Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2640

2. Registrant Information.

Registrant Reference Number: 1978054

Registrant Name (Full Legal Name no abbreviations): BioLab Inc., A Chemtura Company

Address: 1005 Copperstone Drive

City: Pickering

Prov / State: ON

Country: Canada

Postal Code: L1W 4A5

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

Human

4. Date registrant was first informed of the incident.

24-JUN-08

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

6. Date incident was first observed.

17-JUN-08

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. 27257      PMRA Submission No.       EPA Registration No. 67262-29-5185

Product Name: BioGuard Power Chlor (BioGuard Everyday Chlorinating Granules)

• Active Ingredient(s)
  • TRICHLORO-S-TRIAZINETRIONE

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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: Res. - Out Home / Rés - à l'ext.maison

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

It is alleged person pre-dissolved product in a bucket at the kitchen sink.and created fumes.

To be determined by Registrant

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

Yes

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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Irritated throat

• Renal System
  • Symptom - Lack of control of urination
  • Specify - 'feels like she can't hold urination'

• Gastrointestinal System
  • Symptom - Fecal incontinence
  • Specify - 'feels like she can't hold bowl movements'

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-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)

Unknown

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.)

It is alleged person pre-mixed this product in a bucket in her kitchen sink and that she then inhaled the resultant fumes before she could put the product in her pool.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.