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Category:LICENSEE EVENT REPORT (SEE ALSO AO
MONTHYEARML18107A5031999-08-26026 August 1999 LER 99-006-00:on 990729,determined That SG Blowdown RMs Setpoint Was non-conservative.Caused by Inadequate ACs for Incorporating Original Plant Licensing Data Into Plant Procedures.Blowdown Will Be Restricted.With 990826 Ltr ML18107A4691999-07-28028 July 1999 LER 99-008-00:on 990714,determined That Limit Switch Cables Were Subject to Multiple Hot Shorts in Same Fire Area.Caused by Inadequate Original Post Fire Safe Shutdown Analysis.All Limit Switch Cables for MOVs Were Reviewed.With 990728 Ltr ML18107A4441999-07-0606 July 1999 LER 99-007-00:on 990605,surveillance for Quadrant Power Tilt Ratio (QPTR) Was Missed.Caused by Human Error.Qptr Calculation Was Performed & Personnel Involved Have Been Held Accountable IAW Pse&G Policies.With 990706 Ltr ML18107A4211999-07-0202 July 1999 LER 99-005-00:on 990605,11 Containment Declared Inoperable. Caused by Valves 11SW72 & 11SW223 Both Leaking.Procedure S1.OP-ST.SW-0010(Q) Was Enhanced to Provide Specific Instructions to Ensure Proper Sequencing.With 990702 Ltr ML18107A4321999-07-0101 July 1999 LER 99-006-01:on 990501,determined That There Was No Flow in One of Four Injection Legs.Caused by Sticking of Valve in Safety Injection Discharge Line to 21 Cold Leg.Valve Was Cut Out of Sys & Replaced.With 990701 Ltr ML18107A4331999-07-0101 July 1999 LER 99-002-01:on 990405,determined That 2SA118 Failed as Found Leakrate Test.Caused by Foreign Matl Found in 2SA118 valve.2SA118 Valve Was Cycled Several Times & Seat Area Was Air Blown in Order to Displace Foreign Matl.With 990701 Ltr ML18107A3951999-06-17017 June 1999 LER 99-004-00:on 990520,reactor Tripped from 100% Power,Due to Negative Flux Trip Signal from Nuclear Instrumentation. Cause Has Not Been Determined.Discoloration Was Identified on One of Penetrations.With 990617 Ltr ML18107A3661999-06-0909 June 1999 LER 99-003-00:on 990513,unplanned Entry Into TS 3.0.3 Was Made.Caused by Human error.Re-positioned Creacs Supply Fan Selector Switches & Revised Procedures S1 & S2.OP-ST.SSP-0001(Q).With 990609 Ltr ML18107A3551999-06-0202 June 1999 LER 99-005-00:on 990504,failure to Meet TS Action Statement Requirements for High Oxygen Concentration in Waste Gas Holdup Sys Occurred.Caused by Inability of Operators. Existing Procedures Will Be Evaluated.With 990602 Ltr ML18107A3541999-06-0101 June 1999 LER 99-006-00:on 990501,HHSI Flow Balance Discrepancy Was Noted During Surveillance.Caused by Sticking of Check Valve in SI Discharge Line to 21 Cold Leg.Valve 21SJ17,was Cut Out of Sys & Replaced.With 990601 Ltr ML18107A2931999-05-12012 May 1999 LER 99-002-00:on 990413,determined That Number 12 Auxiliary Bldg Exhaust Fan Was Rotating Backwards.Caused by mis-wiring of Motor Due to Human Error by Maint technician.Mis-wiring Was Corrected & Fan Was Returned to Svc.With 990512 Ltr ML18107A2781999-05-10010 May 1999 LER 99-004-00:on 990411,automatic Actuation of ESF Occurred During Reactor Vessel Head Removal in Support of Refueling Operations.Caused by High Radiation Condition.Containment Atmosphere Was Monitored.With 990505 Ltr ML18107A2791999-05-0404 May 1999 LER 99-003-00:on 990406,all Salem Unit 2 Chillers Rendered Inoperable.Caused by Human Error.Lessons Learned from Event Were Communicated to All Operators by Including Them in Night Orders.With 990504 Ltr ML18107A2741999-05-0303 May 1999 LER 99-002-00:on 990405,determined That Containment Isolation Valve Failed as Found Leakrate Test.Caused by Foreign Matl Blocking Valves from Closing.Check Valve Mechanically Agitated.With 990504 Ltr ML18107A2351999-04-23023 April 1999 LER 99-001-00:on 990330,MSSV Failed Lift Set Test.Caused by Setpoint Variance Which Is Result of Aging.Valves Were Adjusted & Retested to Ensure TS Tolerance.With 990423 Ltr ML18106B1471999-03-29029 March 1999 LER 99-001-00:on 990228,reactor Scram Was Noted as Result of Turbine Trip.Caused by Operator Error.Lesson Plans Revised to Explicitly Demonstrate Manner in Which Valve Functions. with 990329 Ltr ML18106B0701999-02-16016 February 1999 LER 98-015-00:on 981208,inadvertent Discharge Through RHR Relief Valve During Startup Was Noted.Caused by Operator Performing Too Many Tasks Simultaneously.Appropriate Actions Have Been Taken IAW Policies & Procedures.With 990216 Ltr ML18106B0491999-01-28028 January 1999 LER 98-007-01:on 980730,reactor Coolant Instrument Line through-wall Leak Was Noted.Caused by Transgranular Stress Corrosion Cracking.Replaced Affected Tubing.With 990128 Ltr ML18106B0401999-01-18018 January 1999 LER 98-016-00:on 981219,ECCS Leakage Was Outside of Design Value.Caused by Leakage Past Seat of 21RH34 Manual Drain. Valve 21RH34 Was Reseated.With 990118 Ltr ML18106B0081998-12-24024 December 1998 LER 97-001-01:on 970215,failure to Perform TS Surveillance of Component Cooling Water Sys Check Valves Occurred.Caused by Inadequate Communication Between EOP Group & IST Reviewers.Procedure Revised.With 981224 Ltr ML18106B0021998-12-17017 December 1998 LER 98-015-01:on 980924,improper Installation of Test Equipment to RPS Occurred.Caused by Inadequate 10CFR50.59 Applicability Reviews During Past Revs.Revised Procedures. with 981217 Ltr ML18106A9551998-11-0303 November 