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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2023-1419
2. Registrant Information.
Registrant Reference Number: HS2311
Registrant Name (Full Legal Name no abbreviations): GOWAN COMPANY, L.L.C.
Address: PO Box 5569
City: Yuma
Prov / State: Arizona
Country: USA
Postal Code: 85366-5569
3. Select the appropriate subform(s) for the incident.
Scientific Study
4. Date registrant was first informed of the incident.
5. Location of incident.
6. Date incident was first observed.
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. 25309
PMRA Submission No.
EPA Registration No.
Product Name: PROSULFURON TECHNICAL HERBICIDE
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform VII: Scientific Study
1. Study Reference
Title SYN552909 -Micronucleus Test in Human Lymphocytes In Vitro Final report
Date 24-MAR-23
2. a) Is an extension needed to translate the document?
No
3. Type of incident identified in the study
New health or environmental hazard
4. Describe the incident identified in the study (e.g. study demonstrates an increased risk to non-Hodgkin's Lymphoma after exposure to pesticide X)
New scientific finding
5. a) Was the study discontinued before completion?
No
5. b) Provide the reason for discontinuation
6. If the study is ongoing, what is the expected completion date?
For Registrant use only
7. Provide supplemental information here
This study was conducted in support of EU registration activities