IR 05000245/1989013
| ML20246B941 | |
| Person / Time | |
|---|---|
| Site: | Millstone  |
| Issue date: | 06/29/1989 |
| From: | Oconnell P, Pasciak W NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| Shared Package | |
| ML20246B939 | List: |
| References | |
| 50-245-89-13-EC, NUDOCS 8907100183 | |
| Download: ML20246B941 (40) | |
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y ENCLOSURE 2
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U. S. NUCIEAR REGUIA70RY 00MMISSION
REGION I
o Report No.
50-245/89-13 Docket No.-
50-245-License No.
. Category C Licensee:
' Northeast Nuclear Energy Company P. O. Box 270 Hartford, Cusinscticut 06101
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Facility Name:: Millstone Nuclear Generatirg Station Unit 1 Meeting At: NRC Region I, Kirn of Prussia, Pennsylvania Meeting CoMv+ad: June 21, 1989 Prepared by:
M~.a I-A ?~ U P. O'Connell, Radiation Specialist, date FRPS, FRSSB Approved by:.
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_. to a e 6. 2% W
.W. Pasciak,~ Chief, Facilities Radiation date Protection Section, Facilities Radiological Safety and Safeguards Branch Naetirn Summary: Enforcement Ocnference at NRC Region I, King of Prussia, Pc41nsylvania, on June 21, 1989, to discuss the findings of NRC Inspection Report No. 50-245/89-13. The topics dia'maad related to the shipment of a high pressure pun 1p and trailer with removable external radioactive contamination from the licensee's reactor site to a vendor site in Moorestown, New Jersey.
. The meeting was attended by NRC arxi licensen managemnt and lasted for approximately two hours.
8907100183 890630 ADOCK0500g5 PDR
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s DETAIIS 1.
Participants 1.1 Northeast Nuclear Enemy Company H. Haynes, Station Services Superintendent, Millstone S. Scace, Station Superintendent, Millstone i
l-F. Sears, Vice President, Nuclear & Environmental Enclneering l-J. Sullivan, Health mysics Operations Supervisor, Millstone
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G. Van Noordennen, Licensiry Supervisor,' Millstone 1.2 NRC Personnel M. Boyle, Senior Project Manager,NRR R. Bellamy, 011ef, FRSSB, RI M. Knapp, Director, IESS, RI J. Gutierrez, Regional Council, RI L. Kolonawski, Resident Inspector, Millstone Unit One P. O'Connell, Radiation Specialist, RI W. Pasciak, 01ief, FRPS, RI W. Thomas, Radiation Specialist, RI E. Wenzinger Sr., Chief, IEP Br.1, RI 2.0 Purpose The Enforcement Cbnference was held at the request of NRC Region I to dier== the circumstances relating to the shipment of a high pressure pump and trailer, which had removable external contamination, from the licensee's reactor site to a vendor's site in Moorestwn, New Jersey. The M4=<'i== ions at this meeting focused on: the identified apparent violations, their safety significance, the rect cause of the event, and licensee corrective actions to pre /ent recurrence.
3.0 Liegnsee Presentation Lfcenses managemnt began their presentation by emphasizing that they are carraitted to makily the necessPIy ChangeG in their program to preclude recta 1xirx of this type of incident. The licensee stated that prior to this incident they made several impmewns in their Health mysics Progran.
The improvements incitded the reorganizincj of the Health mysics Depar^ ment into two groups, Operations and Support; increased staffing to reduce the med for contractor Health mysics support; and a general upcyrado cf Health mysics proceduces. Licensee management stated that this incident der.onstrated that their program still has some weaknesses, particularly in the area of management review of proposed work activities.
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Licensee personnel provided the NRC with handouts which provided an outline of the event and the licensee's corrective actions. These handouts are included in this report as Attachment 1. Licensee personnel reviewed with NRC management.the chronology of the incident, the root causes of the incident, related radiolo ical survey and calculation data, and the licensee's assessment of he safety significance of this incident. The licensee also reviewed the corrective actions which the licensee has implemented. These actions included adopting an interim policy of surveying all-vehicles prior to their leaving the site and having upper plant
' management reemphasize the importance of thorough _ reviews of new procedures or other changes by the Plant Operations Review Committee (See Attachment 2. The licensee also provided timely notification to other utilities of
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t e incident in order to decrease the possibility of a similar incident
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happening elsewhere:(See Attachment 3).
Licensee evaluation of long term corrective actions was still in progress. The licensee committed that the final long term corrective actions will be developed and implemented by September 1, 1989.
4.0 Concluding Statements Licensee management stated that they had no additional qualifying information for the findings presented in NRC Inspection Report No.
50-245/89-13.
NRC Region I management acknowledged that the actions presented' appeared to be responsive to the NRC's concerns. NRC Re ion I management stated that the licensee would be informed of the nee for and the nature of appropriate enforcement action relative to this incident at a later time.
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Attachment 1.
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Docket No. 50-245 -
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Enforcement Conference
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CONTAMINATION OFTHE WESTINGHOUSE HYDROLAZER SYSTEM USED AT MILLSTONE UNIT ONE
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NORTHEASTNUCLEAR ENERGY COMPANY JUNE 21,1989
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DESCRIPTION OF EVENT.
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CAUSE OF EVENT
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ANALYSIS OF EVENT
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ASSESSMENT OF SAFETY SIGNIFICANCE 6-V.
CORRECTIVE ACTION
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ATTACHMENTS I.
