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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-5928
2. Registrant Information.
Registrant Reference Number: 07080101
Registrant Name (Full Legal Name no abbreviations): Nufarm Agriculture Inc.
Address: 5507 1 st Street SE
City: Calgary
Prov / State: AB
Country: Canada
Postal Code: T2H 1H9
3. Select the appropriate subform(s) for the incident.
Packaging Failure
4. Date registrant was first informed of the incident.
01-AUG-07
5. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
Unknown
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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No.
Product Name: Amitrol
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.
plastic bottle became brittle and product drained into storage container it was being stored in.
For Registrant use only
5. Provide supplemental information here.