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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-4639
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.
04-JUN-14Product 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: unknown
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE 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: Agricultural-Outdoor/Agricole-extérieur
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
The caller said his neighbour sprayed a pesticide and it damaged some of his property.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)
Blue spruce
3. Scientific name(s)
Unknown
4. Number of organisms affected
5
5. Description of site where incident was observed
Fresh water
Terrestrial
Residential
Salt Water
6. Check all symptoms that apply
Abnormal abscission
Abnormal leaf discoloration
7. Describe symptoms and outcome (died, recovered, etc.).
He said there isn't too much damage but 4 or 5 of his blue spruce trees had needles that were turning brown and falling off. The weeds between the trees are also dying or dead. He spoke with the farmer and they said both of them had been spraying and they wondered how much damage there was. He said not too much and he hasn't heard from them again. XXXXXX farms with his son XXXXXX. XXXXXX was weed whacking in his yard and noticed the damaged spruce trees on the north side of his property. The white pine on the south side of the property are okay. There was some browning of needles on some of the blue spruce trees but it wasn't every one. The only needles that were browning on the blue spruce trees were found low down and next to the sprayed field.
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?
Unknown
9. b) Up to 3 days after application?
Unknown
10. a) Was there a buffer zone?
Unknown
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)
Green spruce
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
Abnormal abscission
7. Describe symptoms and outcome (died, recovered, etc.).
There were some shorter needled green spruce that were losing needles all around the trees. They didn't look as robust as the other trees, especially the blue spruce.
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?
Unknown
9. b) Up to 3 days after application?
Unknown
10. a) Was there a buffer zone?
Unknown
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
Herbaceous Plants / Plante herbacée
2. Common name(s)
Weeds
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
Abnormal leaf discoloration
7. Describe symptoms and outcome (died, recovered, etc.).
There was also signs of pesticide damage on the weeds between the trees. There also appeared to be some white spots on vegetation across the property towards the back of it and in the laneway between the house and the pond. Some weeds also had some brown spots which could have been fungal. White spots were seen on the weeds between and behind the trees.
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?
Unknown
9. b) Up to 3 days after application?
Unknown
10. a) Was there a buffer zone?
Unknown
10. b) What type?
Aquatic
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
