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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1731

2. Registrant Information.

Registrant Reference Number: 2011-IR-01

Registrant Name (Full Legal Name no abbreviations): E.I. du Pont Canada Company

Address: 7070 Mississauga Road

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: LN 5M8

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

Packaging Failure

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

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.

PMRA Registration No. 25462      PMRA Submission No.       EPA Registration No.

Product Name: Assure II Herbicide

• Active Ingredient(s)
  • QUIZALOFOP P-ETHYL

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

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?

Unknown

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Other / Autre

specify tote bin

2. Did packaging failure occur during?

Storage

3. Did packaging failure result in?

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

The consignee at the warehouse reported leaks from the vented lids of seven tote bins. No injuries. There is a total of 1 to 2 litres that have leaked. The spillage is confined to the top of the tote bins. The consignee stated that they would clean up the spillage and that they wanted to report the situation to the registrant of the product and that no further assistance is required.

For Registrant use only

5. Provide supplemental information here.