ATTACHMENT ONE PAGE 1 OF 3 Hydrolaze'Itailer Location PAGE 2 OF3 HydrolazeTrailer Location PAGE3OF3 Hydrolaze WaterSupply IL ATTACHMENT TWO PAGE 1 OF 2 Hydrolaze System Design
_j PAGE 2 OF2 Hydrolaze 'Itailer - Back and Side View j
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ATTACHMENT THREE Radiological Data: Isotopic Analyses of Water Supply IV. - ATTACHMENT FOUR Radiological Data: Water Supply Hose V.
' ATTACHMENT FIVE Radiological Data: Hydrolazer Trailer Survey of May 15,1989
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ATTACHMENT SIX PAGE 1 OF9 Radiological Data: Survey of Hydrolaze Trailer Water Tank and Dailer PAGE 2 OF9 Radiological Data: Survey of Hydrolaze Trailer Water Tank and nailer PAGE 3 OF9 Radiological Data: Survey of Hydrolaze Dailer PAGE4OF9 Radiological Data: Survey of Hydrolaze Wailer PAGE 5 OF9 Radiological Data: Survey of Hydrolaze Wailer PAGE 6 OF9 Smear u> cations for May 15,1989 Survey by Westinghouse PAGE 7 OF 9 Radiological Data: Survey of Hydrolaze trailer PAGE8OF9 Smear Locations for May 17,1989 Survey by Westinghouse l
PAGE 9 OF 9 Radiological Data: Isotopic Analyses of samples VII.
ATTACHMENT SEVEN PAGE 1 OF 3 Smear Survey of Hose Section at Millstone PAGE 2 OF3 Radiological Data: Smear Survey of Hose Section
. PAGE 3 OF3 Radiological Data: Isotopic Analyses of Pressum Hose Smears -
VIII. ATTACHMENT EIGHT Radiological Data: Isotopic Analyses of Reactor Water and Cavity Wall IX.
ATTACHMENT NINE PAGE 1 OF 2 Radiological Data: Area Survey of Trailer Locale at Unit 1 PAGE 2 OF 2 Radiological Data: Area Survey of Trailer locale at Unit I X.
ATTACHMENT TEN Calculations
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CONTAMINATION OF THE WESTINGHOUSE HYDROLAZER SYSTEM USED AT MILLSTONE UNIT ONE DESCRIPTION OF EVENT On Monday, May 15,1989 a Westinghouse hydrolazer trailer being temporarily stored at the Westinghouse maintenance facility in Moorestown, New Jersey was found by Westinghouse to be radioactively contaminated. Westinghouse notified NNECo on May 15,1989 and stated they believed the contamination originated at Millstone Station. The hydrolazer trailer had been used at Millstone Unit One to decontaminate the refueling cavity.
Investigation of radiological survey data, operating logs and discussions with involved per-sonnel addressed four possible causes of the contamination. These four possible causes are:
'The hydrolazer water tank was internally contaminated due to it's prior use at 1.
Consolidated Edison's Indian Point Unit Two.
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Contaminated water was supplied to the hydrolazer water tank at Millstone One.
3.
The hydrolazer water tank and trailer were intentionally contaminated by others.
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Water from the reactor cavity was inadvertently siphoned, or drained back into the hydrolazing unit.
.After review it has been concluded that the fourth possible cause is most likely. Further ratio-nale for this conclusion is provided in the Analysis of Event section of this report.
a Other than the hydrolazer unit, no people or facilities,were contaminated from this event.
j Appropriate NRC, State of Connecticut DEP notifications were made on May 16,1989 in i
accordance with requirements of 10 CFR 50.72.
Our evaluation indicated this was not reportable per 10CFR 50.73.
Chronology Date Event May 4,1989 Westinghouse hydrolazer crew onsite.
May 5 Equipment setup.
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" Upper Drywell Shielding" (Cattle Chute) hydrolazed (refueling equipment).
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May 10 Reactor Cavity hydrolazed.
May 11 Westinghouse equipment and crew leave sit _ --___ _
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May 12 Hydrolazer trailer arrives at Westinghouse maintenance facility in Moorestown, N.J.
May 15 Westinghouse Survey of trailer reveals contamination in the hydrolazer tank and on the trailer.
CAUSE OF EVENT Millstone procedures SHP 4917 Unconditional Radiciogical Release of Material For Unrestricted Use and HP905/2905/3905 Control And Accountability of Radioactive Material provide instruction for controlling and accounting for radioactive material and to provide a means for the unconditional release of material from contaminated amas for unrestricted use.
These H.P procedures successfully address the majority of possible contamination circum-stances. However, they did not effectively deal with the contamination of the hydrolazer trail-er because they do not address situations in which a possible, but unintentional flow path from a contaminated area to a clean area could exist.
The itydrolazing activity in question and all similar activities are performed using approved procedures. These procedures require Plant Operations Review Committee (PORC) review and approval. This review process is considered to be effective at Millstone. However,in this instance the process failed to identify the potential siphoning scenario and to cause sufficient safeguards to beimplemented.
ANALYSIS OF EVENT For operation at Millstone Unit One, the hydrolazer trailer was situated outside of the Reactor Building at the railway access as illustrated in Attachment One. As shown in Attachment One, water was supplied from the demineralized water storage tank to the hydrolazer supply tank.
The hydrolazer pump discharge line was run into the Reactor Building, and up approximately 100 feet to the refuel floor where the hydrolazing was performed. Page 3 of Attachment One is a schematic of the water supply.
The hydrolazer trailer consists of a 60 gallon supply tank, a pump, and a diesel engine.
Attachment Two is a diagram of the trailer. There are three connections to the tank: an inlet
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located on one end at the top, a pump suction located on the bottom center, and a bypass line located near the bottom, below the inlet line. The tank is vented to atmosphere through a vent panel near the top of the tank.The bypass line has an in-line valve and connects the discharge side of the pump back to the tank. Tank level is normally regulated by an inlet float valve.