1998 LER 96-013-01:on 960711,concluded That Current Gain & Bias Settings Had Rendered Overtemperature Delta Temp Protection Channels Inoperable.Caused by Scaling Error.Licensee Will Revise Scaling Calculations.With 981105 Ltr ML18106A9451998-10-30030 October 1998 LER 97-004-01:on 970408,failure to Comply with TS Action Statement,Dg Start & Inadequate Surveillance Testing,Was Noted.Caused by Inadequate Tracking of Inoperable Equipment. Discussed Event & Lessons Learned.With 981022 Ltr ML18106A9491998-10-22022 October 1998 LER 98-015-00:on 980924,identified Improper Installation of Test Equipment to Rps.Cause Indeterminate.Procedures for Installation of Test Equipment for Collection of State Point Data Were Placed on Administrative Hold.With 981022 Ltr ML18106A9301998-10-21021 October 1998 LER 98-014-00:on 980725,noted Improper Calibr of Liquid Radwaste Effluent Line Radiation Monitor.Caused by Inattention to Detail by Maint Personnel.Channel Calibr Was Successfully Performed on 1R18 on 980821.With 981019 Ltr ML18106A9071998-10-0101 October 1998 LER 98-014-00:on 980918,discovered That Fire Barrier Matl for HVAC Ducts Does Not Meet Required Level of Fire Resistance.Cause Indeterminate.Established Appropriate Compensatory Actions for Fire Barriers.With 981001 Ltr ML18106A8951998-09-28028 September 1998 LER 98-012-01:on 980725,noted That Afs Was Operated with Less than Required Number of Operable AFW Pumps.Caused by Improper Procedure Implementation.Runout Protection Pressure Device for 22 AFW Pumps Was Returned to Svc.With 980928 Ltr ML18106A8821998-09-21021 September 1998 LER 98-013-00:on 980820,noted Surveillance of Containment Penetration Overcurrent Protection Devices Missed.Caused by Human Error.Satisfactorily Tested Apprpriate Breakers & Disciplined Involved Personnel.With 980921 Ltr ML18106A8791998-09-16016 September 1998 LER 96-006-01:on 960717,determined That non-radioactive Liquid Basin Radwaste Monitor Inoperable During Low Head Conditions.Caused by Inadequate Design Change Package.Design Change 1EC3663-01 Has Been Installed.With 980916 Ltr ML18106A8801998-09-0808 September 1998 LER 98-013-00:on 980806,operation with TS Required Equipment OOS Was Noted.Caused by Human Error.Reviewed Processes & Practices Re Safety Sys Status Control,Procedure Rev & Extra Training.With 980908 Ltr ML18106A8531998-08-27027 August 1998 LER 98-007-00:on 980730,reactor Coolant Instrument Line through-wall Leak Was Noted.Cause of Event Has Not Yet Been Determined.Assembled Root Cause Team & Replaced Affected tubing.W/980827 Ltr ML18106A8521998-08-27027 August 1998 LER 98-011-00:on 980803,ESFA During a 4KV Automatic Transfer Test Was Noted.Caused by Premature Release of Control Console Pushbutton Due to Inadequate Procedural Step.Revised procedure.W/980827 Ltr ML18106A8421998-08-24024 August 1998 LER 98-012-00:on 980725,discovered That Plant Had Operated in Modes 1 & 2 w/twenty-two AFW Pumps Inoperable.Caused by Failure to Restore Pump Runout Protection Pressure Device to Svc.Returned Subject Device to svc.W/980824 Ltr ML18106A8431998-08-24024 August 1998 LER 98-009-00:on 980810,failure to Post Continuous Firewatch as Required by Fire Protection Plan Noted.Caused by Failure to Recognize Concurrent Conditions.Continuous Firewatch Was Posted Immediately & Repaired Smoke detectors.W/980824 Ltr ML18106A8141998-08-13013 August 1998 LER 98-010-00:on 980714,determined That Leakage from Boron Injection Tank Exceeded Max Allowable ECCS Leakage from Sources Outside Containment.Caused by Leaking 2SJ404 Manual Sample valve.2SJ404 Valve repaired.W/980813 Ltr ML18106A8201998-08-13013 August 1998 LER 98-012-00:on 980715,potential to Exceed Rating of Piping Due to Isolation of Overpressure Protection Line Was Noted. Caused by Inadequate Procedural Guidance.Appropriate Operations Dept Procedures Have Been revised.W/980813 Ltr ML18106A6931998-06-29029 June 1998 LER 98-003-00:on 980122,inappropriate Plugging of Tubes R9C60 & R10C60 in Salem Unit 2 Sg,Was Performed.Caused by Failure of Qualification,Verification & Validation Process. Tubes Reviewed to Verify No Others Inappropriately Plugged ML18106A6471998-06-0404 June 1998 LER 98-011-00:on 980505,improper Isolation of Single Cell Battery Charger from 125 Vdc Battery Was Noted.Caused by Inadequate 10CFR50.59 Applicability Review.Placed Procedure SC.MD-CM.ZZ-0024(Q) on Administrative hold.W/980604 Ltr ML18106A6421998-06-0101 June 1998 LER 98-010-00:on 931019,reactor Pressure Vessel Insp Plugs Were Out of Configuration,Was Noted.Caused by Personnel Error.Proper Configuration Was Restored Shortly After Discovery Prior to Entering Mode 2.W/980601 Ltr ML18106A6431998-05-29029 May 1998 LER 98-006-01:on 980227,determined Incorrect Scaling Error of First Stage Pressure Transmitter Existed.Caused by Human Error.Revised Setpoint Calculation SC-MS002-01 & Revised Associated Instrument Calibr Database info.W/980529 Ltr ML18106A6141998-05-18018 May 1998 LER 98-008-00:on 970814,failure to Test 21 & 22 AF 40 Valves in Closed Direction as Required by TS 4.0.5 Was Noted.Caused by Inadequate Design Mod Process.Motor Driven 21/22 AF 40 Valves Were Tested IAW Revised procedure.W/980518 Ltr ML18106A5901998-05-0101 May 1998 LER 98-009-00:on 980405,epoxy Missing from Terminals of H Analyzer Was Noted.Caused