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Document Name: Document Revised:22Aug2019 <br /> aceAna"cal' CA Regulated Soil Notification Page 1 of 1 <br /> fJaVoro I CenW b r"Vrpo a In—tion <br /> DocumentNo.: Issuing Authority: <br /> i F-DAV-C-044-Rev.10 Pace National—Sacramento Quality Office <br /> USDA/APHIS regulates material with organic matter,including soil,from specific counties that <br /> have invasive species, pests, or plant diseases present in the county. In order to process your <br /> project, we need to determine if special handling applies to your project. <br /> Any soils received without this completed form cannot be received or processed until the site <br /> address is confirmed. <br /> Receipt of Soils from California: <br /> AZsapies soil or other regulated material? <br /> s ❑ NO Ifno, matrix description: <br /> County <br /> ❑ Alameda ❑ Contra Costa ❑ Humboldt ❑ Lake ❑ Los Angeles* ❑ Marin <br /> ❑ Mendocino ❑ Monterey ❑ Napa ❑ Orange* ❑ Riverside* ❑ San Francisco <br /> ❑ San Mateo ❑ Santa Clara ❑ Santa Cruz ❑ Solano ❑ Sonoma <br /> ❑ Trinity <br /> ❑ Other(specify): -2t__ Vnier .Sc F► 0 _ <br /> (If soils are from one of the 18 counties specified above,the site address is required.) <br /> Site Address: <br /> *Fire Ant and**Fruit Fly quarantines may be partial county quarantines.The site address must be checked against APHIS Interactive maps to <br /> determine if the site Is wMin the quarantine area. <br /> To be completed by Pace National: Lab#(or Client): <br /> Are Samples Regulated? )E� No ❑ Yes (If yes,complete form) <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 anothe r 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 Amountshipped sent with receiving lab's Compliance Agreement? <br /> g ❑ Yes (initial date) <br /> g ❑ Yes (initial/date) <br /> g ❑ Yes (initial/date) <br /> g ❑ yes (initial/date) <br /> *Soilscannotbetransferredtoanother destination withoutaPPQ530form.Contact Jordan Krug atJordan.d.kruR aohls.usda.Rov. <br /> initial/date after a copy of form has been sent to Anthony Jackson, USDA APHIS PPQ <br /> Page 14 of 16 <br />