Health Canada
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Consumer Product Safety
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-1424
2. Registrant Information.
Registrant Reference Number: 246A102
Registrant Name (Full Legal Name no abbreviations): Amvac Chemical Corporation
Address: 4695 MacArthur Court, Suite 1200
City: Newport Beach
Prov / State: California
Country: U.S.A.
Postal Code: 92660
3. Select the appropriate subform(s) for the incident.
Scientific Study
4. Date registrant was first informed of the incident.
5. Location of incident.
6. Date incident was first observed.
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. 20850 PMRA Submission No. EPA Registration No. 5481-485
Product Name: Dacthal Technical
- Active Ingredient(s)
- CHLORTHAL (PRESENT AS ACID)
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 VII: Scientific Study
1. Study Reference
Title Chlorthal Dimethyl (DCPA) Amphibian Metamorphosis Assay Final Report
Date 26-MAR-12
2. a) Is an extension needed to translate the document?
No
3. Type of incident identified in the study
New health or environmental hazard
4. Describe the incident identified in the study (e.g. study demonstrates an increased risk to non-Hodgkin's Lymphoma after exposure to pesticide X)
Results provided could possible suggest an adverse finding for endocrine affects
5. a) Was the study discontinued before completion?
No