by Inadequate Development of Procedure.H Analyzers Were Repaired & Review of Other Safety Related Equipment in Containment Was performed.W/980501 Ltr ML18106A5611998-04-20020 April 1998 LER 98-008-00:on 980323,inadequate Testing of Salem Unit 1 Containment Air Locks Resulted in Entering TS 3.0.3.Caused by less-than-adequate Work Practices During Replacement of Equalizing Valve.Salem Unit 2 Airlocks Were Inspected ML18106A6061998-04-0101 April 1998 Corrected LER 98-004-00:on 980302,failure to Comply W/Tss 4.11.1.1.2 & 3.3.3.8 Was Noted.Caused by Organizational Deficiency.Steps Have Been Taken to Correctly Document Safety Factors.Corrects Prior Similar Occurrences ML18106A4451998-04-0101 April 1998 LER 98-004-00:on 980302,failure to Perform TS 4.11.1.1.2 & 3.3.3.8 Was Noted.Caused by Organizational Deficiency.Steps Were Taken to Correctly Document Safety factors.W/980401 Ltr ML18106A4351998-03-30030 March 1998 LER 98-006-00:on 980227,incorrect Scaling of First Stage Turbine Impulse Pressure Transmitters Noted.Cause Indeterminate.Implemented Procedure Changes & re-scaled Affected Turbine Impulse Pressure transmitters.W/980330 Ltr ML18106A3961998-03-20020 March 1998 LER 98-005-00:on 980219,inoperability of Twelve EDG Fuel Oil Transfer Pump (FOTP) Noted.Caused by Installation of Incorrect Control Switch.Installed Correct off-auto-manual Switch & Verified Operability of Twelve FOTP.W/980320 Ltr ML18106A5781998-03-20020 March 1998 Corrected LER 98-005-00:on 980219,inoperability of 12 Fuel Oil Transfer Pump (Fotp),Noted.Caused by Installation of Incorrect Control Switch.Field Insp Performed to Verify Configuration of Switches for 11,21 & 22 FOTPs ML18106A4021998-03-20020 March 1998 LER 98-007-00:on 980218,failure to Establish Containment Integrity (Closure) Prior to Fuel Movement Was Noted.Caused by Failure to Identify & Include Condensate Pot Vent in Appropriate Valve Lineup.Valves identified.W/980320 Ltr ML18106A4031998-03-20020 March 1998 LER 98-006-00:on 980221,ESF Actuation of 11 & 12 Auxiliary Feedwater Pumps Occurred.Caused by Human Error.Operators Promptly Established Feedwater to All SG & Restored Proper Water levels.W/980320 Ltr 1999-08-26
[Table view] Category:RO)
MONTHYEARML18107A5031999-08-26026 August 1999 LER 99-006-00:on 990729,determined That SG Blowdown RMs Setpoint Was non-conservative.Caused by Inadequate ACs for Incorporating Original Plant Licensing Data Into Plant Procedures.Blowdown Will Be Restricted.With 990826 Ltr ML18107A4691999-07-28028 July 1999 LER 99-008-00:on 990714,determined That Limit Switch Cables Were Subject to Multiple Hot Shorts in Same Fire Area.Caused by Inadequate Original Post Fire Safe Shutdown Analysis.All Limit Switch Cables for MOVs Were Reviewed.With 990728 Ltr ML18107A4441999-07-0606 July 1999 LER 99-007-00:on 990605,surveillance for Quadrant Power Tilt Ratio (QPTR) Was Missed.Caused by Human Error.Qptr Calculation Was Performed & Personnel Involved Have Been Held Accountable IAW Pse&G Policies.With 990706 Ltr ML18107A4211999-07-0202 July 1999 LER 99-005-00:on 990605,11 Containment Declared Inoperable. Caused by Valves 11SW72 & 11SW223 Both Leaking.Procedure S1.OP-ST.SW-0010(Q) Was Enhanced to Provide Specific Instructions to Ensure Proper Sequencing.With 990702 Ltr ML18107A4321999-07-0101 July 1999 LER 99-006-01:on 990501,determined That There Was No Flow in One of Four Injection Legs.Caused by Sticking of Valve in Safety Injection Discharge Line to 21 Cold Leg.Valve Was Cut Out of Sys & Replaced.With 990701 Ltr ML18107A4331999-07-0101 July 1999 LER 99-002-01:on 990405,determined That 2SA118 Failed as Found Leakrate Test.Caused by Foreign Matl Found in 2SA118 valve.2SA118 Valve Was Cycled Several Times & Seat Area Was Air Blown in Order to Displace Foreign Matl.With 990701 Ltr ML18107A3951999-06-17017 June 1999 LER 99-004-00:on 990520,reactor Tripped from 100% Power,Due to Negative Flux Trip Signal from Nuclear Instrumentation. Cause Has Not Been Determined.Discoloration Was Identified on One of Penetrations.With 990617 Ltr ML18107A3661999-06-0909 June 1999 LER 99-003-00:on 990513,unplanned Entry Into TS 3.0.3 Was Made.Caused by Human error.Re-positioned Creacs Supply Fan Selector Switches & Revised Procedures S1 & S2.OP-ST.SSP-0001(Q).With 990609 Ltr ML18107A3551999-06-0202 June 1999 LER 99-005-00:on 990504,failure to Meet TS Action Statement Requirements for High Oxygen Concentration in Waste Gas Holdup Sys Occurred.Caused by Inability of Operators. Existing Procedures Will Be Evaluated.With 990602 Ltr ML18107A3541999-06-0101 June 1999 LER 99-006-00:on 990501,HHSI Flow Balance Discrepancy Was Noted During Surveillance.Caused by Sticking of Check Valve in SI Discharge Line to 21 Cold Leg.Valve 21SJ17,was Cut Out of Sys & Replaced.With 990601 Ltr ML18107A2931999-05-12012 May 1999 LER 99-002-00:on 990413,determined That Number 12 Auxiliary Bldg Exhaust Fan Was Rotating Backwards.Caused by mis-wiring of Motor Due to Human Error by Maint technician.Mis-wiring Was Corrected & Fan Was Returned to Svc.With 990512 Ltr ML18107A2781999-05-10010 May 1999 LER 99-004-00:on 990411,automatic Actuation of ESF Occurred During Reactor Vessel Head Removal in Support of Refueling Operations.Caused by High Radiation Condition.Containment Atmosphere Was Monitored.With 990505 