Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2563

2. Registrant Information.

Registrant Reference Number: DAS12072300

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: Suite 2100, 450 - 1 Street S.W.

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 5H1

3. Select the appropriate subform(s) for the incident.

Environment

4. Date registrant was first informed of the incident.

23-JUL-12

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

12-MAY-12

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

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PMRA Registration No. 28551      PMRA Submission No.       EPA Registration No.

Product Name: Restore A

• Active Ingredient(s)
  • AMINOPYRALID

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PMRA Registration No. 28552      PMRA Submission No.       EPA Registration No.

Product Name: Restore B

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

15

Other Units: ac/case

10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'ext.maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Certified applicator applied product by quad sprayer up to drip line of white spruce, blue spruce and poplar trees. Spruce trees are showing symptoms of herbicide damage. Wind was from SW. Need to investigate more to rule out drifting. Applied to mowed grass area.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Trees or shrubs / Arbre ou arbuste

2. Common name(s)

white spruce, blue spruce

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Residential

Salt Water

6. Check all symptoms that apply

Abnormal leaf discoloration

Visible injury ( eg. chlorosis, necrosis, bleaching)

7. Describe symptoms and outcome (died, recovered, etc.).

Spruce trees are showing signs of turning a light green to brown at ends of growing points. Apparently no sign of growing point twisting. Will confirm this on visit to site. Will need to wait until next year to see if recovery happens.

8. a) Was the incident a result of (select all that apply)

Application

N/A

8. b) i) How many times has the product been applied this year?

Unknown

8. b) ii) What was the date of the last application?

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

No

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

Minor

13. Please provide supplemental information here