Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-6254

2. Registrant Information.

Registrant Reference Number: 3700144

Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.

Address: 202-6835 Century Ave

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5N 7K2

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

Environment

4. Date registrant was first informed of the incident.

26-AUG-23

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

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. 33637      PMRA Submission No.       EPA Registration No.

Product Name: ORTHO BEETLE B GON MAX BEETLE KLR 150G

• Active Ingredient(s)
  • BACILLUS THURINGIENSIS SUBSP. GALLERIAE, STRAIN SDS-502

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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: Res. - Out Home / Rés - à l'ext.maison

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

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

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)

Maple tree

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

Visible injury ( eg. chlorosis, necrosis, bleaching)

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

08/26/2023 I created a damage case, and I am asking the customer to call in so we can gather more information, since his email stated the product had turned the leaves brown and curled up on his maple tree. No further 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)

Moderate

13. Please provide supplemental information here

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.