Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-3369

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: SASKATCHEWAN

6. Date incident was first observed.

04-JUL-19

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: Liberty

• Active Ingredient(s)
  • GLUFOSINATE-AMMONIUM

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Agricultural-Outdoor/Agricole-extérieur

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

Note: In the submitted report, the product was identified as "probably Liberty". The following was reported: A strong east north east wind on july 4th 2019 allowed the chemical from (name's) sprayer to drift across property lines killing the crops. I personally watched him spray and took a video on my phone and it clearly shows the chemical drifting away towards my crop. as well the machines exhaust is noticalbe drifting to the southwest as well. This has happened on numerous occasions in past consecutive years. I have held discussions with (name) in the past and it appeared he really was not concerned about what he was doing. He has also damaged trees in neighbouring yards as well as other neighbours crops in resent times. It appears he has no consideration for the safety of people or their property. I have made (name) aware of the damages he has caused but he contineus his reckless actions. I will provide my video to the investigor when they arrive.

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

Herbaceous Plants / Plante herbacée

2. Common name(s)

Crops (unspecified), grass

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

Death

Visible injury ( eg. chlorosis, necrosis, bleaching)

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

The following was reported: Aprox. 10 acres of my crop and a larger amount on my neighbours to the west, as well as damage to an occupied farm yard. Crops affected are dying. Grass in ditches is dying as well trees maybe affected.

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?

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?

Unknown

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

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

Agricultural

Salt Water

6. Check all symptoms that apply

Visible injury ( eg. chlorosis, necrosis, bleaching)

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

The following was reported: Aprox. 10 acres of my crop and a larger amount on my neighbours to the west, as well as damage to an occupied farm yard. Crops affected are dying. Grass in ditches is dying as well trees maybe affected.

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?

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?

Unknown

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