Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4789

2. Registrant Information.

Registrant Reference Number: Univar Fire - Kelowna

Registrant Name (Full Legal Name no abbreviations): Gowan Company, L.L.C.

Address: P.O. Box 5569

City: Yuma

Prov / State: AZ

Country: USA

Postal Code: 85366-5569

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

Environment

4. Date registrant was first informed of the incident.

10-AUG-10

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

31-JUL-10

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. 23006      PMRA Submission No.       EPA Registration No. Unknown

Product Name: Imidan 50-WP Instapak Insecticide

• Active Ingredient(s)
  • PHOSMET

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

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 IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Fish-Non-schooling/Poisson-Autre poisson

2. Common name(s)

Unknown

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Stream

Terrestrial

Salt Water

6. Check all symptoms that apply

Death

7. Describe symptoms and outcome (died, recovered, etc.).

unknown

8. a) Was the incident a result of (select all that apply)

Other

Fire at Univar Warehouse. Water used to control fire ran off into creek.

8. b) i) How many times has the product been applied this year?

8. b) ii) What was the date of the last application?

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Unknown

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

Moderate

13. Please provide supplemental information here

Fire at Univar Warehouse. According to July-end inventory, our distributor, UAP Canada, had 11 cases (10 x 2 x 1kg) of product housed there. According to Univar, all of their inventory was destroyed during the fire. It is unknown whether or not this product was responsible for any environmental damages.