Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2015-7010

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: x

Nom du titulaire (nom légal complet, aucune abbréviation): x

Adresse: x

Ville: x

État: x

Pays: x

Code postal /Zip: X

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Environnement

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

5. Lieu de l'incident.

Pays: CANADA

État: ONTARIO

6. Date de la première observation de l'incident.

12-JUN-13

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

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ARLA No d'homologation 27833      ARLA No de la demande d'homologation       EPA No d'homologation.

Nom du produit: CALLISTO 480SC HERBICIDE

• Matière active
  • MESOTRIONE

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ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation.

Nom du produit: Primextra II Magnum

• Matière active
  • ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
  • S-METOLACHLOR AND R-ENANTIOMER

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ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation.

Nom du produit: Touchdown

• Matière active
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)

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7. b) Type de formulation.

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Oui

9. Dose d'application.

10. Site d'application (choisir tout ce qui s'applique).

Site: Agricultural-Outdoor/Agricole-extérieur

Specify Type: corn

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

Caller complains that a company has been spraying an application of weed-control chemicals that has been damaging the crops on his farm. The chemical has been used to control weeds on a corn farm and include the following substances: 85 mL of Callisto-480-SC, 1L/acre of Prime-Extra-2-Magnum and 1L/acre of Touchdown.

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire IV : Environnement (y compris les plantes, les insectes et la faune)

1. Type d'organisme touché

Trees or shrubs / Arbre ou arbuste

2. Nom(s) commun(s)

raspberry

3.Nom(s) scientifique(s)

Inconnu

4. Nombre d'organismes touchés

Inconnu

5. Description du lieu où l'incident a été observé:

Eau douce

Terrestre

Agricole

Eau salée

6. Cocher tous les symptômes qui s'appliquent à:

Lésions visibles à l'oeil nu (p. ex. chlorose [jaunissement], nécrose, décoloration)

7.Décrire les symptômes et issue (mort, rétablissement, etc.).

June 12, Caller noticed that it had affected his farm yesterday when he observed his rasberry crops had discolouration on the tops of the canes, occurring for a length of 15-20 ft across his crops. When he looked closer at the corn adjacent to the roads, the weeds were dead allowing him to realize that the application had spread to his farm. Caller explains that the winds on that day were excessive and spraying should not have occurred. June 19, caller reports that pumpkin plants at XXX XXXXX., are now also showing some blocking and narcosis and notice this at 9:30 near a spot where he observed the custom applicator spraying what he believed were pesticides on Saturday June 15, 2013. On Saturday June 15, 2013 at 19:00 he was sitting on his back patio of his home. He reports he observed 500 metres from his patio to the tree line. He observed brown dust and a plume of 25-30 feet above the crest of the hill and then equipment -a tractor- crest the hill. He observed equipment spray a white mist which tumbled 25-30 feet up in the air. He believed this mist was a pesticide as it was being applied to the corn plantation owned by neighbour, the same farmer who owns the corn planted at XXX XXXXX St. in XXXXX , adjacent to the affected raspberry crop. He believed it was the same custom applicator at both locations. He noted the winds were from the west and high winds. the white mist believed to be pesticides applied to corn was seen tumbling east and the equipment applying pesticides was also moving east. At this point he was not aware his raspberry crops were damaged or would be damaged. On Wednesday June 19, 2013 he noticed some yellow splotching on the older larger leaves of his pumpkin plants. The pumpkin plants are 50-100 feet from the edge of the corn field where pesticides were believed to be applied. there is a line of grass and weds between the corn and pumpkin planting. This yellow splotching on pumpkin plants leaves is believed to be the same as that on the raspberry plants at XXX XXXXX St. XXXXX reports that the yellow splotching has progressed and is more identifiable in more of the plants, so it is easier to see. The plants had no fruit or flowers on them yet.