Ltr ML18107A2791999-05-0404 May 1999 LER 99-003-00:on 990406,all Salem Unit 2 Chillers Rendered Inoperable.Caused by Human Error.Lessons Learned from Event Were Communicated to All Operators by Including Them in Night Orders.With 990504 Ltr ML18107A2741999-05-0303 May 1999 LER 99-002-00:on 990405,determined That Containment Isolation Valve Failed as Found Leakrate Test.Caused by Foreign Matl Blocking Valves from Closing.Check Valve Mechanically Agitated.With 990504 Ltr ML18107A2351999-04-23023 April 1999 LER 99-001-00:on 990330,MSSV Failed Lift Set Test.Caused by Setpoint Variance Which Is Result of Aging.Valves Were Adjusted & Retested to Ensure TS Tolerance.With 990423 Ltr ML18106B1471999-03-29029 March 1999 LER 99-001-00:on 990228,reactor Scram Was Noted as Result of Turbine Trip.Caused by Operator Error.Lesson Plans Revised to Explicitly Demonstrate Manner in Which Valve Functions. with 990329 Ltr ML18106B0701999-02-16016 February 1999 LER 98-015-00:on 981208,inadvertent Discharge Through RHR Relief Valve During Startup Was Noted.Caused by Operator Performing Too Many Tasks Simultaneously.Appropriate Actions Have Been Taken IAW Policies & Procedures.With 990216 Ltr ML18106B0491999-01-28028 January 1999 LER 98-007-01:on 980730,reactor Coolant Instrument Line through-wall Leak Was Noted.Caused by Transgranular Stress Corrosion Cracking.Replaced Affected Tubing.With 990128 Ltr ML18106B0401999-01-18018 January 1999 LER 98-016-00:on 981219,ECCS Leakage Was Outside of Design Value.Caused by Leakage Past Seat of 21RH34 Manual Drain. Valve 21RH34 Was Reseated.With 990118 Ltr ML18106B0081998-12-24024 December 1998 LER 97-001-01:on 970215,failure to Perform TS Surveillance of Component Cooling Water Sys Check Valves Occurred.Caused by Inadequate Communication Between EOP Group & IST Reviewers.Procedure Revised.With 981224 Ltr ML18106B0021998-12-17017 December 1998 LER 98-015-01:on 980924,improper Installation of Test Equipment to RPS Occurred.Caused by Inadequate 10CFR50.59 Applicability Reviews During Past Revs.Revised Procedures. with 981217 Ltr ML18106A9551998-11-0303 November 1998 LER 96-013-01:on 960711,concluded That Current Gain & Bias Settings Had Rendered Overtemperature Delta Temp Protection Channels Inoperable.Caused by Scaling Error.Licensee Will Revise Scaling Calculations.With 981105 Ltr ML18106A9451998-10-30030 October 1998 LER 97-004-01:on 970408,failure to Comply with TS Action Statement,Dg Start & Inadequate Surveillance Testing,Was Noted.Caused by Inadequate Tracking of Inoperable Equipment. Discussed Event & Lessons Learned.With 981022 Ltr ML18106A9491998-10-22022 October 1998 LER 98-015-00:on 980924,identified Improper Installation of Test Equipment to Rps.Cause Indeterminate.Procedures for Installation of Test Equipment for Collection of State Point Data Were Placed on Administrative Hold.With 981022 Ltr ML18106A9301998-10-21021 October 1998 LER 98-014-00:on 980725,noted Improper Calibr of Liquid Radwaste Effluent Line Radiation Monitor.Caused by Inattention to Detail by Maint Personnel.Channel Calibr Was Successfully Performed on 1R18 on 980821.With 981019 Ltr ML18106A9071998-10-0101 October 1998 LER 98-014-00:on 980918,discovered That Fire Barrier Matl for HVAC Ducts Does Not Meet Required Level of Fire Resistance.Cause Indeterminate.Established Appropriate Compensatory Actions for Fire Barriers.With 981001 Ltr ML18106A8951998-09-28028 September 1998 LER 98-012-01:on 980725,noted That Afs Was Operated with Less than Required Number of Operable AFW Pumps.Caused by Improper Procedure Implementation.Runout Protection Pressure Device for 22 AFW Pumps Was Returned to Svc.With 980928 Ltr ML18106A8821998-09-21021 September 1998 LER 98-013-00:on 980820,noted Surveillance of Containment Penetration Overcurrent Protection Devices Missed.Caused by Human Error.Satisfactorily Tested Apprpriate Breakers & Disciplined Involved Personnel.With 980921 Ltr ML18106A8791998-09-16016 September 1998 LER 96-006-01:on 960717,determined That non-radioactive Liquid Basin Radwaste Monitor Inoperable During Low Head Conditions.Caused by Inadequate Design Change Package.Design Change 1EC3663-01 Has Been Installed.With 980916 Ltr ML18106A8801998-09-0808 September 1998 LER 98-013-00:on 980806,operation with TS Required Equipment OOS Was Noted.Caused by Human Error.Reviewed Processes & Practices Re Safety Sys Status Control,Procedure Rev & Extra Training.With 980908 Ltr ML18106A8531998-08-27027 August 1998 LER 98-007-00:on 980730,reactor Coolant Instrument Line through-wall Leak Was Noted.Cause of Event Has Not Yet Been Determined.Assembled Root Cause Team & Replaced Affected tubing.W/980827 Ltr ML18106A8521998-08-27027 August 1998 LER 98-011-00:on 980803,ESFA During a 4KV Automatic Transfer Test Was Noted.Caused by Premature Release of Control Console Pushbutton Due to Inadequate Procedural Step.Revised procedure.W/980827 Ltr ML18106A8421998-08-24024 August 1998 LER 98-012-00:on 980725,discovered That Plant Had Operated in Modes 1 & 2 w/twenty-two AFW Pumps Inoperable.Caused by Failure to Restore Pump Runout Protection Pressure Device to Svc.Returned Subject Device to svc.W/980824 Ltr ML18106A8431998-08-24024 August 1998 LER 98-009-00:on 980810,failure to Post Continuous Firewatch as Required by Fire Protection