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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-3999

2. Registrant Information.

Registrant Reference Number: PI 1372

Registrant Name (Full Legal Name no abbreviations): ADAMA Agricultural Solutions Canada Limited

Address: 300 - 191 Lombard Avenue

City: Winnipeg

Prov / State: Manitoba

Country: Canada

Postal Code: R3B 0X1

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: PRINCE EDWARD ISLAND

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. 29052      PMRA Submission No.       EPA Registration No.

Product Name: SILENCER 120 EC EMULSIFIABLE CONCENTRATE INSECTICIDE

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

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?

Jug-plastic / Cruche-plastique

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.

In a warehouse, a fibreboard case containing the product appeared wet. Upon investigation, the closures on the plastic jugs were loose. After randomly selecting cases to inspect, other jugs were found with loose caps and improperly sealed containers. To prevent leakage, staff opened all cases and screwed down all caps prior to the product being transferred to a an approved manufacturing facility for rework (proper torque closure and induction sealing). It is possible that a defect in the caps prevented proper closure and sealing. No actual exposure to humans, animals or the environment occurred.

For Registrant use only

5. Provide supplemental information here.