However, it was learned from Westinghouse that the float was not operable during the period of May 4 - May 12,1989 and tank level was being maintained by the equipment operator through visual inspection. The hydrolazer pump is a positive displacement pump designed to deliver discharge pressures up to 11,000 PSI.
Three types of hydrolazing attachments were used. They were a ' remote lance' for the upper
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drywell shielding, a ' control gun' in the cavity, and a ' flex lance' in the cavity drains. The con-trol gun has a trigger to shut off water flow while the remote and flex lances have no local con-trol of water flow. During the hydrolazer activity there were periods when these attachments were required to be submerged.The remote lance was underwater during the entire effort to decontaminate the upper drywell shielding. The flex lance was submerged while cleaning the drains. The control gun was used in "open air" and not normally submerged.
Operation of all three hydrolazing attachments required coordination between the person hydrolazing and the pump operator at the trailer in order to regulate line pressure. The lance operator communicated by hand signals to a worker at the reactor cavity rail, who communi-cated to the pump operator via headset. The pump operator controls pressure by varying the speed of the diesel engine.
Radiological data Six categories of radiological survey data were evaluated as listed below:
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1. watersupply; 2. the water supply hose; 3. the hydrolazer trailer including the tank, pump, diesel and fuel tank, and interconnecting lines; 4. the pressure hose; 5. reactor cavity water and wall; 6. area surveys.
All contamination survey data are included in Attachments Three through Ten. The signifi-cance of the data for each category is discussed below.
Water supyjy-Water samples taken from the demineralized water storage tank and the con-
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densate storage tank show no radioactivity and no identifying peaks when isotopically ana-lyzed. Results of weekly CST samples were the same for May 2, May 9, and May 15. Based on this, the water supply was eliminated from consideration as the source of contamination.
Water supply hose-The two sections of water supply hose used during the decon activity J
were obtained from the Millstone warehouse. Smear surveys of the inside and outside of the two sections of supply hose showed no radioactive contamination. One of the hoses was l
smeared internally at the center by cutting open the hose. These sample results confirm that the water supply was free of radioactive contamination.
Cavity Water - Reactor water samples routinely show the isotopes of Cr-51, Mn-54, Co-58, Fe-59, Co40, Zn-65, and Cs-137. Zinc-65 is the predominant isotope. Unit I uses the zine injection process to reduce Co-60 deposition and ultimately lower radiation levels throughout the reactor coolant system associated piping. An isotopic analysis of a smear of the cavity wall showed the same isotopes except for Cs-137. The relative abundance of Zn45 in the cavity
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wall sample is much smaller although it is still almost 15% of the total activity. Variation of the Zn-65 relative abundance would occur because of mixing from other sources of water such as
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the spent fuel pool and because of differing plateout characteristics of different isotopes.
Routine Unit One rad waste samples show typical isotopic mixes with 40-70% Zn-65. Thus the values of 20-65% relative abundances of Zn-65 seen in the hydrolazer tank, on the trailer,
and in the pressure hoses would be within the expected range of values for contamination by I
cavity water.
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Hydrolazer trailer - All the survey results on pages one through eight of Attachment Six are I
Westinghouse results provided to NNECo. The highest level of contamination was inside the tank below the supply inlet near the bypass inlet. There was also contamination inside the inlet connector on both sides of the supply valve,inside the bypass line on both sides of the bypass valve, and inside the tank outlet fitting for the pump suction line. The interior of the suction line from the tank to the pump was not contaminated except for some small amount of contamination in the line near the tank. These levels and distribution of contamination sug-gests that the contamination could have entered the tank either through the inlet supply line or through the bypass line. Since there is a lack of evidence of supply water contamination, the bypass line becomes the suspected route of contamination. Moreover, the absence of any sig-nificant level of contamination in the pump suction line suggests contamination of the tank after completion of pumping activities. There is also contamination on the tank,on the tank mount structures, and on the deck of the trailer under and around the tank. External contami-nation is thought to have occurred as a result of draining the supply tank by the Westinghouse operators in preparation for transporting the unit offsite.
NNECo obtained smears from Westinghouse of the trailer deck, the interior of the supply line inlet fitting, both sides of the water filter located inside the tank on the outlet line and of the vacuum hose used to clean the inside of the tank. Westinghouse also provided a crud sample from the bottom of the tank and residual water from the pump supply line. All samples were isotopically analyzed and found to have isotopes common to Millstone Unit One. The most predominant isoto'pe identiSed was Zn-65 with a relative abundance ranging from 20-65%.
This finding makes Unit One cavity water the primary suspect for the source of contamination discussed fw:ther below.
Pressure hmg - Six sections of high pressure hose were used.Five sections of the hose and all the lances were found to be externally contaminated when the equipment was being disassembled.
The extemal contamination was attributed to contamination originating on the refuel floor, there-fore this was not cause for concern at the time. This equipment was not released by NNECo. One section of hose was clean and released to Westinghouse. After the trailer contamination was dis-covered by Westinghouse on May 15, the five sections were checked internally by inserting Q-tips in the ends. All five were internally contaminated. The section of hose kept by Westinghouse was subsequently found to have internal contamination. Isotopic analyses of smears of the hoses showed the same characteristic isotopic mix as the tank contamination samples.
Area surveys - A survey for removable contamination of the area where the hydrolazer had
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been operated was initiated upon notification by Westinghouse. Attachment Nine page 1 pro-vides the details of this survey. No detectable contamination was found.
A survey for fixed contamination was conducted on May 17. The survey indicated one spot of
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contamination of approximately 2 cm in area (Attachment Nine Page 2). Analysis of the con-
taminated asphalt indicated Zn-65, C0-58 and Co-60.