Plan Noted.Caused by Failure to Recognize Concurrent Conditions.Continuous Firewatch Was Posted Immediately & Repaired Smoke detectors.W/980824 Ltr ML18106A8141998-08-13013 August 1998 LER 98-010-00:on 980714,determined That Leakage from Boron Injection Tank Exceeded Max Allowable ECCS Leakage from Sources Outside Containment.Caused by Leaking 2SJ404 Manual Sample valve.2SJ404 Valve repaired.W/980813 Ltr ML18106A8201998-08-13013 August 1998 LER 98-012-00:on 980715,potential to Exceed Rating of Piping Due to Isolation of Overpressure Protection Line Was Noted. Caused by Inadequate Procedural Guidance.Appropriate Operations Dept Procedures Have Been revised.W/980813 Ltr ML18106A6931998-06-29029 June 1998 LER 98-003-00:on 980122,inappropriate Plugging of Tubes R9C60 & R10C60 in Salem Unit 2 Sg,Was Performed.Caused by Failure of Qualification,Verification & Validation Process. Tubes Reviewed to Verify No Others Inappropriately Plugged ML18106A6471998-06-0404 June 1998 LER 98-011-00:on 980505,improper Isolation of Single Cell Battery Charger from 125 Vdc Battery Was Noted.Caused by Inadequate 10CFR50.59 Applicability Review.Placed Procedure SC.MD-CM.ZZ-0024(Q) on Administrative hold.W/980604 Ltr ML18106A6421998-06-0101 June 1998 LER 98-010-00:on 931019,reactor Pressure Vessel Insp Plugs Were Out of Configuration,Was Noted.Caused by Personnel Error.Proper Configuration Was Restored Shortly After Discovery Prior to Entering Mode 2.W/980601 Ltr ML18106A6431998-05-29029 May 1998 LER 98-006-01:on 980227,determined Incorrect Scaling Error of First Stage Pressure Transmitter Existed.Caused by Human Error.Revised Setpoint Calculation SC-MS002-01 & Revised Associated Instrument Calibr Database info.W/980529 Ltr ML18106A6141998-05-18018 May 1998 LER 98-008-00:on 970814,failure to Test 21 & 22 AF 40 Valves in Closed Direction as Required by TS 4.0.5 Was Noted.Caused by Inadequate Design Mod Process.Motor Driven 21/22 AF 40 Valves Were Tested IAW Revised procedure.W/980518 Ltr ML18106A5901998-05-0101 May 1998 LER 98-009-00:on 980405,epoxy Missing from Terminals of H Analyzer Was Noted.Caused by Inadequate Development of Procedure.H Analyzers Were Repaired & Review of Other Safety Related Equipment in Containment Was performed.W/980501 Ltr ML18106A5611998-04-20020 April 1998 LER 98-008-00:on 980323,inadequate Testing of Salem Unit 1 Containment Air Locks Resulted in Entering TS 3.0.3.Caused by less-than-adequate Work Practices During Replacement of Equalizing Valve.Salem Unit 2 Airlocks Were Inspected ML18106A6061998-04-0101 April 1998 Corrected LER 98-004-00:on 980302,failure to Comply W/Tss 4.11.1.1.2 & 3.3.3.8 Was Noted.Caused by Organizational Deficiency.Steps Have Been Taken to Correctly Document Safety Factors.Corrects Prior Similar Occurrences ML18106A4451998-04-0101 April 1998 LER 98-004-00:on 980302,failure to Perform TS 4.11.1.1.2 & 3.3.3.8 Was Noted.Caused by Organizational Deficiency.Steps Were Taken to Correctly Document Safety factors.W/980401 Ltr ML18106A4351998-03-30030 March 1998 LER 98-006-00:on 980227,incorrect Scaling of First Stage Turbine Impulse Pressure Transmitters Noted.Cause Indeterminate.Implemented Procedure Changes & re-scaled Affected Turbine Impulse Pressure transmitters.W/980330 Ltr ML18106A3961998-03-20020 March 1998 LER 98-005-00:on 980219,inoperability of Twelve EDG Fuel Oil Transfer Pump (FOTP) Noted.Caused by Installation of Incorrect Control Switch.Installed Correct off-auto-manual Switch & Verified Operability of Twelve FOTP.W/980320 Ltr ML18106A5781998-03-20020 March 1998 Corrected LER 98-005-00:on 980219,inoperability of 12 Fuel Oil Transfer Pump (Fotp),Noted.Caused by Installation of Incorrect Control Switch.Field Insp Performed to Verify Configuration of Switches for 11,21 & 22 FOTPs ML18106A4021998-03-20020 March 1998 LER 98-007-00:on 980218,failure to Establish Containment Integrity (Closure) Prior to Fuel Movement Was Noted.Caused by Failure to Identify & Include Condensate Pot Vent in Appropriate Valve Lineup.Valves identified.W/980320 Ltr ML18106A4031998-03-20020 March 1998 LER 98-006-00:on 980221,ESF Actuation of 11 & 12 Auxiliary Feedwater Pumps Occurred.Caused by Human Error.Operators Promptly Established Feedwater to All SG & Restored Proper Water levels.W/980320 Ltr 1999-08-26
[Table view] Category:TEXT-SAFETY REPORT
MONTHYEARML20217A9931999-09-30030 September 1999 NRC Regulatory Assessment & Oversight Pilot Program, Performance Indicator Data ML18107A5581999-09-30030 September 1999 Monthly Operating Rept for Sept 1999 for Salem,Unit 2.With 991014 Ltr ML18107A5571999-09-30030 September 1999 Monthly Operating Rept for Sept 1999 for Salem,Unit 1.With 991014 Ltr ML18107A5301999-08-31031 August 1999 Monthly Operating Rept for Aug 1999 for Salem,Unit 2.With 990913 Ltr ML18107A5311999-08-31031 August 1999 Monthly Operating Rept for Aug 1999 for Salem,Unit 1.With 990913 ML18107A5031999-08-26026 August 1999 LER 99-006-00:on 990729,determined That SG Blowdown RMs Setpoint Was non-conservative.Caused by Inadequate ACs for Incorporating Original Plant Licensing Data Into Plant Procedures.Blowdown Will Be Restricted.With 990826 Ltr ML18107A5201999-08-12012 August 1999 Rev 0 to Sgs Unit 2 ISI RFO Exam Results (S2RFO#9) Second Interval,Second Period, First Outage (96RF). ML18107A4811999-07-31031 July 1999 Monthly Operating Rept for July 1999 for Salem,Unit 1.With 990813 Ltr ML18107A4821999-07-31031 July 1999 Monthly Operating Rept for July 1999 for Salem,Unit 2.With 990813 Ltr ML18107A4691999-07-28028 July 1999 LER 99-008-00:on 990714,determined That Limit Switch Cables Were Subject to Multiple Hot Shorts in Same Fire Area.Caused by Inadequate Original Post Fire Safe Shutdown Analysis.All Limit Switch Cables for MOVs Were Reviewed.With 990728 Ltr ML18107A4441999-07-0606 July 1999 LER 99-007-00:on 990605,surveillance for Quadrant Power Tilt Ratio (QPTR) Was Missed.Caused by Human Error.Qptr Calculation Was Performed & Personnel Involved Have Been Held Accountable IAW Pse&G Policies.With 990706 Ltr ML18107A4211999-07-0202 July 1999 LER 99-005-00:on 990605,11 Containment Declared Inoperable. Caused by Valves 11SW72 & 11SW223 Both Leaking.Procedure S1.OP-ST.SW-0010(Q) Was Enhanced to Provide Specific Instructions to Ensure Proper Sequencing.With 990702 Ltr ML18107A4331999-07-0101 July 1999 LER 99-002-01:on 990405,determined That 2SA118 Failed as Found Leakrate Test.Caused by Foreign Matl Found in 2SA118 valve.2SA118 Valve Was Cycled Several Times & Seat Area Was Air Blown in Order to Displace Foreign Matl.With 990701 Ltr ML18107A4321999-07-0101 July 1999 LER 99-006-01:on 990501,determined That There Was No Flow in One of Four Injection Legs.Caused by Sticking of Valve in Safety Injection Discharge Line to 21 Cold Leg.Valve Was Cut Out of Sys & Replaced.With 990701 Ltr ML18107A5211999-07-0101 July 1999 Rev 0 to Sgs Unit 2 ISI RFO Exam Results (S2RFO#10) Second Interval,Second Period,Second Outage (99RF). ML18107A4351999-06-30030 June 1999 Monthly Operating Rept for June 1999 for Salem,Unit 1.With 990713 Ltr ML18107A4341999-06-30030 June 1999 Monthly Operating Rept for June 1999 for Salem,Unit 2.With 990713 Ltr ML20196H8621999-06-30030 June 1999 NRC Regulatory Assessment & Oversight Pilot Program, Performance Indicator Data, June 1999 Rept ML18107A3951999-06-17017 June 1999 LER 99-004-00:on 990520,reactor Tripped from 100% Power,Due to Negative Flux Trip Signal from Nuclear Instrumentation. Cause Has Not Been Determined.Discoloration Was Identified on One of Penetrations.With 990617 Ltr ML18107A3661999-06-0909 June 1999 LER 99-003-00:on 990513,unplanned Entry Into TS 3.0.3 Was Made.Caused by Human error.Re-positioned Creacs Supply Fan Selector Switches & Revised Procedures S1 & S2.OP-ST.SSP-0001(Q).With 990609 Ltr ML18107A3551999-06-0202 June 1999 LER 99-005-00:on 990504,failure to Meet TS Action Statement Requirements for High Oxygen Concentration in Waste Gas Holdup Sys Occurred.Caused by Inability of Operators. Existing Procedures Will Be Evaluated.With 990602 Ltr ML18107A3441999-06-0101 June 1999 Interim Part 21 Rept Re Premature Over Voltage Protection Actuation in Circuit Specific Application in Dc Power Supply.Testing & Evaluation Activities Will Be Completed on 990716 ML18107A3541999-06-0101 June 1999 LER 99-006-00:on 990501,HHSI Flow Balance Discrepancy Was Noted During Surveillance.Caused by Sticking of Check Valve in SI Discharge Line to 21 Cold Leg.Valve 21SJ17,was Cut Out of Sys & Replaced.With 990601 Ltr ML18107A3681999-05-31031 May 1999 Monthly Operating Rept for May 1999 for Salem Generating Station,Unit 1.With 990611 Ltr ML18107A3721999-05-31031 May 1999 Monthly Operating Rept for May 1999 for Salem Generating Station,Unit 2.With 990611 Ltr ML18107A2931999-05-12012 May 1999 LER 99-002-00:on 990413,determined That Number 12 Auxiliary Bldg Exhaust Fan Was Rotating Backwards.Caused by mis-wiring of Motor Due to Human Error by Maint technician.Mis-wiring Was Corrected & Fan Was Returned to Svc.With 990512 Ltr ML18107A2781999-05-10010 May 1999 LER 99-004-00:on 990411,automatic Actuation of ESF Occurred During Reactor Vessel Head Removal in Support of Refueling Operations.Caused by High Radiation Condition.Containment Atmosphere Was Monitored.With 990505 Ltr ML18107A2791999-05-0404 May 1999 LER 99-003-00:on 990406,all Salem Unit 2 Chillers Rendered Inoperable.Caused by Human Error.Lessons Learned from Event Were Communicated to All Operators by Including Them in Night Orders.With 990504 Ltr ML18107A2741999-05-0303 May 1999 LER 99-002-00:on 990405,determined That Containment Isolation Valve Failed as Found Leakrate Test.Caused by Foreign Matl Blocking Valves from Closing.Check Valve Mechanically Agitated.With 990504 Ltr ML18107A3711999-04-30030 April 1999 Corrected Monthly Operating Rept for Apr 1999 for Salem Generating Station,Unit 1 ML18107A3151999-04-30030 April 1999 Submittal-Only Screening Review of Salem Generating Station Individual Plant Exam for External Events (Seismic Portion), Rev 1 ML18107A2991999-04-30030 April 1999 Monthly Operating Rept for Apr 1999 for Salem Unit 1.With 990514 Ltr ML18107A2971999-04-30030 April 1999 Monthly Operating Rept for Apr 1999 for Salem Unit 2.With 990514 Ltr ML18107A2351999-04-23023 April 1999 LER 99-001-00:on 990330,MSSV Failed Lift Set Test.Caused by Setpoint Variance Which Is Result of Aging.Valves Were Adjusted & Retested to Ensure TS Tolerance.With 990423 Ltr ML18107A2881999-04-0707 April 1999 Rev 0 to NFS-0174, COLR for Salem Unit 2 Cycle 11. ML18107A1821999-03-31031 March 1999 Monthly Operating Rept for Mar 1999 