Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1843

2. Registrant Information.

Registrant Reference Number: 11041901

Registrant Name (Full Legal Name no abbreviations): Nufarm Agriculture Inc.

Address: 5507 1st Street SE

City: Calgary

Prov / State: AB

Country: Canada

Postal Code: T2H 1H9

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

Domestic Animal

4. Date registrant was first informed of the incident.

19-APR-11

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

18-APR-11

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. 29124      PMRA Submission No.       EPA Registration No.

Product Name: Credit 45 Herbicide

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

1

Other Units: cup

10. Site pesticide was applied to (select all that apply).

Site: Other / Autre

Préciser le type: Pond

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

Accidentally spilled approximately 1 cup of Credit 45 into a 5000 gallon fish pond.

To be determined by Registrant

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

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Fish / Poisson

3. Breed

Goldfish

4. Number of animals affected

30

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Eye

Oral

Respiratory

9. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Caller would not divulge how the material ended up being placed into the pond, would only say it was accidental. Was not willing to give name, location etc.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here