8. a) Est-ce que l'incident a été causé par (coucher tout ce qui s'applique) :

Dérive de pulvérisation

8. b) i)Combien de fois le produit a-t-il été appliqué cette année?

8. b) ii)Date de la dernière application

9. Est-ce qu'il a plu

9. a) Pendant l'application?

Non

9. b) Jusqu'à 3 jours après l'application?

Non

10. a)Y avait-il une zone tampon?

Non

10. b) De quel genre?

Aquatique

10. c) Quelle étaite la taille de la zone tampon?

11.Est-ce que des échantillons ont été recueillis dans l'environnement et analysés?

Non

À être déterminé par le titulaire

12.Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

13.Donner des renseignements additionnels ici

Sous-formulaire IV : Environnement (y compris les plantes, les insectes et la faune)

1. Type d'organisme touché

Herbaceous Plants / Plante herbacée

2. Nom(s) commun(s)

pumpkins

3.Nom(s) scientifique(s)

Inconnu

4. Nombre d'organismes touchés

Inconnu

5. Description du lieu où l'incident a été observé:

Eau douce

Terrestre

Agricole

Eau salée

6. Cocher tous les symptômes qui s'appliquent à:

Lésions visibles à l'oeil nu (p. ex. chlorose [jaunissement], nécrose, décoloration)

7.Décrire les symptômes et issue (mort, rétablissement, etc.).

June 12, Caller noticed that it had affected his farm yesterday when he observed his rasberry crops had discolouration on the tops of the canes, occurring for a length of 15-20 ft across his crops. When he looked closer at the corn adjacent to the roads, the weeds were dead allowing him to realize that the application had spread to his farm. Caller explains that the winds on that day were excessive and spraying should not have occurred. June 19, caller reports that pumpkin plants at XXX XXXXX., are now also showing some blocking and narcosis and notice this at 9:30 near a spot where he observed the custom applicator spraying what he believed were pesticides on Saturday June 15, 2013. On Saturday June 15, 2013 at 19:00 he was sitting on his back patio of his home. He reports he observed 500 metres from his patio to the tree line. He observed brown dust and a plume of 25-30 feet above the crest of the hill and then equipment -a tractor- crest the hill. He observed equipment spray a white mist which tumbled 25-30 feet up in the air. He believed this mist was a pesticide as it was being applied to the corn plantation owned by neighbour, the same farmer who owns the corn planted at XXX XXXXX St. in XXXXX , adjacent to the affected raspberry crop. He believed it was the same custom applicator at both locations. He noted the winds were from the west and high winds. the white mist believed to be pesticides applied to corn was seen tumbling east and the equipment applying pesticides was also moving east. At this point he was not aware his raspberry crops were damaged or would be damaged. On Wednesday June 19, 2013 he noticed some yellow splotching on the older larger leaves of his pumpkin plants. The pumpkin plants are 50-100 feet from the edge of the corn field where pesticides were believed to be applied. there is a line of grass and weds between the corn and pumpkin planting. This yellow splotching on pumpkin plants leaves is believed to be the same as that on the raspberry plants at XXX XXXXX St. XXXXX reports that the yellow splotching has progressed and is more identifiable in more of the plants, so it is easier to see. The plants had no fruit or flowers on them yet.

8. a) Est-ce que l'incident a été causé par (coucher tout ce qui s'applique) :

Dérive de pulvérisation

8. b) i)Combien de fois le produit a-t-il été appliqué cette année?

8. b) ii)Date de la dernière application

9. Est-ce qu'il a plu

9. a) Pendant l'application?

Non

9. b) Jusqu'à 3 jours après l'application?

Non

10. a)Y avait-il une zone tampon?

Non

10. b) De quel genre?

Aquatique

10. c) Quelle étaite la taille de la zone tampon?

11.Est-ce que des échantillons ont été recueillis dans l'environnement et analysés?

Non

À être déterminé par le titulaire

12.Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

13.Donner des renseignements additionnels ici