Discussion of nossible scenarios and conclusions reached As previously mentioned four possible contamination scenarios have been considered:
1. The hydrolazer water tank was internally contarninated due to it's prior use at Indian Point Two. This has been discounted based on discussion with Consolidated Edisons personnel and radiological data from that facility.
2. Contaminated water was supplied to the hydrolazer water tank at Millstone
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One. This has been discounted by radiological data.
3. The hydrolazer water tank and trailer wem intentionally contaminated by others.
This possibility is discounted for the following reasons:
- The Westinghouse contractor was the only bidder on the cavity decon work and a minimum number of people on-site knew of the crew's func-tion. The general decon contractor dedined to bid on this activity.
Additionally them is no evidence of any animosity between contractor and any personnel while they were on site.
The door to the railway access hatch was for the most part dosed during
the time period in question which would make it quite. difficult to obtain a sample of primary water and pass through radiation detection equipment to exit the containtnent building unnoticed.
4. Water from the reactor cavity, was inadvertently siphoned or drained back into the hydrolazer unit. This is considered the probable scenario.
Discussion of the probable scenario It has not been possible to identify the specific system operation which caused this event.
From discussions with Westinghouse personnel, no specific operational sequence could be identified that caused feedback. Certain factors are supportive of the feedback or siphoning scenario. These factors indude a system pathway which could have allowed feedback, a pat-tern of contamination which follows that pathway, and isotopic analysis from contamination samples which dearly indicate Millstone Unit One cavity water as the primary contaminant.
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ASSESSMENT OF SAFETY SIGNIFICANCE Maximum potential doses resulting from the hydrolazer trailer contamination were estimated based on post-incident surveys. Four dose categories were established - public dose due to release of contaminated water, internal dose to a worker, internal dose to a member of the public, and skin dose to a worker. In each category, considered conservative assumptions were made to postulate the worst case dose scenario. For this reason the doses are considered maxi-mum potential doses.
All of the maximum potential dose estimates are well within the 10 CFR 20 whole body limits of 500 mrem in a year for a member of the public and 1,250 mrem in a quarter for a worker and the skin dose limit of 7,500 mrem in a quarter for a worker.
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Public dose due to off-site release of liquids via the storm drains
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WHOLE BODY:
2.69E-3 mrem G1(MAX ORGAN):
7.92E-3 mrem POPULATION:
WHOLE BODY:
7.28E-3 person Rem 2. Internal dose to worker:
WHOLE BODY:
0.3 mrem GI(MAX ORGAN):
0.8 mrem 3. Internal dose to public:
WHOLE BODY:
0.03 mrem GI(MAX ORGAN):
0.09 mrem 4. Skin dose to worker:
38 mrem (5 cm radius)
Methodology and Assumptions for Determining Doses 1. Public dose from off-site release The release pathway was from water spilling and draining out of the hydrolaze tank, onto the ground, into the yard storm drain, and out to the discharge quarry. It was assumed that the total volume of the tank (60 gal) with a radionuclides concentration equal to cavity water (0.1 uCi/cc) was released. The computer code LADTAP2 was used to calculate the public doses
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resulting from this release. The actual dose will probably be lower because the cavity water activity concentration of 0.1 uCi/ccis the upper limit of measurements taken of the cavity water. Also, the 60 gallon release of cavity water is an upper limit because of the dilution with supply water.
2. Internal dose to worker The worst scenario for intake of radioactive material would be transfer of contamination from the trailer deck onto a hand and then transferred to food being eaten. The following assump-tions were made:
The average trailer deck contamination of 15,000 DPM/100 cm seen in the trailer
survey is 10% of the activity deposited before being washed off by rain.
Contamination from a 1,000 cm area was transferred by contact to a hand.
, Ten percent of the hand contamination was ingested.
With these assumptions an intake of 0.08 uCi is postulated.Using the isotopic mix seen in the trailer smears and the dose conversion factors from Regulatory Guide 1.109, the internal dose was calculated. All Westinghouse personnel involved in this evolution recieved a whole body count upon leaving the site with no indication of internal activity.
3. Internal dose to public The public internal dose was calculated in the same way as worker internal dose. With the public dose however the activity is reduced by a factor of ten because of wash-off prior to I
leaving the site.
4. Skin dose I
It was assumed that a 100 cm area of deck contamination of 150,000 DPM/100 cm2 was trans-
3 ferred to a 5 cm diameter circle of skin. The activity was assumed to reside on the skin for 24 I
hours. Using the isotopic mix seen in the trailer smears and the Code VARSIGN the skin dose was calculated.
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Based on the above, NNECo concluded that this event was not significant with respect to the I
actual consequences to plant personnel or the public.
CORRECTIVE ACTION:
Immediate Following discovery of the contamination incident, meetings were held between the Health Physics Supervisor and the Radiation Protection Supervisors to discuss the hydrolazer release
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from the site and to obtain input on program weaknesses which need to be resolved. During
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these meetings, requirements were established for surveys of any equipment with a potential for contamination due to a positive interface with a contaminated area / system.
As an interim measum to prevent recurrence NNECo has instituted a program for surveying all vehicles leaving the protected area.
To make station supervision aware of the situation, the Station Superintendent has issued a memo to all members of the unit PORCs. This event is to be used to reemphasize the need for comprehensive evaluations of new and contractor procedures with an emphasis on the "What if..." possibilities. This memo was copied to the Superintendent of the Haddam Neck Station.
To make other utilities aware of the possibility of such an unanticipated contamination occur-rence, a NETWORK entry was prepared and issued.
In addition this report was reviewed by Haddam Neck management. It was determined that sufficient controls are in place to prevent a similar event from happening at that facility.
