Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-1587

2. Registrant Information.

Registrant Reference Number: DASC052517

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

Address: 2400, 215-2nd Street S.W.

City: Alberta

Prov / State: Calgary

Country: Canada

Postal Code: T2P 1M4

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

Environment

4. Date registrant was first informed of the incident.

25-MAY-17

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

Unknown

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. 27634      PMRA Submission No.       EPA Registration No.

Product Name: Grazon

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

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

Caller hired a contractor to spray the product in her pasture and backyard where her horses graze to control baby's breath, Russian thistle, and prickly lettuce. The applicator used both a quad and hand held sprayer. She said he was spraying in shorts and not using coveralls or a respirator. She is noticing alleged potential damage to her pine, spruce, apricot and sea buckthorn trees and commented that the blue dye that was used while spraying can be seen on the trees.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Trees or shrubs / Arbre ou arbuste

2. Common name(s)

Pine Tree, Spruce Tree, Apricot Tree, Willow and Seabuckthorn Bush

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.).

Approximately one acre was sprayed. All spray was under the apricot, seed buckthorn, three pine trees and one Blue Spruce. Willows are starting to look affected as well. Coniferous species needles are starting to brown off but no twisting to speak of.

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