Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-2424
2. Registrant Information.
Registrant Reference Number: EDJ
Registrant Name (Full Legal Name no abbreviations): LES PRODUITS INDUSTRIELS JEAN-PAULCOTE INC
Address: 545 RUE DE L'ARGON
City: QUEBEC
Prov / State: QUEBEC
Country: CANADA
Postal Code: G2N 2E3
3. Select the appropriate subform(s) for the incident.
Packaging Failure
4. Date registrant was first informed of the incident.
19-JUN-14
5. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
19-JUN-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)
PMRA Registration No. 21674
PMRA Submission No.
EPA Registration No.
Product Name: JPC "12"
- Active Ingredient(s)
- AVAILABLE CHLORINE, PRESENT AS SODIUM HYPOCHLORITE
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?
Other / Autre
specify Citerne de transport pour produits chimiques
2. Did packaging failure occur during?
Other
specify Le conducteur a recule et frappe un muret qui a brise le tuyau de transvidage
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.
Un deversement d'hypochorite de sodium de 3000 litres qui a ete deverse dans egout qui conduisait directement a l'usine d'epuration de la Ville de (ville). Le conducteur a heurte un muret de beton qui a brise le tuyau de transvidage.
For Registrant use only
5. Provide supplemental information here.
Le tout fut dilue avec de l'eau des pompiers de la ville de (ville).