Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-8819

2. Registrant Information.

Registrant Reference Number: IRF# 119

Registrant Name (Full Legal Name no abbreviations): Chemtura Canada Co./Cie

Address: 25 Erb Street

City: Elmira

Prov / State: Ontario

Country: Canada

Postal Code: N3B 3A3

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

Human

4. Date registrant was first informed of the incident.

02-NOV-07

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

01-NOV-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. 7251      PMRA Submission No.       EPA Registration No.

Product Name: Quintozene (Terraclor) 75WP Fungicide

• Active Ingredient(s)
  • QUINTOZENE

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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: Other / Autre

Préciser le type: Golf Course

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

* there is a slight formulation difference (1.5% formulant) between the US registered product and the Canadian registered product, otherwise they are the same. The caller indicated that they had been spraying quintozene for the first time on Wednesday, October 31, 2007. One of his employees developed a redness on his face, much like a sunburn, around the area of his goggles and respirator. He noticed the sunburn on Thursday and had gone to see his doctor who said that it will clear up on its own (which was starting to happen).

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.

Other

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Red skin

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?

No

6. b) For how long?

7. Exposure scenario

Occupational

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

Application

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

Goggles

Respirator

Unknown

10. Route(s) of exposure.

Skin

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.)

It was discussed with the caller the health effects associated with Quintozene as identified on our MSDS. This included both the effects from general exposure (e.g. potential irritation/sensitization).

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.