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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-0460

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.

12-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)

PMRA Registration No. 19349 PMRA Submission No. EPA Registration No.

Product Name: MARKSMAN HERBICIDE

Active Ingredient(s)
- ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
  - Guarantee/concentration 261 g/L
- DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, POTASSIUM SALT, OR SODIUM SALT)
  - Guarantee/concentration 132 g/L

PMRA Registration No. PMRA Submission No. EPA Registration No.

Product Name: ROUNDUP

Active Ingredient(s)
- GLYPHOSATE

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

200

Units: L/ha

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).

The following was reported: Products were applied to corn crops (4-6 inches tall) by a licensed applicator on June 21 and 22, 2019. The target weed was broadleaf. Size of treatment area ~16 ha. A course TEEJet Air Induction nozzle was used. Spray volume rate of ~200L/ha. Environmental conditions reported on June 23: high of 26 temperature; avg 75% humidity; wind speed at high 20km/h, never below 7 km/hr, always blowing north. Given the 2 day range of when application occurred, the weather measurements reported are the extreme highs during that window, and not necessarily relative to the date or time of application. A thermal inversion meter was not used. (Weather gathered from local station and not accurate to conditions at the site of the incident. Average windspeed below 15km/h). No rainfall reported in the 48 hours following product application. Sensitive IP soybeans were located nearby, but not downwind.

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)

IP Soybeans

3. Scientific name(s)

Glycine max

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

Abnormal plant stance

Deformities

Stunted vegetative growth

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

Type of injury reported: cupping and strapping, and stunted. Severity is 10-30% IP soybeans damaged. Damage at the south (back) of field. Showed injury along whole west side of the field as well. Injury differed in severity through the damaged area. App. 17 acres showing some symptoms. Some areas less severe than others. Field size is app. 52 acres. No other injuries from nearby plants/crops noticed or reported in the area.

8. a) Was the incident a result of (select all that apply)

Unknown

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?

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

10. b) What type?

Terrestrial

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)

Minor

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Incident Report

Subform I: General Information

1. Report Type.

2. Registrant Information.

3. Select the appropriate subform(s) for the incident.

4. Date registrant was first informed of the incident.

5. Location of incident.

6. Date incident was first observed.

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.

7. b) Type of formulation.

Application Information

8. Product was applied?

9. Application Rate.

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

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

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

2. Common name(s)

3. Scientific name(s)

4. Number of organisms affected

5. Description of site where incident was observed

Fresh water

Terrestrial

Salt Water

6. Check all symptoms that apply

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

8. a) Was the incident a result of (select all that apply)

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?

9. b) Up to 3 days after application?

10. a) Was there a buffer zone?

10. b) What type?

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

11. a) Were environmental samples collected and analysed?

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