Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-5455
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: QUEBEC
6. Date incident was first observed.
28-MAY-12
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.
Product Name:
- Active Ingredient(s)
- ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
- CLOTHIANIDIN
- PENDIMETHALIN
- S-METOLACHLOR AND R-ENANTIOMER
- THIAMETHOXAM
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).
Cultures dominantes mais et soya (a moins de 100 m du rucher). Le soya a ete seme environ 2 semaines avant levenement. Du mais avait ete seme plus tot en saison, mais le champ adjacent a ete seme deux jours auparavant.
Methode d application principale semoir pneumatique.
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)
Apis mellifera
4. Number of organisms affected
200
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.).
Abeilles particulierement agressives en comparaison avec leur comportement habituel. Accumulation de cadavres a lentree des ruches. Plusieurs dizaines de cadavres devant toutes les ruches. Activite normale a lentree des ruches. Mort
Numero dechantillon analyse par le MAPAQ
70405501 0,007 mg g de Clothianidine et 0,001 mg g de Thiamethoxame.
Contenait aussi 0,004 mg g d Atrazine, 0,005 mg g de Desethyl Atrazine, 0,005 mg g de Metolachlore et 0,003 mg g Pendimethaline
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?
Terrestrial
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
Yes
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