Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-0273

2. Registrant Information.

Registrant Reference Number: Ticket 3593720

Registrant Name (Full Legal Name no abbreviations): Arch Chemicals Inc.

Address: 1955 Lake Park Drive, Suite 100

City: Smyrna

Prov / State: Georgia

Country: U.S.A.

Postal Code: 30080

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

Human

4. Date registrant was first informed of the incident.

16-JUN-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

16-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.       PMRA Submission No.       EPA Registration No. 1258-1042

Product Name: HTH Spa Chlorinating Granules

• Active Ingredient(s)
  • SODIUM DICHLORO-S-TRIAZINETRIONE

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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 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

• Respiratory System
  • Symptom - Shortness of breath

• Nervous and Muscular Systems
  • Symptom - Dizziness

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

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.

Respiratory

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

Caller's friend inhaled product and became dizzy and short of breath.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Responder advised caller to take her friend to seek medical attention since she was not feeling any better. Responder read the first aid information to her from the MSDS for the HTH Spa Chlorinating Granules and advised her to take our number with her to the doctor. Responder also advised caller that we could send her friend's doctor a copy of the MSDS for the product and that her doctor could also speak to one our toxicologists on call if they wished.