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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-1684

2. Registrant Information.

Registrant Reference Number: SC1413884

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

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

City: Alberta

Prov / State: Calgary

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.

30-JUN-14

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

12-JUN-14

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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Tandem (unspecified)

  • Active Ingredient(s)
    • FLUROXYPYR 1-METHYLHEPTYL ESTER
    • PYROXSULAM

PMRA Registration No. 29622      PMRA Submission No.       EPA Registration No.

Product Name: plus M Ester 600

  • Active Ingredient(s)
    • MCPA (PRESENT AS ESTERS)

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

6

Other Units: per acre

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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: spring wheat

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

A farmer applied the products to a field of spring wheat late afternoon/early evening on June 12th. There was a light breeze blowing towards two yard sites across the road but not excessive. Weather data from nearby station shows 10-15km per hour wind and an average temperature of 21C. The field is predominantly upslope from the yard sites. Several days later the occupants of the yard sites alleged chemical injury to several trees and plants in their yard sites.

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)

deciduous trees, evergreens, maple, elm, oak and fruit trees

3. Scientific name(s)

n/a

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

Epinasty (leaf wilt)

Visible injury ( eg. chlorosis, necrosis, bleaching)

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

Leaves on the deciduous trees were cupped with twisted petioles. Candles on evergreen trees were also slightly curled. Symptoms most evident on maple, elm, oak and fruit trees. Lambsquarters in a garden in the far back of the yard were also twisted and yellowing.

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

Drift

N/A

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

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

9. Did it rain

9. a) During application?

No

9. b) Up to 3 days after application?

No

10. a) Was there a buffer zone?

No

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

n/a