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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-2391

2. Registrant Information.

Registrant Reference Number: 20140618

Registrant Name (Full Legal Name no abbreviations): Mitsui Chemicals Agro, Incorporated

Address: 105 Victoria Street, Suite 408

City: Toronto

Prov / State: Ontario

Country: Canada

Postal Code: M5C 3B4

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. 30330      PMRA Submission No.       EPA Registration No.

Product Name: Penthiopyrad Technical

• Active Ingredient(s)
  • PENTHIOPYRAD

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 Gene Mutation Test with M11 using Mouse Lymphoma L5178Y Cells (LMA)

Date 27-JAN-14

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)

Receipt of Toxicological Study Report

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?

For Registrant use only

7. Provide supplemental information here

Study requested by EU Regulatory Authorities.