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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-5889

2. Registrant Information.

Registrant Reference Number: 338168

Registrant Name (Full Legal Name no abbreviations): Premier Tech Ltd.

Address: 1 avenue Premier

City: Riviere-du-Loup

Prov / State: Quebec

Country: Canada

Postal Code: G5R 6C1

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: ONTARIO

6. Date incident was first observed.

Unknown

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. 31794      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Wipe Out Total Weed & Grass Killer

• Active Ingredient(s)
  • AMMONIUM SALT OF FATTY ACID

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?

Spray Bottle / Flacon pulvérisateur

2. Did packaging failure occur during?

Transportation

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.

Consumer wanted to bring bottle to his office and placed it into briefcase, with lunch, documents and computer. Bottle leaked in the briefcase; documents and lunch had to be discarded.

For Registrant use only

5. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident.