ML18100B166
| ML18100B166 | |
| Person / Time | |
|---|---|
| Site: | Salem  |
| Issue date: | 06/24/1994 |
| From: | Wiggins J NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | Miltenberger S Public Service Enterprise Group |
| Shared Package | |
| ML18100B167 | List: |
| References | |
| EA-94-112, NUDOCS 9407010048 | |
| Download: ML18100B166 (5) | |
See also: IR 05000272/1994080
Text
,_:
,,
Docket Nos. 50-272
50-311
Mr. Steven E. Miltenberger
JUN 2 A 1994
Vice President and Chief Nuclear Officer
Public Service Electric and Gas Company
P. 0. Box 236
Hancocks Bridge, New Jersey 08038
Dear Mr. Miltenberger:
SUBJECT:
NRC AUGMENTED INSPECTION TEAM (AIT) REPORT NOS.
50-272/94-80 AND 50-311/94-80
The enclosed report refers to a special onsite review by an NRC Augmented Inspection Team
(AIT) from April 8 through April 26, 1994. The team reviewed the circumstances surrounding
the automatic reactor shutdown and two automatic actuations of the
11 safety injection
11 system that
occurred at Salem Unit 1 on April 7, 1994.
The report discusses areas examined during the inspection. The inspection focus was on the
potential safety significance of the events, and included detailed fact-finding, determination of
root causes, and evaluation of operational and managerial performance. The inspection consisted
of selective examination of procedures and representative records, observations, and interviews
with personnel.
The AIT determined that the predominant cause of the event was the combination of pre-existing
equipment problems or vulnerabilities and the resultant challenges to the operators, and operator
errors that occurred during the transient. Other failures and their causes were reviewed and are
discussed in the attached report. The AIT concluded that both the equipment problems and
operator errors could, and should have been avoided by licensee management through a closer
review of the operator needs in response to the frequent and expected transient conditions
resulting from the grass intrusions at the circulating water structure.
The AIT found the licensed operator response to the initiating event; a loss of circulating water,
was weak. Operators did not take some actions that they were trained to perform. However,
overall operator response was successful in achieving a stable plant condition; unfortunately,
much later in the event sequence than expected, and too late to avoid a significant challenge to
the pressurizer power operated relief and safety relief valves.
While we note the actions of PSE&G to improve plant hardware and procedures prior to the
event, both hardware deficiencies and inadequate procedures played key roles throughout the
event sequence. Also, the actions taken by PSE&G before and during the event to mitigate the
frequent grass intrusions at the Salem circulating water structure were both well conceived and
9407010048 940624
ADOCK 05000272
0
.
j)O'
-
UNITED STATES
.UCLEAR REGULATORY COMMISSIO
REGION I
475 ALLENDALE ROAD
Docket Nos. 50-272
50-311
EA No. 94:..112
Mr. Steven E. Miltenberger
KING OF PRUSSIA, PENNSYLVANIA 19406-1415
JUN 2 A \\994
Vice President and Chief Nuclear Officer
Public Service Electric and Gas Company
P. 0. Box 236
Hancocks Bridge, New Jersey 08038
Dear Mr. Miltenberger:
ENCLOSURE
SUBJECT:
NRC AUGMENTED INSPECTION TEAM (AIT) REPORT NOS.
50-272/94-80 AND 50-311/94-80
The enclosed report refers to a special onsite review by an NRC Augmented Inspection Team
(AIT) from April 8 through April 26, 1994. The team reviewed the circumstances surrounding
the automatic reactor shutdown and two automatic actuations of the "safety injection" system that
occurred at Salem Unit 1 on April 7, 1994.
The report discusses areas examined during the inspection. The inspection focus was on the
potential safety significance of the events, and included detailed fact-finding, determination of
root causes, and evaluation of operational and managerial performance. The inspection consisted
of selective examination of procedures and representative records, observations, and interviews
with personnel.
The AIT determined that the predominant cause of the event was the combination of pre-existing
equipment problems or vulnerabilities and the resultant challenges to the operators, and operator
errors that occurred during the transient. Other failures and their causes were reviewed and are
discussed in the attached report. The AIT concluded that both the equipment problems and
operator errors could, and should have been avoided by licensee management through a closer
review of the operator needs in response to the frequent and expected transient conditions
resulting from the grass intrusions at the circulating water structure.
The AIT found the licensed operator response to the initiating event, a loss of circulating water,
was weak. operators did not take some actions that they were trained to perform. However,
overall operator response was suecessful in achieving a sta.ble plant condition; unfortunately,
much later in the event sequence than expected, and too late to avoid a significant challenge to
the pressurizer power operated relief and safety relief valves.
