Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2102

2. Registrant Information.

Registrant Reference Number: 2009-IR-03

Registrant Name (Full Legal Name no abbreviations): E. I. du Pont Canada Company

Address: P.O. box 2300, Streetsville

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5M 2J4

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

Human

4. Date registrant was first informed of the incident.

24-JUN-09

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

6. Date incident was first observed.

01-AUG-06

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: DuPont Lannate(r) LV Insecticide/Nematacide

• Active Ingredient(s)
  • METHOMYL
    • Unknown

---

7. b) Type of formulation.

Liquid

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.

Other

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Nausea

• Respiratory System
  • Symptom - Other
  • Specify - adverse affect on his respiratory health

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?

Unknown

6. b) For how long?

7. Exposure scenario

Non-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?

>15 min <=2 hrs / >15 min <=2 h

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.)

According to an aerial applicator, in August 2006, a truck driver filling diesel fuel tank near location that aerial applicator was loading chemicals (alleged to be DuPont Lannate) alleged that exposure to fumes had an adverse affect on his respiratory health. Truck driver is now pursuing lawsuit against aerial applicator. This incident was originally included in an aggregate report for the 3rd quarter 2006. The reported symptom from the truck driver in 2006 was "nausea". He was reportedly "taken to a hospital, was under observation, but as far as we know, no treatment was given and he got better." "Exposure to fumes had an adverse affect on his respiratory health".

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.