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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-0142

2. Registrant Information.

Registrant Reference Number: NCR 19029

Registrant Name (Full Legal Name no abbreviations): Interprovincial Cooperative Limited

Address: P.O. Box 1050

City: Saskatoon

Prov / State: Saskatchewan

Country: Canada

Postal Code: S7K 3M9

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. 31598      PMRA Submission No.       EPA Registration No.

Product Name: CO-OP VECTOR 540 LIQUID HERBICIDE

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

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?

Tank tote / Cuve

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.

A distributor's warehouse advised that one tote of Vector 540 450L was found to have a manufacture defect where the liquid product was slowly leaking by the discharge valve. The volume of leakage (10 L) was absorbed, cleaned and the defective tote was contained in a spill drum.

For Registrant use only

5. Provide supplemental information here.