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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-3152

2. Registrant Information.

Registrant Reference Number: 310048-6

Registrant Name (Full Legal Name no abbreviations): Petro-Canada Lubricants Incorporated

Address: 2310 Lakeshore Road West

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5J 1K2

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

Packaging Failure

4. Date registrant was first informed of the incident.

26-JUN-14

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

26-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. 29825      PMRA Submission No.       EPA Registration No.

Product Name: CIVITAS

  • Active Ingredient(s)
    • MINERAL OIL (INSECTICIDAL)

7. b) Type of formulation.

Application Information

8. Product was applied?

No

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 5 Gallon Plastic Pail

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.

Product was found leaking on pallet in warehouse. No exposure/injury was reported.

For Registrant use only

5. Provide supplemental information here.

As follow up to this incident, extra quality assurance steps have been put in place.