for Salem,Unit 1.With 990414 Ltr ML18107A1831999-03-31031 March 1999 Monthly Operating Rept for Mar 1999 for Salem,Unit 2.With 990414 Ltr ML18106B1471999-03-29029 March 1999 LER 99-001-00:on 990228,reactor Scram Was Noted as Result of Turbine Trip.Caused by Operator Error.Lesson Plans Revised to Explicitly Demonstrate Manner in Which Valve Functions. with 990329 Ltr ML18106B1021999-02-28028 February 1999 Monthly Operating Rept for Feb 1999 for Salem Unit 2.With 990315 Ltr ML18106B1011999-02-28028 February 1999 Monthly Operating Rept for Feb 1999 for Salem Unit 1.With 990315 Ltr ML18106B0931999-02-25025 February 1999 Part 21 Rept Re Possible Defect in Swagelok Pipe Fitting Tee,Part Number SS-6-T.Caused by Crack Due to Improper Location of Heated Bar.Only One Part Out of 7396 Pieces in Forging Lot Was Found to Be Cracked.Affected Util,Notified ML18106B0701999-02-16016 February 1999 LER 98-015-00:on 981208,inadvertent Discharge Through RHR Relief Valve During Startup Was Noted.Caused by Operator Performing Too Many Tasks Simultaneously.Appropriate Actions Have Been Taken IAW Policies & Procedures.With 990216 Ltr ML18106B0551999-02-0101 February 1999 Part 21 Rept Re Possible Matl Defect in Swagelok Pipe Fitting Tee,Part Number SS-6-T.Defect Is Crack in Center of Forging.Analysis of Part Is Continuing & Further Details Will Be Provided IAW Ncr Timetables.Drawing of Part,Encl ML18106B0561999-01-31031 January 1999 Monthly Operating Rept for Jan 1999 for Salem Generating Station,Unit 2.With 990212 Ltr ML18106B0571999-01-31031 January 1999 Monthly Operating Rept for Jan 1999 for Salem Generating Station,Unit 1.With 990212 Ltr ML20205P1671999-01-31031 January 1999 a POST-PLUME Phase, Federal Participation Exercise ML18106B0441999-01-29029 January 1999 Part 21 Rept Re Possible Defect in Swagelok Pipe Fitting Tee Part Number SS-6-T.Caused by Crack in Center of Forging. Continuing Analysis of Part & Will Provide Details in Acoordance with NRC Timetables ML18106B0491999-01-28028 January 1999 LER 98-007-01:on 980730,reactor Coolant Instrument Line through-wall Leak Was Noted.Caused by Transgranular Stress Corrosion Cracking.Replaced Affected Tubing.With 990128 Ltr ML18106B0401999-01-18018 January 1999 LER 98-016-00:on 981219,ECCS Leakage Was Outside of Design Value.Caused by Leakage Past Seat of 21RH34 Manual Drain. Valve 21RH34 Was Reseated.With 990118 Ltr ML18106B0251998-12-31031 December 1998 Monthly Operating Rept for Dec 1998 for Salem Unit 2.With 990115 Ltr 1999-09-30
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I Public Service .Electric and Gas Company P.O. Box 236 _Hancocks Bridge, New Jersey 08038-0236 I
Nuclear Business Unit MAR 2 o 1998 LR-N980129 U.
- S. Nuclear Regulatory Cmmnission Document Control Desk Washington, DC 20555 LER 272/98-006-00 SALEM GENERATING STATION - UNIT 1 FACILITY OPERATING LICENSE NO. DPR-70 DOCKET NO. 5-0-272 Gentlemen:
This Licensee Event Report entitled "ESF Actuation of *11 arid 12 Auxiliary Feedwater Pumps" is being submitted pursuant to the requirements of the Code of Federal Regulations ****10CFR50.73 (a_) (2) (iv)****.
Sincerely, A. c. Bakken III General Manager_
Salem Operations Attachment
- ~PJD/kjb c Distribution LER File 3.7 r-, -I
~f_ . dd I 9803310173 980320 PDR ADOCK 05000272 S PDR The power is in your hands.
95-2168 REV. 6/94
--~_,
. I NRCl"'ORM366 (4-95)
U.S. NUCLEAR REGULATORY COMMISSION LICENSEE EVENT _REPORT (LER)
- APPROVED BY OMB*NO. 3150-0104 EXPIRES 04/30/98 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS MANDATORY INFORMATION COLLECTION REQUEST: 50.0 HRS.
REPORTED LESSONS LEARNED ARE INCORPORATED INTO THE LICENSING PROCESS AND FED BACK TO INDUSTRY.
COMMENTS REGARDING BURDEN ESTIMATE TO THE INFORMATION AND FORWARD
.' RECORDS MANAGEMENT BRANCH (T-6 F33), U.S. NUCLEAR (See reverse for required number of REGULATORY COMMISSION, WASHINGTON, DC 20555-0001, AND TO THE PAPERWORK REDUCTION PROJECT (3150-0104), OFFICE OF digits/characters for each block) MANAGEMENT AND BUDGET, WASHINGTON, DC 20503.
F1..;1LITT NAllE (1) DOCKET NUllBER (2) PAGE (3)
SALEMUNIT1 05000272 1 OF4 TITLE (4)
ESF Actuation of 11 and 12 Auxiliary Feedwater Pumps EVENT DATE (5) LER NUMBER (6) REPORT DATE (7) OTHER FACILITIES INVOLVED (8)
FACILITY NAME DOCKET NUMBER MONTH DAY YEAR' YEAR I SEQUENTIAL . I REVISION MONTH DAY YEAR 2 21 98 98 -- 006 -- 00 3 20 98 FACILITY NAME DOCKET NUMBER OPERATING THIS REPORT IS SUBMITTED PURSUANT TO THE REQUIREMENTS OF 10 CFR §: (Check one or more) (11)
. MODE (9) 4 20.2201(b) 20.2203(a)(2)(v) 50.73(a)(2)(i)(B) 50.73(a)(2)(viii)
POWER 20.2203(a)(1) 20.2203(a)(3)(i) 50.73(a)(2)(ii) 50.73(a)(2)(x)
LEVEL (10) 0 20.2203(a)(2)(i) 20.2203(a)(3)(ii) 50. 73(a)(2)(iii) 73.71 x
20.2203(a)(2)(ii) 20.2203(a)(4) 50. 73(a)(2)(iv) OTHER 20.2203(a)(2)(iii) 50.36(c)(1) 50. 73(a)(2)(v) Spec~in Abstract below or in C Form 366A 20.2203(a)(2)(iv) 50.36(c)(2) 50.73(a)(2)(vii)
LICENSEE CONTACT FOR THIS LER (12)
NAME TELEPHONE NUMBER (Include Area Code)
Philip J. Duca, Salem Licensing Engineer (609) 339-2381 COMPLETE ONE LINE FOR EACH COMPONENT FAILURE DESCRIBED IN THIS REPORT (13)
CAUSE SYSTEM COMPONENT MANUFACTURER REPORTABLE CAUSE SYSTEM COMPONENT MANUFACTURER REPORTABLE TONPRDS TONPRDS IYES SUPPLEMENTAL REPORT EXPECTED (14)
(If yes, complete EXPECTED SUBMISSION DATE).