Corrective Action:
Long Term Evaluation of long term corrective action is in progress. By September 1,1989 Millstone will have implemented final corrective actions that will address both the upgrade of our radiologi-cal controls program, to insure contaminated equipment is not released from the Millstone site and enhancements in work control processes that are deemed appropriate based on our detailed event analysis.
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ATI'ACHMENT ONE PAGE 3 OF 3
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HYDROLA7R WATER SUPPLY O
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ATTACHMENT TWO PAGE 1 OF 2
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HYDROLA7E SYSTEM DESIGN
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ATTACHMENT TWO
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HYDROLA7R TRAIT FR - BACK AND SIDE VIEWS l
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UNLOADER VALVE / \\
PRESSURE REGULATOR PUMP OUTLET
- _ - _ __ _ ___
-. _ _ _ _
_ _ _ _ _ _ _ _ - _ _ - _ _ _ _ - _ - - _ - _ _ - - - _ _ - -
_ _ _ _
_
_ _ _,
_. - - _ _ _ _ _ _ _ -
_-
_ _ _ _
'-
ATTACHMENT THREE
.
RADIOLOGICAL DATA ISOTOPIC ANALYSER OF WATER SUPPLY Samnle Date Volume Count Time Results CST'
5/2/89 1,000 ml 30 min No radionuclides identified CST'
5/9/89 1,000 ml 30 min No radionuclides identified CST'
5/16/89 1,000 ml 30 min No radionuclides
.
identified DWST'
5/15/89 1,000 ml 30 min No radionuclides identified DWST2 5/18/89 1,000 ml 30 min K-40 only 1) Comientate Storage Thnk 2) Demineralized Water Storage 7hnk sampled via valve 1-DW-117 j
l
.
t.
_
_
.. _ _ _ _ _ _ _ _ _ _. _... _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
.
..
..
- -_.
_
__
_ __
. _.
-
_.
-_-.. _
- - - - _ _. _ _ -.
..
ATTACHMENT FOUR
'
.
RADIOLOGICAL DATA * WATER SUPPLY HOSE Surveys Performed by Millstone Nuclear Power Station Removable Contamination Sample Date Results (dom /100cm ]
External 5/15/89
<1000 y <20 n Internal 5/15/89
<1000 y <20 a External-Large Area 5/15/89
<1000 y <20 a Connectors 5/15/89 c1000 py <20 cx
.
Fixed Contamination Samnle Date Results (dom / frisk)
External 5/15/89 4 5000 y <100 a(both hoses)
Internal 5/18/89 4 5000 y <100 a(one hose)
Isotonic Analyses of Smears Samnle Mc Count time Results External 5/15/89 10 min No radionuclides identified (both hoses)
'
Internal 5/18/89 10 min No radionuclides i:enti5ed (one hose)
l l
_ - - - - _ - - -
, _ - _
__
- - - _ - -.
E
..
ATTACHMENT FIVE
RADIOLOGICAL DATA: HYDROLAZE TRATTRR SURVEY OF MAY 15.1989 Survey on May 15,1989 by Westinghouse
@
@ 0_-
k
~
n b
PPL VALVI f
,
WATER TANN
@
C
.J b
BYP ASS LINI i
PUMP r
n OUTLET *
f
@Ch
'
""* (1)
WATER SUPPL 1
,
oo
.
@
UNLOADER VALVE /
PRESSURE REGULATOR No.
dpm/100cm'
Location
1263 Water inlet Fittings
1663 Water inlet inside
10863 Water inlet inside
2863 Inside Lid
1963 Tank Fitting for Suction Hose
550 inside Suction Hose Tank End
<MDA inside Suction Hose Pump End
<MDA Pump Inle't D
15413 Bypass Hose by Water Tank
5125 Tank Fitting for Bypass
(MDA Bypass Hose by Valve
1188 inside Bypass Valve Tank
438 Inside Bypass Valve Pump
<MDA Plunger
<MDA Plunger
<MDA Plunger
<MDA Plunger Housing Base
<MDA Plunger Housing Base
g Water Outlet
,
l
_. _ _ _.._.
- _ _.
_
..
_ - _ _ _ - - _ _
_____
l
'
- .
, *'
ATTACHMENT SIX PAGE 1 OF 9
,
RADIOLOGICAL DATA: SURVEY OF HYDROLA7R TRAITRR WATER TANK AND TRAITRR EXTERNAL CONTAMINATION Survey on May 15,1989 by Westinghouse O
= smear location
%
Q%
6-10 taken on motorside of tank (O
@
(
k
)
11-17taken inside water tank
@
g/
I'
i N
g
,
\\
\\\\
\\
/
@
@
@
O
.
All results in dpm/100cm (MDA = minumum detectable activity)
Smear Number Results Smear Number Results
<MDA
15538
<MDA
4538
613
<MDA
<MDA
438
1063
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
2538
300
1200
600
2875
-_
_
- _ - -
..
-
.
'~..
ATTACIBIENT SIX
-
PAGE 2 OF 9
,
RADIOLOGICAL DATA: SURVEY OF HYDROLA7E TRAITRR WATER TANK AND TRAITRR Internal Contamination and Dose Rates Survey on May 15,1989 by Westinghouse O
= mR/hr on contact O
= smear location 6"t. 2 g
@"*
k
[
6-10 taken on motorside of tank
O (if
"
11-17 taken inside water tank
...
d.4
"B B
@
8@
/
i i
N
'
'
L
/
-
\\
,\\
/
s s
All results in dpm /100cm' (MDA = minumum detectable activity)
Smear #
Results
675
1150
3400
9925
225088
813
3788
_ _ - _ _ _ _ - _ - -.
_.
_._ _
_ _ _ _ _ _ _ _ - _ _ _ _
-
,
-
. *
ATI'ACHMENT SIX PAGE 3 OF 9
,
.
