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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-7003
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.
14-MAY-13Product 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: Touchdown
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
PMRA Registration No. PMRA Submission No. EPA Registration No.
Product Name: Primextra
- Active Ingredient(s)
- ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
- S-METOLACHLOR AND R-ENANTIOMER
PMRA Registration No. PMRA Submission No. EPA Registration No.
Product Name: Callisto
- Active Ingredient(s)
- MESOTRIONE
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
Site: Agricultural-Outdoor/Agricole-extérieur
Préciser le type: corn
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Caller stated that his neighbour sprayed pesticides and affected his apple orchard. The caller has a weather station and the winds at the time of spraying were between 15 to 20 km/h. He said there is spray drift about 800 feet into his farm. The spraying occurred May 14, 2013.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)
apple
3. Scientific name(s)
Unknown
4. Number of organisms affected
Unknown
5. Description of site where incident was observed
Fresh water
Terrestrial
Agricultural
Salt Water
6. Check all symptoms that apply
Visible injury ( eg. chlorosis, necrosis, bleaching)
7. Describe symptoms and outcome (died, recovered, etc.).
Caller states there was quite a bit of damage to his orchard. The farmer sprayed Touchdown, Primextra and Calisto. He aid the trees closest to the gap in the tree row were hit the hardest. XXXXX said the corn field was sprayed on May 14th and he started seeing some spots on Sunday May 19 then more after that.
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?
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?
Aquatic
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
