Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-1162

2. Registrant Information.

Registrant Reference Number: A190100680

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: 24th Floor, 215 2nd Street SW

City: Alberta

Prov / State: Calgary

Country: Canada

Postal Code: T2P 1M4

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

Environment

4. Date registrant was first informed of the incident.

11-JUN-19

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

01-JUN-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. 30914      PMRA Submission No.       EPA Registration No.

Product Name: Curtail M Herbicide

• Active Ingredient(s)
  • CLOPYRALID
  • MCPA (PRESENT AS ESTERS)

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PMRA Registration No. 22878      PMRA Submission No.       EPA Registration No.

Product Name: Curtail F Herbicide

• Active Ingredient(s)
  • CLOPYRALID
  • MCPA (PRESENT AS ESTERS)

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

Product Name: Methoprene

• Active Ingredient(s)

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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).

Incident occurred in homeowners yard. Application rate, amount and treated area unknown.

To be determined by Registrant

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

No

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Fish-Non-schooling/Poisson-Autre poisson

2. Common name(s)

Koi

3. Scientific name(s)

Unknown

4. Number of organisms affected

90

5. Description of site where incident was observed

Fresh water

Pond

Terrestrial

Residential

Salt Water

Other

6. Check all symptoms that apply

Abnormal behavioural effects

Impairment of health

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

The exposure was accidental, and occurred in home owner's yard. The neighbor sprayed this product without the koi owner knowing, and the fish became symptomatic about a week later. Fish behavior was reported unusual as they were laying at the bottom of the pond, while some were floating on their sides; once touched, they would respond. This product is expected to be nontoxic to fish.

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

Application

N/A

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?

No

To be determined by Registrant

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

Moderate

13. Please provide supplemental information here