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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-2231
2. Registrant Information.
Registrant Reference Number: x
Registrant Name (Full Legal Name no abbreviations): x
Address: x
City: x
Country: x
3. Select the appropriate subform(s) for the incident.
Environment
4. Date registrant was first informed of the incident.
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
07-AUG-14Product 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.
Product Name: unknown
- Active Ingredient(s)
- HYDROGEN PEROXIDE
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
it was determined that the hydrogen peroxide was mixed in the spray solution at 0.2% using a boom pressure of 90 psi and ultra-coarse nozzles using 25 gal of water per acre. No other insecticides were used in the tank prior to the application and the tank was cleaned using a tank cleaner to remove any pesticide residue since the sprayer was last used to apply glyphosate in the spring.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
Terr. Invrtbrt-Honey Bee/Inv.Ter-Abeille
2. Common name(s)
Honey Bee
3. Scientific name(s)
Unknown
4. Number of organisms affected
Unknown
5. Description of site where incident was observed
Fresh water
Terrestrial
Agricultural
Salt Water
6. Check all symptoms that apply
Abnormal behavioural effects
Death
7. Describe symptoms and outcome (died, recovered, etc.).
Based on the description provided by Bker and the observation I made at the time of inspection there was a small number of dead bees in front of multiple hives at both locations that seem to have died at the same time, likely the day prior to the inspection as indicated by BKer during the site visit. The application of a foliar fertilizer (Releaf) with the addition of hydrogen peroxide was applied in two nearby bean fields around the same time as the bees at both yards appeared to have been impacted (showing signs of agitation and some dead bees in front of multiple hives).
8. a) Was the incident a result of (select all that apply)
Unknown
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
