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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-5060

2. Registrant Information.

Registrant Reference Number: NUA

Registrant Name (Full Legal Name no abbreviations): Nufarm Agriculture Inc

Address: 5101, 333 96th Ave. NE

City: Calgary

Prov / State: AB

Country: Canada

Postal Code: T3K 0S3

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. 32885      PMRA Submission No.       EPA Registration No.

Product Name: STATUE HERBICIDE

• Active Ingredient(s)
  • CLETHODIM
    • Guarantee/concentration 240 g/L

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.

Cargill warehouse (CWS) found Statue leaking. Caps not properly tightened. The leak was discovered on a skid as a case was wet, the jug inside was discovered to have a loose cap.

For Registrant use only

5. Provide supplemental information here.

No exposure and no injury reported