Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-0508

2. Registrant Information.

Registrant Reference Number: DASC072318

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.

23-JUL-18

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

25-JUN-18

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. 28945      PMRA Submission No.       EPA Registration No.

Product Name: Grazon XRT

  • Active Ingredient(s)
    • TRICLOPYR

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: Other / Autre

Préciser le type: Along a retaining wall

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

Applicator controlling non-desirable shrubs and broad leaf weeds along retaining wall / fenced area reported drift into non-target area.

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)

Crab apple trees and shrubs

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

Epinasty (leaf wilt)

Visible injury ( eg. chlorosis, necrosis, bleaching)

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

Cupping/browning (dessication) of affected, non-target foliage of shrubs. Alleged crab apple trees showed yellowing of leaves.

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

Drift

N/A

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?

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