Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-4487

2. Registrant Information.

Registrant Reference Number: 1-49473771

Registrant Name (Full Legal Name no abbreviations): ADAMA Agricultural Solutions Canada Ltd.

Address: 300 191 Lombard Avenue

City: Winnipeg

Prov / State: MB

Country: Canada

Postal Code: R3B 0X1

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

Environment

4. Date registrant was first informed of the incident.

25-AUG-17

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

20-AUG-17

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. 29052      PMRA Submission No.       EPA Registration No.

Product Name: SILENCER 120 EC EMULSIFIABLE CONCENTRATE INSECTICIDE

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

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).

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

Fish - Schooling/Poisson-Vivant en banc

2. Common name(s)

trout

3. Scientific name(s)

Unknown

4. Number of organisms affected

400

5. Description of site where incident was observed

Fresh water

Pond

Terrestrial

Other

Salt Water

6. Check all symptoms that apply

Death

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

The farmer's neighbour puts trout fry in a small pond (dug out) on his property every spring to raise them up over the summer and harvest in the fall. About 3-4 days ago (approximately August 20, 2017), an aerial sprayer was applying the product on a nearby field and some drift got into the pond and all the fish died.

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)

Major

13. Please provide supplemental information here

Environmental conditions (weather), crop, rate and depth of the pond were not reported to the registrant.