Regulated? fYNo ❑ Yes Lab ID (if applicable): <br /> Regulated for? ❑ Phyto hthora 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 samples: <br /> JReceiving lab notified soils are regulated?Shipment <br /> Receiving Lab mount shipped sent with receiving lab's Compliance Agreement? <br /> 9 Yes (initial/date) <br /> g Yes (initial/date) <br /> g Yes (initial/date) <br /> g Yes (initial/date) <br /> Soils cannot be transferred to another destination without either a PPQ 530 or PPQ 540 form. Contact APHIS before proceeding. <br /> Initial/date after a copy of fl rm has been sent to Luis Oquendo, USDA APHIS PPQ <br /> H:\QAQC\Public\Controlled Docs\DAV-31 CA Regulated Soil Notification.docx <br /> DAV-31 <br /> Rev 6 <br /> 10/11/2021 <br />