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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3412

2. Registrant Information.

Registrant Reference Number: DAS130501-00

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

Address: Suite 2100, 450 - 1 Street S.W.

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 5H1

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: BRITISH COLUMBIA

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. 14879      PMRA Submission No.       EPA Registration No.

Product Name: Lorsban 4E Insecticide

• Active Ingredient(s)
  • CHLORPYRIFOS

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?

Jug-plastic / Cruche-plastique

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.

DAS was made aware of leaking plastic jugs found in approximately 1.5 pallets of product that were in storage at a farm retail warehouse. It appeared that some of the seals on the jugs did not seal properly during manufacture, so some of the product leaked out during shipping / storage. It is unknown exactly how much product leaked out, but it was a very small amount per jug (just enough to drip down the sides of some of the jugs). There was no human or environmental exposure as the issue was identified at the retail warehouse before any product was sold to end-users. DAS Supply Chain staff were made aware of the issue and changes were subsequently made at the manufacturing / packaging facility to address the container seal issue.

For Registrant use only

5. Provide supplemental information here.