Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-4565

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: MANITOBA

6. Date incident was first observed.

13-AUG-17

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.       PMRA Submission No.       EPA Registration No.

Product Name: Matador

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

83

Units: mL/ha

10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: canola

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

Spray plane noticed flying over (location) Lake, the morning of August 12 2017. On August 13,2017, on the beach of (location), many dead water beetles and dead crayfish were observed and subsequently reported to the Manitoba Sustainable Development. Manitoba Sustainable Development notified the Manitoba Pesticide Compliance Program and Manitoba Agriculture about the incident. It was determined that the aerial applicator was spraying Matador (Lambda Cyhalothrin) on canola beside/near the lake for bertha army worms. Spray records indicate that on August 12 2017 at approximately 7:50am product was applied on Canola field.

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

Aquatic Invertebrate/Invertébré aquat.

2. Common name(s)

water beetles

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Lake

Terrestrial

Salt Water

6. Check all symptoms that apply

Death

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

Individual noticed an oily film on top of the water therefore exited the lake. On morning of August 13, 2017 it was noticed that many dead insects (water beetles) and crayfish were found on the beach of the lake. Called the Manitoba Sustainable Development on Monday, August 14 2017 to advise of incident. Samples of water and crayfish were taken by Manitoba Sustainable Development and spray records were retrieved by Manitoba Agriculture.

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?

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?

Yes

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Aquatic Invertebrate/Invertébré aquat.

2. Common name(s)

Crayfish

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Lake

Terrestrial

Salt Water

6. Check all symptoms that apply

Death

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

Individual noticed an oily film on top of the water therefore exited the lake. On morning of August 13, 2017 it was noticed that many dead insects (water beetles) and crayfish were found on the beach of the lake. Called the Manitoba Sustainable Development on Monday, August 14 2017 to advise of incident. Samples of water and crayfish were taken by Manitoba Sustainable Development and spray records were retrieved by Manitoba Agriculture.

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?

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?

Aquatic

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Yes

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here