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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2380

2. Registrant Information.

Registrant Reference Number: 2013-04-01

Registrant Name (Full Legal Name no abbreviations): Syngenta Canada Inc.

Address: 140 Research Lane, Research Park

City: Guelph

Prov / State: Ontario

Country: Canada

Postal Code: N1G 4Z3

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. 18438      PMRA Submission No.       EPA Registration No.

Product Name: ATRAZINE TECHNICAL

• Active Ingredient(s)
  • ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)

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 A Study of the Effects of Short-Term Atrazine Exposure on the Estrogen-Induced Luteinizing Hormone (LH) Surge in Ovariectomized Young-Adult Sprague Dawley Female Rats and A Study of the Effects of 1, 2, 3 or 4 Days of Atrazine Exposure on the Estrogen-Induced Luteinizing Hormone (LH) Surge in Ovariectomized Sprague Dawley Rats

Date 17-APR-13

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)

Novel finding.

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

See attached confidential test data.