RADIOLOGICAL DATA: SURVEY OF HYDROLAZE TRAILER EXTERNAL CONTAMINATION AND DOSE RATES S uvey on May 15,1989 by Westinghouse
- 7m - - - -
gy;, 4.j.
q
,
gyWw s,r *
'
%
+<
- .v.
,
,7
.
InB}hr On Cont 8Ct
- -
.4
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a1
=
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-
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<
, C._.:' g r: WS,t., % a
,
l
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sinearlocation
^
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~:;
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-
,
. $9f$,$f~f'
~
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>
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42 ea :
c.2
<.2
.
7s 37
-%
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38
i m..
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.a.y i M M a gg% <.2 1 4 i. W
'
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- N;r:;Q E.,,v;7 44.
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&
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-
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$
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, 4. ~:;.. S. :(i
-
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...,
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.
5[ +, y.4::fQAM:hh([i
Md,,;. e, ud
$
h
5$w{igjpyg,M4as W dem..ii2.
__
.
__
All results in dpm/100cm2 (MDA = minimum detectable activity)
Smear #
Results
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
-
_ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ - _ - - _ - - _
_
. _ _ _ _ _ _ _ _ _ _ _ _ _
'
-
.,
j
.
ATTACHMENT SIX PAGE 4 OF 9
,
.
RADIOLOGICAL DATA SURVEY OF HYDROLA7E TRAILER
{
EXTERNAL CONTAMINATION AND DOSE RATES
{
Survey on May 17,1989 By Westinghouse
.D
_H
@
_
/
V59
%
- * E".'?.?2 I^\\
r::::- :.=:
ca)
-
---.
..
.,
-
g,,
y" ". -
""""
""
"
L
@
O
= mR/hr on contact
-
. -
-
I <a \\
@
.":::
.=,Kst
"
..
r, j - - -.
...
-
- r-O,
'g ex,xc o
= smear iocation
-
MT@M g
,9l.2l
.
- .. :
o
.
.
--
-
v
@
j2l
@
l
<2 1
@
All results in dpm/100cm2 (MDA = minimum detectable activity)
Smear #
Results
<MDA
<MDA
363
338
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
26375
<MDA
_ _ _ _ _ _ _ _ _ _ _. _
_ _ - _ _ - _ _ _ _ _
_
_ _.
- ^
"
..*'
ATTACHMENT SE PAGE 5 OF 9
,
'
(
)
RADIOLOGICAL DATA: SURVEY OF HYDROLAZE TRAILER
')
PUMP SIDE OF TRAILER
)
i Survey on May 15,1989 by Westinghouse O
= mR/hr on contact o
O
= smear location b
f-- QA 73-78 taken on trailer deck A
79-81 traken on fluidside of J
pump
@
g(,,
o
ep-g 71 2 h h f
@
<,
@
@
<,
All results in dpm/100cm2 (MDA = minimum detectable activity)
Smear #
Results Smear #
Results Smear #
Results Smear #
Results
500
<MDA
25075
<MDA SS 1213
<MDA
7437
<MDA-
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
9613
<MDA
<MDA
300
<MDA
<MDA
288
<MDA
<MDA
<MDA
<MDA
1525
<MDA
_ - _-__-.
.
. _ _ _ - _ _ _ _ _ _ _
<
~-
..
ATTACInfENT SIX
'
PAGE 6 OF 9
{
,
SMEAR LOCATIONS FOR MAY 15.1989 SURVEY BY WESTINGHOUSE Smear Location Smear Location
Outside of water tank
Trailer frame
See Figure
Trailer frame
See Figure
Trailer frame
See Figure
Tank mount - outside
See Figure
End of water tank
See Figure
Fuel Tank
See Figure
Fuel Tank
See Figure
Fuel Tank
See Figure
Fuel Tank
Outside of water tank
Radiator cover
.11 Inside of water tank
Radiator cover
See Figure
Radiator cover 13-See Figure
Trailer deck
See Figure
Trailer deck
See Figure
End of tank-outside
See Figure
Water tank mount
See Figure
Water supply line
Trailer deck
Pump
Trailer deck
Pump
Water tank mount
Pumo
Face of water block
Fuel tank
Face of water block G2 Fuel tank
Water tank mount
Pulley cover
Water tank mount
Pulley Cover
Trailer frame
Face of motor cover
Trailer frame
Face of motor cover
Trailer frame
Face of motor cover
Trailer frame
Trailer frame
Trailer frame
Trailer frame
Trailer frame
Trailer frame
Trailer frame
Trailer deck
Trailer frame
Trailer deck
Motor Cover
Trailer deck
Motor Cover
Trailer deck
Motor Cover
Trailer deck
Motor Cover
Trailer deck
Pulley Cover
Trailer deck
Pulley Cover
Trailer deck
Pulley Cover
Fluid end of pump
Pulley Cover
Fluid end of pump
Top of motor cover
Fluid end of pump
_ - _ _ _ _ _
-
-
--
._ -.
f
,,.
' *
ATTACHMENT SIX PAGE 7 OF 9
.
,
RADIOLOGICAL DATA: SURVEY OF HYDROLA7F TRAILER
.
Survey on May 17,1989 by Westinghouse q)
O
= mR/hr on contact
'
O
= smear location i
.
b g
~
/
i
't N
s
@
/
\\ s\\
/
R I
@
@
PLUNGER HOUSING WATER Puh/P OUTLET All results in dpm/100cm2 (MDA = minimum detectable activity)
Smear #
Results Smear #
Results
10863
<MDA
1663
1963
2863
<MDA
1263
10038
15413
<MDA
388
<MDA
438
<MDA
1188
<MDA
5125
<MDA
550
.
