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DC# Title: ENV-FRM-SACR-0030 CA Regulated Soil Notification ace 4ksLYTtAL SERVOS Effective Date: 11/18/2022 USDA/APHIS regulates material with organic matter, including soil, from specific counties that have invasive species, pests, or plant diseases present in the county. In order to process your project, we need to determine if special handling applies to your project. Any soils received without this completed form cannot be received or processed until the site address is confirmed. Receipt of Soils from California: Are samples soil or other regulated material? XYes ❑ No If no,matrix description: County ❑ Alameda ❑ Contra Costa ❑ Del Norte ❑ Humboldt ❑ Lake ❑ Los Angeles ' ❑ Marin ❑ Mendocino ❑ Monterey ❑ Napa ❑ Orange',' ❑ Riverside' ❑ San Diego z ❑ San Francisco ❑ San Mateo ❑ Santa Clara ❑ Santa Cruz ❑ Solano ❑ Sonoma ❑ Trinity I Other(specify): :)iL4 it �a a iLj it (if soils are from one of the counties specified above, the site address is required.) Site Address: Fire Ant 1 and Fruit Fly z quarantines may be partial county quarantines. The site address must be checked against APHIS interactive maps to determine if the site is within the quarantine area. To be completed by Pace National: Client: 4 LIi L= I OACc� Lab ID (if applicable): Are Samples Regulated? tX No ❑ Yes Regulated for? ❑ Phytophthora Ramorum ❑ Fire Ants ❑ Fruit Flies* Amount of soil received: — grams. Received on: Will any analysis be done at another lab? ❑ Yes ❑ No If yes, complete the following for each lab that will receive the regulated samples: Shipment sent with the receiving lab's Soil Receiving Lab Amount Shipped Permit/Compliance Agreement. ❑ Yes (initial/date) ❑ Yes (initial/date) ❑ Yes (initial/date) g ❑ Yes (initial/date) *Soils cannot be transferred to another destination without either a PPQ 530 or PPQ 540 form. Contact APHIS before proceeding. Qualtrax ID: 71192 Page 1 of 1