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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3414

2. Registrant Information.

Registrant Reference Number: DAS130521-00

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

Address: Suite 2100, 450 - 1 Street S.W.

City: Calgary

Prov / State: Alberta

Country: Canada

Postal Code: T2P 5H1

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

Packaging Failure

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

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. 29651      PMRA Submission No.       EPA Registration No.

Product Name: PrePass XC A Herbicide

• Active Ingredient(s)
  • FLORASULAM

PMRA Registration No. 29652      PMRA Submission No.       EPA Registration No.

Product Name: PrePass XC B Herbicide

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS DIMETHYLAMINE SALT)

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 VI: Packaging Failure

1. What is the type of packaging that failed?

Jug-plastic / Cruche-plastique

2. Did packaging failure occur during?

Storage

3. Did packaging failure result in?

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

Warehouse person noticed wet outer package (cardboard case) on product involved. Opened case to inspect and found jug of PrePass XC B had a small leak in bottom of one of the jugs.

For Registrant use only

5. Provide supplemental information here.