Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5817

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: PRINCE EDWARD ISLAND

6. Date incident was first observed.

29-SEP-13

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. 28198      PMRA Submission No.       EPA Registration No.

Product Name: ROUNDUP TRANSORB HC LIQUID HERBICIDE

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS POTASSIUM SALT)

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PMRA Registration No. 17511      PMRA Submission No.       EPA Registration No.

Product Name: IPCO 2,4-D AMINE 600 LIQUID HERBICIDE

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)

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PMRA Registration No. 5931      PMRA Submission No.       EPA Registration No.

Product Name: 2,4-D AMINE 600 HERBICIDE

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)

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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

Préciser le type: clover

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

A farmer in

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)

Bees

Unknown

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Agricultural

Salt Water

6. Check all symptoms that apply

Death

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

It was recently brought to my attention that on September 20, a farmer in western PEI applied herbicides to a clover field; during the spray application 14 bee hives that were in the field for pollination purposes received a direct pesticide hit (the farmer reportedly admitted that the sprayer boom passed directly over the hives.) On September 29, dead bees were found outside of each hive and many more bees were Province of PEI is investigating the incident have seized the farmers spray and purchase records. They have determined that the pesticide products used on Sept 20 were Round up Transorb HC Liquid Herbicide (PCP #28198); 2,4-D Amine 600 Liquid Herbicide (PCP 17511) and 2,4-D Amine 600 Herbicide (PCP #5931).

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

Application

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?

No

10. b) What type?

Aquatic

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