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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-5739

2. Registrant Information.

Registrant Reference Number: 332344

Registrant Name (Full Legal Name no abbreviations): Intelligro, a Suncor Energy business

Address: 2489 North Sheridan Way

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5K 1A8

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: ONTARIO

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. 29825      PMRA Submission No.       EPA Registration No.

Product Name: CIVITAS FUNGICIDE FOR GOLF COURSE TURF

• Active Ingredient(s)
  • MINERAL OIL (INSECTICIDAL)

7. b) Type of formulation.

Application Information

8. Product was applied?

No

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 Plastic Pail

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.

Package leaked from crack in bottom of pails on to warehouse floor where it was contained. It is unknown if rough handling was the cause of the cracks.

For Registrant use only

5. Provide supplemental information here.