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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2133

2. Registrant Information.

Registrant Reference Number: 88899.1

Registrant Name (Full Legal Name no abbreviations): U.S. BORAX INC.

Address: 8051 E. Maplewood Ave.

City: Greenwood Village

Prov / State: CO

Country: USA

Postal Code: 80111

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.

PMRA Registration No. 18292      PMRA Submission No.       EPA Registration No.

Product Name: 20 MULE TEAM BORIC ACID TECHNICAL

• Active Ingredient(s)
  • BORACIC ACID (BORIC 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 Boric Acid Reproductive Toxicity Test with the Mallard (Anas platyrhynchos) Following OPPTS 850.2300 and OECD 206

Date 21-NOV-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)

The outcome of this test indicated reduced survivability between embryonic day 21 and hatching or reduced hatchability of embryos that were alive on day 21. No significant differences in mean number of eggs produced per hen, number of eggs set per hen, viable embryos per hen, live embryos per hen, number of hatchlings per hen, or eggshell thickness were detected between any treatment group and the control group.

5. a) Was the study discontinued before completion?

No

5. b) Provide the reason for discontinuation

6. If the study is ongoing, what is the expected completion date?

Unknown

For Registrant use only

7. Provide supplemental information here