Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-3187
2. Registrant Information.
Registrant Reference Number: Ontario MOECC
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.
Unknown
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. 29341
PMRA Submission No.
EPA Registration No.
Product Name: Halex GT Herbicide
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS POTASSIUM SALT)
- MESOTRIONE
- S-METOLACHLOR AND R-ENANTIOMER
PMRA Registration No. 18450
PMRA Submission No.
EPA Registration No.
Product Name: Aatrex Liquid 480 Herbicide
- Active Ingredient(s)
- ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
PMRA Registration No. 28327
PMRA Submission No.
EPA Registration No.
Product Name: PRO-SURF II A NON-IONIC LIQUID WETTING AND SPREADING AGENT
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: Agricultural-Outdoor/Agricole-extérieur
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
As per farmer, Halex was the product at 1.7 lt per acre, atrazine @ .25 lt per acre and pro-surf II. This combo would hit grass hard. Cows are still in pasture today so can't be too concerned. Finished our corn by 22 May so was before then. Spray date was prior to May 22.
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
Herbaceous Plants / Plante herbacée
2. Common name(s)
Unknown
3. Scientific name(s)
Unknown
4. Number of organisms affected
Unknown
5. Description of site where incident was observed
Fresh water
Terrestrial
Salt Water
6. Check all symptoms that apply
Visible injury ( eg. chlorosis, necrosis, bleaching)
7. Describe symptoms and outcome (died, recovered, etc.).
8. a) Was the incident a result of (select all that apply)
Application
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?
No
9. b) Up to 3 days after application?
Unknown
10. a) Was there a buffer zone?
Unknown
10. b) What type?
Aquatic
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