Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-4637

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: 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.

27-MAY-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. 29334      PMRA Submission No.       EPA Registration No.

Product Name: GARLDON RTU HERBICIDE

  • Active Ingredient(s)
    • TRICLOPYR, PRESENT AS BUTOXYETHYL ESTER

PMRA Registration No. 24359      PMRA Submission No.       EPA Registration No.

Product Name: GLYFOS SOLUBLE CONCENTRATE HERBICIDE

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Unknown / Inconnu

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

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)

Cherry tree, Manitoba Maple, Sugar maples, Norway maples, Mulberries

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Other

Salt Water

6. Check all symptoms that apply

Death

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

Caller reports on May 23 they sprayed Glyfos for noxious weeds and Garlin RTU for Buckthorn. The caller noted there are no noxious weeds and they have killed Cherry Tree, Manitoba Maple, Sugar Maples, Norway Maples, Mulberries all in a natural area on the north side.Some red coloured pesticides signs were observed in the area. There was also evidence of pesticide application on vegetation namely Buckthorn trees, which are an invasive species. There were some other non targeted tree species that were effected by pesticide drift. Tree species observed to be impacted were maples and cherry. there was some drift during the application, however he stopped when the drift was bad.

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

Drift

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)

13. Please provide supplemental information here

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Trees or shrubs / Arbre ou arbuste

2. Common name(s)

Beech tree

3. Scientific name(s)

Unknown

4. Number of organisms affected

1

5. Description of site where incident was observed

Fresh water

Terrestrial

Other

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.).

Some red coloured pesticides signs were observed in the area. There was also evidence of pesticide application on vegetation namely Buckthorn trees, which are an invasive species. There were some other non targeted tree species that were effected by pesticide drift. a large beech tree showing signs of stress in the leaves. The leaves appeared to be brown and curling, the beech tree was across the paved path where an area of forest had been sprayed by pesticides. there was some drift during the application, however he stopped when the drift was bad.

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

Drift

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)

13. Please provide supplemental information here