Persistent Herbicide Incidence Reporting Form

In order to stop the use of persistent herbicides in ways that impact compost, we need to know what and where the impacts are. If you suspect presence of persistent herbicides in compost or damage from persistent herbicides contained in compost please complete this form. This information will be kept confidential by the USCC unless permission to share it is granted.

Please complete a separate report form for each incident.

PART I. EVIDENCE OF PERSISTENT HERBICIDES
Details/Evidence of Event (an “event” is evidence of suspected herbicide damage from compost. This could be in a field, plot, or even bioassay screen): Be brief but as specific as possible in providing details about the event. Additional information about the event, such as photos, lab reports or other supporting documentation, may be sent by email by clicking the link at the end of the form.*
Where did the event take place? (eg, garden, field, lab, etc)*
State where event occurred*
County where event occurred*
Date adverse effects first observed*
MM slash DD slash YYYY
Ending date of observed adverse effects
MM slash DD slash YYYY
Please provide details about the plants affected during this event below. Please include the name of the effected plant (species if known), the age of the plants when damage was first observed, and either the percent of the planting or the number of plants affected. (at least one plant and age is required)*
Is there any evidence of herbicide use/misuse: (please choose 1)
PART II. SUSPECTED SOURCES OF CONTAMINATION
IIA--FOR COMPOST PRODUCERS ONLY
How big is your composting operation (tons/year or cubic yards/year)?
What feedstocks were used in the manufacturing of the compost?
Which of your feedstock(s) do you suspect are the source(s) of persistent herbicide?
Do you have any evidence to support this suspicion? If so, what is it?
IIB--FOR COMPOST USERS ONLY
Where did you get the suspected tainted compost?
How much did you get?
When did you get it?
Can you rule out the following scenarios that may have contributed to abnormal plant growth?
Herbicides applied to adjacent lawn or property
- Yes
- No
Ethylene toxicity in a greenhouse environment
- Yes
- No
PART III. CONTACT INFORMATION
Please provide contact information for the person responsible for this report. This information will be kept confidential unless you give us permission to share it. Providing it will allow us to ask follow up and clarifying questions.
Name*
First Last
Title
Company Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Information from this form will be kept confidential and only reported in aggregate unless specific permission is given. Giving us information to share with the EPA will allow the event to be investigated in detail.
- I give the USCC permission to share the contents of this form with the U.S. Environmental Protection Agency, and, if in California or New York, the appropriate state agency. Data from this form may be used to inform decision-making in the federal regulation of pesticides. Please note that the information submitted through this portal will not be used for targeted enforcement. If you wish to speak with someone about a potential investigation, please contact your state's lead agency for pesticide enforcement. Please note that government agencies cannot ensure that personally identifiable information in reports will be kept confidential.
- Please send any additional information about this exposure you can. Items you may wish to provide might include: Photos of the suspected persistent herbicide impacts. Results of persistent herbicide indicator tests (bioassay). (Please include indicator species, sample description, measured value, and units.) Results of pesticide residue analysis of tissue or soil samples. (Please include species, sample description, name of the pesticide or degradation product, measured value, and units.) Any other environmental measurements taken at the incident site can also be sent.
To send photos, lab results, or other supplemental information, click HERE
Phone
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