Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4451

2. Registrant Information.

Registrant Reference Number: 2007-11

Registrant Name (Full Legal Name no abbreviations): BASF Canada

Address: 100 Milverton, 5Th

City: mississauaga

Prov / State: ON

Country: Canada

Postal Code: L5R4H1

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

Human

4. Date registrant was first informed of the incident.

13-JUN-07

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

13-JUN-07

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. 19349      PMRA Submission No.       EPA Registration No.

Product Name: marksman herbicide

• Active Ingredient(s)
  • ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)

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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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: cornfields adjacent

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

On june 3 the cornflields adjacent were sprayed with Marksman herbicide

To be determined by Registrant

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

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Numbness

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Other

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

12. Time between exposure and onset of symptoms.

>1 wk <=1 mo / > 1 sem < = 1 mois

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

On June 3 the cornfields adjacent to the callers home were sprayed w Marksman herbicide. Caller concerned that could have gotten into their well water which she says is ground water/springs and rain water.She and husband have been having symptoms, caller states they can smell herbicide in the well water. She complains of numbness in her arms since yesterday (6/12)

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Symptoms do not correspond with expected response to the product. Concerned re possible misinterpretation of symptoms, and/or possible misidentification of product or mixed exposure. There would only be parts per billion if any in the well water and no expected acute toxicity from this situation. poison control center advised symptoms not related to exposure if any-if symptoms continue follow up with pMD.