Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0407

2. Registrant Information.

Registrant Reference Number: 904

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

Address: 5660 New Northside Drive, Suite 1100

City: Atlanta

Prov / State: Georgia

Country: U.S.A.

Postal Code: 30328

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

Human

4. Date registrant was first informed of the incident.

31-JUL-09

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

31-JUL-09

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. 21958      PMRA Submission No.       EPA Registration No.

Product Name: CALCIUM HYPOCHLORITE GRANULAR

• Active Ingredient(s)
  • CALCIUM HYPOCHLORITE

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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.

Other

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing
  • Symptom - Burning lungs

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)

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?

<=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.)

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Caller's husband had opened a container of HTH Sock It and had inhaled the fumes. 10 minutes had passed since the time they called in. At the time of the call the victim was coughing and experiencing a burning sensation in his chest. We advised caller to remove him to fresh air and have him sip on water if possible between the coughs, and that if symptoms persisted after another 10 or 15 minutes to go ahead and seek medical attention. We advised her to have the ACEAN number with her when she did this, in case the doctor needed to contact us for any additional information. Prior to opening the chemical, it had sat outside at the residence for two weeks. Caller wasn't sure why; she thought they might have just forgotten about it. We advised that in the future she would want to store her chemicals in a cool, dry, indoor place. The product was presently sitting in her kitchen. We provided her disposal recommendations as per the MSDS in case she did not feel comfortable adding the chemical to her pool.