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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-4652
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: ONTARIO
6. Date incident was first observed.
24-JUL-14Product 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. PMRA Submission No. EPA Registration No.
Product Name: Garlon
- Active Ingredient(s)
- TRICLOPYR, PRESENT AS BUTOXYETHYL ESTER
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).
is concerned for the creek which borders hers and a neighbouring farmers property. The neighbouring farmer cut down the majority of trees on his side of the creek, claiming that they were impacting his tile drainage. After cutting these trees, "someone in a white suit and goggles" was seen spraying something along the freshly cut area. is also concerned as the creek, which usually runs clear has now become murky and milky.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
Unknown
5. Description of site where incident was observed
Fresh water
Terrestrial
Residential
Salt Water
6. Check all symptoms that apply
Abnormal leaf discoloration
Visible injury ( eg. chlorosis, necrosis, bleaching)
7. Describe symptoms and outcome (died, recovered, etc.).
The area has now become an eyesore and trees on her property were exhibiting signs of pesticide use (browning, wilting, dying).is also concerned as the creek, which usually runs clear has now become murky and milky. Children and the family dog usually enjoy playing in the creek and she is concerned about what kind of chemicals could have been used on the creek to make it this way. She also notes concerns about her well water, and the animal life found in and near the creek.
8. a) Was the incident a result of (select all that apply)
Application
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
