Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-8026

2. Registrant Information.

Registrant Reference Number: 2007 IR-01

Registrant Name (Full Legal Name no abbreviations): Nalco Canada Company

Address: 1055 Truman Street, POBox 5002

City: Burlington

Prov / State: Ontario

Country: Canada

Postal Code: L7R 3Y9

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

Human

4. Date registrant was first informed of the incident.

22-SEP-07

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

02-AUG-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. 17574      PMRA Submission No.       EPA Registration No.

Product Name: Nalco 7320

• Active Ingredient(s)
  • 2,2-DIBROMO-3-NITRILOPROPIONAMIDE

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

5000

Units: ppm

10. Site pesticide was applied to (select all that apply).

Site: Industrial / Industriel

Préciser le type: Metalworking Fluids containing water

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

Incident Summary ¿ Pertinent Details ¿ 10 Gallons of Dasco Clear 584 was added to at least 3 flush booths. ¿ 3 Gallons of Nalco 7320 was added to each of the 3 flush booths approximately 15 minutes after the Dasco Clear 584 addition. o Each Flush booth system volume is approximately 600 USG. o Use concentration of Nalco 7320 was 5,000 ppm product to system volume. o Prescribed use concentration of Nalco 7320 is 150 to 200 ppm to system volume. ¿ High concentrations of both Dasco Clear 584 and Nalco 7320 caused irritating fumes to personnel in the area. o Those that were affected were evacuated until the fumes dissipated. ¿ Flush booth contents were drained to the pit, then, refilled with fresh city water. ¿ Contents of flush booths were diluted with 20 USGPM of city water in the pit for approximately 90 minutes. o The contents of the pit were transferred to the storage tanks in the mechanical room for liquid waste disposal. o Noco contacted Nalco for Nalco 7320 data. o Estimated concentration of Nalco 7320 after dilution and residence time is 800 ppm.

To be determined by Registrant

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

No

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

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Irritated throat

• Eye
  • Symptom - Irritated eye

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Occupational

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

Drift from the application site

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

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

To the best of our knowledge, all 3 criteria for minor classification are met.