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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-0915

2. Registrant Information.

Registrant Reference Number: DASL111108

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

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

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 5H1

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

Domestic Animal

4. Date registrant was first informed of the incident.

08-NOV-11

5. Location of incident.

Country: UNITED STATES

Prov / State: OREGON

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.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Outpost 22K

  • Active Ingredient(s)
    • PICLORAM (PRESENT AS ACID)
      • Unknown

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

6.4

Other Units: pt/acre

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

Site: Pub. Area - Outdoor/Zone publique - ext

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

THE TREATMENT AREA WAS ROADSIDE ROW THROUGH 2 RURAL SUBDIVISIONS. SPOT TREATMENT APPLICATIONS USING A 300 GALLON TRUCK MOUNTED SPRAYER AND HAND GUN. MIXTURE WAS 1 GALLON OUTPOST 22K PER 100 GALLONS OF WATER (1% SOLUTION). APPLICATION RECORDS INDICATE THAT HERBICIDE USE RATES EXCEEDED LABEL DIRECTIONS WITH RATES OF 6.4 TO 8.0 PT/ACRE APPLIED AT VARIOUS DATES BETWEEN JULY 12 AND AUGUST 4, 2010.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Dog / Chien

3. Breed

Saint Bernard

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify unknown

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

THE STATE HAS RECEIVED A REPORT OF ONE ST BERNARD THAT DIED THE YEAR OF TREATMENT (2010). NAMES AND SPECIFICS UNKNOWN AS ALL INFORMATION WAS OBTAINED FROM 3RD PARTY SOURCES.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

APPLICATION OF OUTPOST 22K IN ROADSIDE RIGHTS-OF-WAY BY KLAMATH COUNTY PUBLIC WORKS (OREGON) FOR THE CONTROL OF KNAPWEED ALLEDGEDLY RESULTED IN 1 DOG (MORTALITY). INFORMATION IS BASED ON VERBAL INFORMATION OBTAINED.