I
_ _ _ _
. _ _ _ _ - _ _ -
l.
..~
' +
ATTACIIMENT SIX PAGE 8 OF 9
,
.. -
SMEAR LOCATIONS FOR MAY 17.1989 SURVEY BY WESTINGHOUSE SmearJ.
Location l
Waterinlet-inside l
Watn-inier-inside
'
Inside ventlid
Waterinlet fitting
Bypass hose by water tank
Bypass hose by pump
Inside bypass valve-pump side
Inside bypass valve - tank side
Tank fitting for bypass
Inside suction hose - tank end
Inside suction hose -pump end
Tank fitting for suction hose
Pump inlet
Water outlet
Plunger housing base
Plunger housing base
Plunger (
Plunger
'
Plunger
__
Y
.g ATTACHMENT SIX PAGE 9 OF 9
.
'
-
>
RADIOLOGICAL DATA ISOTOPIC ANALYSER OF SAMPI.ER j
Samnle
g
A g
g i
Activity Ci (unless noted)
5.3E-2 1.5E-2 3.2E-2 5.5E-3 1.3E-3 9.5E-2 5.4E-3 ( Ci/ml)
% OfTotal Activity For Co-58 2.4 NI 2.2 NI NI 1.4 1.7 Co-65 36.9 21.3 31.3 30.6 44.8 30.1 30.6
Cr-51 18.0 17.1 15.9 22.2 NI 15.0 17.7 Fe-59 4.8 7.3 7.4 NI NI 6.4 8.1 Mn 54 15.3 17.6 17.7 18.0 15.8 15.6 19.2 Zn-65 22.4 36.6 25.6 29.4 39.2 31.5 23.1 NI = not identified Sample identification 1 - Smear of trailer 2 - Smear of water filter inside tank on outlet line (pump side)
l l
3 - Smear of water filter inside tank on outlet line (tank side)
'
4 - Smear of vacuum hose used to clean inside of tank 5 - Smear ofinside ofinlet line outboud of valve 6 - Crud from bottom of tank
7 - Water sample from tank
l l
All samples were obtained by Westinghouse All analyses were performed at Millstone l
..
_,m__________________m---__
- - - - - - - - - - - -
[;..
I li,.
'
'
ATTACHMENT SEVEN
~
PAGE 1 OF 3
.
SMEAR SURVEY OF HOSE SECTIONS AT MHLSTONE l
Hose connection swine samnles from Unit I Cavity Decon Hydroinzer Hose2 Hose #
Smear #
intemal (dom /"O-Tio"):
Smear #
Extemal(dom / Smear)2
1 25,000
5,000
90,000
30,000
3 5,000
15,000
30,000
450,000
5 2,000
<1,000 I
,
2,000
<1,000
7 10,000
<l 000
10,000
<1,000
9 25,000
<1,000
20,000
<1,000
Results of May 17.1989 survey of sections of hose #52 Two cuts were made in the hose and cotton (Q-Tips) swabs were used to sample the interior of the hose. The saw used had a new blade.
Cotton Swabs of hose (cut) ends: (Measured thru 8 mils ofplastic)
Q-Tip CCPM'
- 1 700
- 2 100
- 3 1200 l
- 4 100 l
1 - Alpha c.,tamination not detectable in any sample 2 - Beta-Gamma activity
-
_ _ _ _ _ _ _ _ _ _
,_ _.
--- - -. - - - - - - - _ - -
-.,
, *-
NIT'iCHMENT SEVEN PAGE 2 OF 3
,
RADIOLOGICAL DATA SMEAR SURVEY OF HOSE SECTION Survey on May 15,1989 by Westinghouse (2)
- )
[ sl (4)
(
.
6)
(7 )
-
_
%
_
SMEAR #
DPM/100cm2
4900
<MDA
<MDA
<MDA
<MDA
<MDA
<MDA
5050 MDA = minimum detectable activity I
____-
. _ _ _ _
_ _ - _ _ _ _ _
< f i
,
ATTACHMENT SEVEN
)
.
PAGE 3 OF 3 l
-
'
RADIOLOGICAL DATA: ISOTOPIC ANALYSES OF PRESSURE HOSE SMEARS Samole
2
i i
i
Actitivity ( Ci)
3.4E-3 3.1 E-2 2.7E-1 1.5E-1 4.7E-2 4.0E-3 1.1 E-1
% Of Total Activity Co-58 NI Ni 2.1 1.6 1.4 N1 1.6 Co-60
, 27S 16.5 22.3 26.3 26.8 42.1 27.3 q
Cr-51 NI 9.9 18.9 13.8 20.9 Ni 21.8 i
Fe-59 NI NI 12.2 6.2 6.8 NI 6.7 Mn-54 21.2 8.9 20.7 13.7 18.0 22.3 17.0 Zn-65 51.0 64.7 23.8 38.4 26.1 35.6 25.6 NI = Not Identified Smear identification:
1 - Hose end taken May 15 - Millstone 2-Inside swab of hose #3 taken on May 15 - Millstone 3-External smear of cavity hose taken on May 17 - Millstone 4-Inside of cavity hose taken on May 17-Millstone 5 - Swab #1 of hose #5-Millstone 6 -- Swab #2 of hose #5-Millstone 7 - Swab #3 of hose #5-Millstone AII analyses were performed at Millstone
'
,
_____._m___.__
__
.-
_ - - -
- .., - "l ATTACHMENT EIGHT
.
RADIOLOGICAL DATA ISOTOPIC ANALYSES OF RFACTOR WATER AND CAVITY WATL SAMPLE J
3 A
Activity mei/m1(unless noted)
1.0E-2 1.1E-2 2.1E-2 3.1E00(mci)
% OF TOTAL ACTIVITY Co-58 0.4 0.5 1.0 2.4
.
