Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-3285

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: SASKATCHEWAN

6. Date incident was first observed.

19-JUN-19

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. 30391      PMRA Submission No.       EPA Registration No.

Product Name: AXIAL XTREME HERBICIDE

• Active Ingredient(s)
  • FLUROXYPYR (PRESENT AS 1-METHYLHEPTYL ESTER)
  • PINOXADEN

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7. b) Type of formulation.

Liquid

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 following was reported: On June 19th, between the hours of 1100 and 1600, the farmer sprayed his crop/field, situated directly East of our yard/residence. I motioned/waved to get his attention, but was not successful. I was standing right by the municipal road. I took the first video at 1300. It was very windy, from the SE. The wind speed with the high rate of speed of the tractor/sprayer combined to move the chemical cloud quite a distance onto our property. The spray covered our gardens, fruit trees, house, vehicles and everything on our property including our renters canola crop.

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)

Unknown

3. Scientific name(s)

Unknown

4. Number of organisms affected

1000

5. Description of site where incident was observed

Fresh water

Terrestrial

Residential

Agricultural

Salt Water

6. Check all symptoms that apply

Abnormal leaf discoloration

Deformities

Epinasty (leaf wilt)

Visible injury ( eg. chlorosis, necrosis, bleaching)

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

The following was reported: Plants/trees burnt crispy, yellow, white discoloration, curling and cupping, browned, wilted distorted, mutation.

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?

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?

Aquatic

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Unknown

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)

Unknown

3. Scientific name(s)

Unknown

4. Number of organisms affected

1000

5. Description of site where incident was observed

Fresh water

Terrestrial

Residential

Agricultural

Salt Water

6. Check all symptoms that apply

Abnormal leaf discoloration

Deformities

Epinasty (leaf wilt)

Visible injury ( eg. chlorosis, necrosis, bleaching)

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

The following was reported: Plants/trees burnt crispy, yellow, white discoloration, curling and cupping, browned, wilted distorted, mutation. (Note: The spray covered the reporter's gardens, fruit trees, house, vehicles and everything on their property including the renter's canola crop).

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?

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?

Aquatic

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Unknown

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