While we note the actio~s of PSE&G to improve plant hardware and procedures prior to the
event, both hardware deficiencies and inadequate procedures played key roles throughout the
event sequence. Also, the actions taken by PSE&G before and during the event to mitigate the
frequent grass intrusions at the Salem circulating water structure were both well conceived and
-'Jtfo 7o 1ootft- c5 ff*
Mr. Steven E. Miltenberger
2
generally well performed. However, these initiatives were not accompanied by a similar review
of task performance and procedural guidance in the control rooms to ensure that licensed
operator resp0nse _to the potential or actual loss of circulating water would also be successful.
It is for these reasons that the NRC views the relatively poor performance of the operating crew
during the April 7, 1994 event to indicate not just weak performance of certain licensed
operators; but rather, and more imi)ortantly, an inadequate assessment by management of the
prevalent operating * conditions at the plant and subsequent development of an appropriate
- operating philosophy to meet the expected needs.
It is not the responsibility of an AIT to determine compliance with NRC rules and regulations
. or to recommend enforcement actions. These aspects will be developed following additional
NRC management review of this report.
A representative from the State of New Jersey, Department of Environmental Protection and
Energy (DEPE), observed parts of the onsite AIT inspection activities. A copy of a letter from
Mr. Anthony J. McMahon, Acting Assistant Director, Radiation Protection Element, ~J DEPE
to NRC is enclosed With thi~*letter. That correspondence describes three issues not specifically
addressed in the AiT report. Also enclosed is the NRC reply letter describing our plans to
address those concerns.
In accordance with IO CFR 2. 790 of the Commission's regulations, a copy of this letter and the
enclosures will be placed in the NRC Public Document Room.
We will gladly discuss any questions you have concerning this inspection.
Sincerely,
~,"'-r*
'6'r~
.{(,hes. i. Wiggins, Acting Director
Division of Reactor Safety
Enclosures:
1. Inspection Report Nos. 50-272/94-80
2. Letter, dated May 20, 1994, from A. J. McMahon, NJ DEPE to J. T. Wiggins, NRC
3. Letter, dated June 24, 1994, from J. T._ Wiggins, NRC to A. J. McMahon, NJ DEPE
,.
JUN24.
Mr. Steven E: Miltenberger
3
cc w/encls:
J. J. Hagan, Vice President-Operations/General Manager-Salem Operations
S. La.Bruna, Vice President - Engineering and Plant Betterment
C. Schaefer, External Operations - Nuclear, Delmarva Power & Light Co.
R. Hovey, General Manager - Hope Creek Operations
F. Thomson, Manager, Licensing and Regulation
R. Swanson, General Manager - QA and Nuclear Safety Review
J. Robb, Director, Joint Owner Affairs
A. Tapert, Program Administrator
R. Fryling, Jr., Esquire
M. Wetterhahn, Esquire
P. J. Curham, Manager, Joint Generation Department
Atlantic Electric Company
Consumer Advocate, Office of Consumer Advocate
William Conklin, Public Safety Consultant, Lower Alloways Creek Township
K. Abraham, PAO (2)
Public Document Room (PDR)
Local Public Document Room (LPDR)
Nuclear Safety Information Center (NSIC)
NRC Resident Inspector
State of New Jersey
D. Davis
H .. Otto, State of Delaware, Department of Natural Resources & Environmental Control
Mr. Steven E. Miltenberg.
bee w/encls:
The Chairman
Commissioner Rogers
Commissioner Remick
Commissioner de Planque
J. Taylor, EDO
J. Te1.tum, OEDO
- W. Dean, OEDO
J. Stone, NRR
S. Dembek, NRR
C. Miller, PDI-2, NRR
J. Wenniel, NRR
A. Thadani, NRR
J. Calvo, NRR
R. Jones, NRR
W. Russell, NRR
I. Ahmed, NRR
H. Rathbun, NRR
W. Lyon, NRR
A. Chaffee, NRR/DORS/EAB
M. Callahan, OCA
J. Kauffman, AEOD
E. Jordan, AEOD
M. Hodges, RES
P ~ Lewis, Research
M. McCormick-Barger, Rill
Paul Boehnert, Chairman, ACRS
Ken Raglin, Technical Training Center
DCD (OWFN Pl-37) (Dist. Code #lElO)
T. Martin, RA
W. Kane, DRA
J. Wiggins, DRS
R. Blough, DRS
E. Kelly, DRS
W. Lanning, DRP
J. Durr, DRP
R. Summers, DRP
S. Barr, DRP
L. Scholl, DRP
R. Skokowski, DRS
J. Stewart, DRS
D. Holody, EO
E. Weniinger, DRP
J. White, DRP
C. Marschall, SRI - Salem
Resident Inspector, IP2
Region I Docket Room (with concurrences)
4
JU~A 1994.