Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-5192

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-41473665

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

Address: 140 Research Lane, Research Park

City: Guelph

Prov / State: Ontario

Country: Canada

Postal Code: N1G4Z3

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

Environment

4. Date registrant was first informed of the incident.

04-AUG-15

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

31-JUL-15

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. 31058      PMRA Submission No.       EPA Registration No.

Product Name: Reglone Ion

• Active Ingredient(s)
  • DIQUAT

---

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: Peas

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

Peas were sprayed with aerial application. No additional application information is known.

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

Herbaceous Plants / Plante herbacée

2. Common name(s)

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

Visible injury ( eg. chlorosis, necrosis, bleaching)

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

1-41473665-The reporter, a registrant employee, indicated that a vegetable garden had inadvertently been exposed to an herbicide containing the active ingredient diquat. The reporter stated that a farmer had his peas sprayed via aerial application four days prior to initial contact with the registrant. Some drift ended up on the neighbors vegetable garden and at the time of the call there was unspecified damage to the garden plants. No additional information is available.

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

Application

N/A

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?

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)

Minor

13. Please provide supplemental information here