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Client: 11 k'e <br />Lab ID lii plica biej:_ <br />To be completed by Pace National: <br />Are Samples Regulated? o 0 Yes <br /> 11 -N-3c5u <br />DC#Jitle: ENV-FRM-SACR-0030 CA Regulated Soil Notification <br />Effoctive Date: 07/13/2022 <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 />„R Yes No If no, matrix :.ivscription: <br />County <br />Alameda 0 Contra Costa 0 Del Norte 0 Humboldt 0 Lake <br />0 Los Angeles ' 0 Mann 0 Mendocino 0 Monterey 0 Napa <br />O Orange ] 0 Riverside 1 0 San Francisco 0 San Mateo <br />Santa Clara 0 Santa Cruz 0 Solana 0 Sonoma 0 Trinity <br />Other (specify): <br />(if soils sails are from one of the counties specified above, the site address is required.) <br />Site Address: <br />1-..ne Ant and rruit Phi qi;arautines may at partiJI county quafantirtes. The site address must be tiecken against APHIS interactioe r11.22S to determine if the aces vritWn the quarar Tire arra. <br />Regulated for? 0 Phytophthora Ramorum 0 Fire Ants 0 Fruit Flies* <br />Amount of soil received: — grams <br />Received on: <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 />Receiving lab notified soils are regulated? Shipment <br />Receiving Lab Amount shipped sent with receiving lab's Compliance Agreement? <br /> <br />Yes (initial / date) <br />g Yes (initial / date) <br />g Yes (initial / date) <br />Yes (initial / date) <br />Sods tanoot be tr.230ernnl ano her nestinaton wIhmst either a rpa 510 or PPC154D form. Cccaacr APHIS before proceeclinfl <br />mitral <br />. <br />/ date after a copy of form bas been sent to LuiS OquendO, USDA APHIS PPQ <br />Qualtrax ID: 71192 <br />Page 1 of 1 <br />ace Analytical <br />ENVIRONMENTAL SCIENCES <br />Chain of Custody and Cooler Receipt Form for 2218356 Page 2 of 3 <br />Me results in this report apply to the samples analyzed in accordance with the chain of custody document. Ibis aneil.vtical report must he 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 />4100 Atlas Court Bakersfield, CA 93308 (661) 327-4911 FAX (661) 327-1918 www.pacelabs.com Report ID: 1001335654 Page 4 of 31