Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1324

2. Registrant Information.

Registrant Reference Number: 2014-04-02

Registrant Name (Full Legal Name no abbreviations): Amvac Chemical Corporation

Address: 4695 MacArthur Court, Suite 1200

City: Newport Beach

Prov / State: California

Country: USA

Postal Code: 92660

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

Human

4. Date registrant was first informed of the incident.

02-APR-14

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

02-APR-14

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. 30889      PMRA Submission No.       EPA Registration No. 5481-571

Product Name: SmartBlock

• Active Ingredient(s)
  • 3-DECEN-2-ONE

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

97

Units: mL

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

Site: Agricultural-Indoor / Agricole-intérieur

Préciser le type: Potato

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

SmartBlock application was made at 97mL/ton (2,000 lbs) into a potato storage unit. The exact application was 10 gals for 392 tons. Application made as athermal fog using commercial fogging equipment.

To be determined by Registrant

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

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Burns (superficial)
  • Specify - Burns of unknown severity

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

7

Day(s) / Jour(s)

7. Exposure scenario

Occupational

8. How did exposure occur? (Select all that apply)

Application

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Long-sleeve shirt

Long pants

Chemical resistant gloves

Chemical resistant coveralls

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

There is an ongoing investigation. Based on what we know today, the applicator was applying SmartBlock to a potato storage unit was partially full with potatoes in (name), Alberta. Something caused a fire to start inside the storage and an explosion occurred soon thereafter which caused the fire to spread to other storage units. As of today we do not know if there was an equipment malfunction or other event that caused the fire and resulting explosion. A similar type of fogging equipment has been used in the past without incident.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

Patient was treated for symptoms of smoke inhalation from the fire, not symptoms arising from specific exposure to the product.