Co-60 2.0 1.5 3.2 20.3 Cr-51 0.8 0.3 1.2 15.9 Fe-59 NI NI 1.5 18.4 Mn-54 1.3 1.2 4.1 28.7 Zn-65 93.8 94.8 88.3 14.3 Cs-137 1.7 1.7 0.7 NI
?
N1 = Notidentified Sample Identification:
1 - Reactor Water May 8 - Millstone Unit 1
-
2-Reactor Water
- May 9 - Millstone Unit 1 3 - Reactor Water
- May 10- Millstone Unit 1 4 - Reactor Cavity Wall-May 17-Millstone Unit 1 All analyses were performed at Millstone
- - _ _ _ _
-
_ _ _ _ _
~
e
-
..,
ATTACIIMENT NINE PAGE 1 OF 2
-
,
,
,
l RADIOLOGICAL DATA ADF A SURVEY OF TRATTRR LOCATR AT UNIT 1 Survey on May 15,1989 By Millstone
!
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oO
,
g CS T MOAT 1-D W-117 WORK AREA
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Y ARD AREA SMEARS l-50 <1K DPM/IDOCM
'
S U P PLY H OS ES S ME ARED I/S AND O/S <1K DPM/200CM
0
t.ms
S UPPLY VALVE l-DW-117 S MEARED <1K DPM/100CH p
S U PPLY VALVE 1-D W-127 WORK AREA SMEARED <1K DPM/100CM
<
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_ _ _ _. _ _ _ _ _ _ _ _ _ _ _
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ATTACHMENT TEN
, CALCULATION &
J.
Public dose:
(60 gal) X (0.1 Ci/gm) x (4 x 10' gm/ gal) = 24 mci released See LADTAP2 printoutfor dose results.
2.
Internal dose: -
(15,000 DPM/100 cm ) x 10 = 150,000 DPM/100 cm initial contamination
2 (150,000 DPM/100 cm ) x (1,00 cm ) = 1,500,00 DPM on contaminated hand (150,000 DPM for public)
2 (1,500,000 DPM) x 0.1 = 150,000 DPM (0.08 pCi) ingested (0.008 pCi for public)
The following values were used to calculate dose
.
gG mrem /uCi/(RG-1.109) '
mrem
.
0.016 4.7 0.075 Zn-65 20 -
0.016 7.0 0.112 Co-58
0.0024 1.7 0.004 Mn-54
0.02 0.9 0.018 Cr 51
0.013
0 Fe-59
0.013 4.0 0.052 TOTAL:
0.261
,
For the maximum organ dose the ratio of maximum organ to whole body dose found by LADTAP2 was used to factor the intemal whole body dose.
7.92 x 105 L
X 0.3 mrem = 0.9 mrem 2.69 x 102 (GI ORGAN)
3.
Skin dose (150,00 DPM/100 cm ) x 100 cm = 150,00 DPM on skin
2 Used with 5 cm radius on skin and 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> exposure in VARSKIN
See VARSKINprintoutfor dose results.
_____-_______ _ _-_-_ _
. _ _ _ _
_
.
<
"'
Attachment 2.
NORTHEAST UTILITIES b~
=
=-
S
!
<
[==_._=. _==__
,
Mg_l
=
<
_
_.
June 20, 1989 MP-13224 TO:
PORCMEMBERS From:
S.
he Station Superintendent Millstone Nuclear Power Station (Ext 4300)
.
Subject: Procedure Review Approval Process By now you should all be aware of the recent incident in which a contaminated hydrolazer trailer was released from the site without being surveyed.
Your Superintendent has additional details of the
' event.
An extensive investigation of the activities for which the trailer was used concluded that the contamination most likely resulted from water siphoning back to the trailer from the refuel cavity during a period of hydrolazer inactivity.
The decontamination work was done using a vendor procedure reviewed and approved by PORC.
This emphasizes the need to ask the WHAT IF questions, especially when reviewing new and third party procedures.
I realize that we can never address all possible scenarios which might occur, but I feel that we can increase our efforts to step back, take a good look and ask "What if...... ?"
I have asked each superintendent to use this incident to reinforce the need to thoroughly examine and question these types of issues as they come before PORC.
SES/fdd
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cc:
W.D.Romberg
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D.B. Miller Jr.
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OS70 REV. 3-83
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ATTACHMENT 3.
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INTEROFFICE MEMORANDUM Date:
15-Jun-1989 03:51pm EST From:
MICHAEL R.
STROUT STROUMR AT Al AT BERLN1 Dept:
NUCLEAR OPERATIONS Tel No:
TO:
Harry F.
Haynes ( HAYNEHF AT Al AT MP0001 )
Subject: NUCLEAR NETWORK OPERATING EXPERIENCE ENTRY UNIT.............................. MILLSTONE UNIT ONE EVENT DATE........................MAY 16,1989 NSSS/AE...........................GE/EBASCO RATING...........................
654MWe DATE OF COMMERCIAL OPERATION...... DECEMBER 26, 1970 Millstone Nuclear Power Station conducted a hydrolase
' decontamination of the Unit 1 cavity during May 1989.
During the work process it is postulated that siphoning occured feeding contaminated water back through the hose to the pump and supply tank.
The hydrolaser unit was positioned outside of the reactor building in a clean area on the 14'-6" elevation while the d2 contamination was conducted on the refueling floor 108'
olevation.
The' hydrolaser trailer was released without survey since it had been in a clean area.
Millstone was notified of the hydrolaser unit contamination once it was surveyed at the vendor facility.
Millstone continues to investigate this occurrence.
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