Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-2374
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: ONTARIO
6. Date incident was first observed.
27-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)
PMRA Registration No. 27884
PMRA Submission No.
EPA Registration No.
Product Name: PAR III TURF HERBICIDE
- Active Ingredient(s)
- 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
- DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, POTASSIUM SALT, OR SODIUM SALT)
- MECOPROP-P (PRESENT AS DIMETHYLAMINE SALT)
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: Res. - Out Home / Rés - à l'ext.maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Caller suspects the neighbour may be using poison which is killing her trees. Neighbour indicated that sprays his grass and other five properties with PAR III Turf Herbicide (Class 4; PCP #27884) also sprays the grass around theXXXXXs condos at the golf course.
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
Trees or shrubs / Arbre ou arbuste
2. Common name(s)
cedar
3. Scientific name(s)
Unknown
4. Number of organisms affected
Unknown
5. Description of site where incident was observed
Fresh water
Terrestrial
Residential
Salt Water
6. Check all symptoms that apply
Death
Visible injury ( eg. chlorosis, necrosis, bleaching)
7. Describe symptoms and outcome (died, recovered, etc.).
Cedar trees forming a hedge between properties are getting poisoned. Bottom1 - 1.5 ft of hedge is brown/dead. Some time last week the bottom part of the cedar hedge on the northern side of the property was sprayed with some sort of chemical. A pine tree located in proximity of the southwest corner of the house, close to the south property boundary (cedar hedge) was also sprayed and dying.
8. a) Was the incident a result of (select all that apply)
Drift
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?
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)
13. Please provide supplemental information here
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Trees or shrubs / Arbre ou arbuste
2. Common name(s)
pine
3. Scientific name(s)
Unknown
4. Number of organisms affected
1
5. Description of site where incident was observed
Fresh water
Terrestrial
Salt Water
6. Check all symptoms that apply
Death
Visible injury ( eg. chlorosis, necrosis, bleaching)
7. Describe symptoms and outcome (died, recovered, etc.).
Cedar trees forming a hedge between properties are getting poisoned. Bottom1 - 1.5 ft of hedge is brown/dead. Some time last week the bottom part of the cedar hedge on the northern side of the property was sprayed with some sort of chemical. A pine tree located in proximity of the southwest corner of the house, close to the south property boundary (cedar hedge) was also sprayed and dying.
8. a) Was the incident a result of (select all that apply)
Drift
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?
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)
13. Please provide supplemental information here