Ixi NO EXPECTED SUBMISSION DATE (15)
MONTH xx DAY xx YEAR xx ABSTRACT (Limit to 1400 spaces, i.e., approximately 15 single-spaced typewritten lines) (16)
At 1332 on February 21, 1998 with Salem* Unit 1 operating in Mode 4 (Hot Shutdown), 11 and 12 Auxiliary Feedwater Pumps automatically started on Lo-Lo Steam Generator level in 14 Steam Generator.
The cause of this event was human error. The Main Steam lines were being warmed through the Main Steam Stop Bypass Valves. These valves had been opened wider during the night shift increasing the steaming rate of the steam generator$. The operators did not adequately monitor steam generator water levels nor did they anticipate the increased steaming rate. Contributing causes were ineffective shift turnover and poor team communication.
The operators promptly established feedwater to all steam generators and restored water levels. Other corrective actions induded discussion of the event and lessons learned by the personnel involved with all operating crews, and a reemphasis of responsibilities and the importance of safe operations by the shift superintendents. Additionally, personnel involved have been held accountable in accordance with PSE&G procedures and policies.
A 4 hour4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> telephone notification was made to the NRC at 1500 on February 21, 1998 in accordance with 10CFR50.72(b)(2)ii; this report is being submitted in accordance with 10CFR50.73(a)(2)(iv); both required for "any event or condition that resulted in a manual or automatic actuation of any Engineered Safety Feature (ESF) ...... ".
NRC FORM 366 (4-95)
NRC FORM 366A (4-95)
FACILITY NAME (1)
LICENSEE EVENT REPOIJT (LER)
TEXT CONTINUATION DOCKET NUMBER (2)
U.S. NUCLEAR REGULATORY COMMISSION LER NUMBER (6) PAGE (3)
YEAR I SEQUENTIAL NUMBER I REVISION NUMBER SALEM UNIT1 05000272 - 98 -- 006 -- 00 2 OF 4 TEXT (If more space is required, use additional copies of NRC Form 366A) (17)
PLANT AND SYSTEM IDENTIFICATION Westinghouse - Pressurized Water Reactor Auxiliary/Emergency Feedwater System {BA/-}*
- Energy Industry Identification System (EllS) codes and component function identifier codes appear as {SS/CCC}.
CONDITIONS PRIOR TO OCCURRENCE At the time of the occurrence Salem Unit *1 was in Mode 4 at 0 % Power with the Residual Heat Removal System in service providing core cooling.
DESCRIPTION OF OCCURRENCE On February 19, the night shift (1900-0700) commenced warming up the Main Steam lines in accordance with procedures being utilized to take the plant from Cold Shutdown to Hot Standby.
Warming up the Main Steam lines requires opening of the Main Steam Stop Bypass Valves (11-14MS18 valves). In Mode 4 feedwater is manually supplied to the steam generators on a periodic basis. This was being accomplished by starting and stopping of the Auxiliary Feedwater pumps.
Establishing flow through the MS18 valves increased the steaming rate of the steam generators, thereby_increasing the required frequency of providing feedwater to the steam generators to maintain
- water levels. The MS18 valves were opened approximately 1 to 2% of valve open position. The increased steaming rate required the starting of Auxiliary Feedwater pumps approximately once per 12 hour1.388889e-4 days <br />0.00333 hours <br />1.984127e-5 weeks <br />4.566e-6 months <br /> shift in order to maintain steam generator levels. On February 20, the night shift further opened all MS18 valves to approximately 4% valve open position. The steam generators were filled to greater than 33% narrow range level at 0451 on the morning of February 21. The additional steam demand, which caused water levels to fall at an increased rate, was not anticipated by the on-coming day shift (0700-1900). 14 Steam Generator Narrow Range Level dropped from 36% to 9% in approximately 8.5 hours5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br />.
Prior to the event steam generator water level narrow range chart recorders and steam generator water level program deviation console alarms on Control Console 2 were inoperable due to Advanced Digital Feedwater Control System testing which was in progress.
NRC FORM 366A (4*95)
)
NRC FORM 366A (4-95)
LICENSEE EVENT REPORT (LER)
TEXT CONTINUATION DOCKET NUMBER (2)
U.S. NUCLEAR REGULATORY COMMISSION LER NUMBER (6) PAGE (3)
FACILITY NAME (1)
YEAR I SEQUENTIAL NUMBER I REVISION NUMBER SALEM UNIT 1 05000272 98 -- 006 -- 00 3 OF 4 TEXT (If more space is required, use additional copies of NRC Form 366A) (17)
DESCRIPTION OF OCCURRENCE (continued)
Following the event, all steam generator water level narrow range chart recorders and program water level deviation alarms were returned to service. All steam generator levels were restored to greater than 33% as indicated on the narrow range level instruments.
CAUSE OF OCCURRENCE The cause of this event was human error. The *unit 1 Reactor Operator, Plant Operator (the other contra.I room Nuclear Control Operator), and Control Room Supervisor did not adequately monitor steam generator water levels nor did they anticipate the increased feedwater requirements. The Reactor Operator did not determine the rate at which steam generator water levels were decreasing.
Steam generator narrow range water levels are logged every 6 hours6.944444e-5 days <br />0.00167 hours <br />9.920635e-6 weeks <br />2.283e-6 months <br />. The Unit 1 Reactor Operator logged 14 Steam Generator Narrow Range Level at 32% at 0730. At 1330, while performing his logs, he noted 14 level to be 12% based on one of three narrow range level instruments. *The other two narrow range level instruments were at 9%. When level reached 9 %, the autostart of the auxiliary feedwater pumps occurred as designed.
A contributing cause* of this event was ineffective shift turnover and poor team communication.
Although the additional steam demand on the steam generators was discussed during the individual watch turnovers, the subject was never discussed at the Pre-watch Shift Brief nor did the Unit 1 Control Room Crew discuss any increased monitoring of steam generator water levels. The operating crew also did not discuss what steam generator water level should be maintained. The Operations Superintendent was not informed that the MS18 valves were opened an additional 2%.
NRC FORM 366A (4*95)
1 NRC r-"ORM 366A (4-95)
LICENSEE EVENT REPORT (LER)
TEXT CONTINUATION DOCKET NUMBER (2)
U.S. NUCLEAR REGULATORY COMMISSION LER NUMBER (6) PAGE (3)
FACILITY NAME (1)
YEAR I SEQUENTIAL NUMBER I REVISION NUMBER SALEM UNIT1 05000272 98 -- 006 -- 00 4 OF 4 TEXT (If more space is required, use additional copies of NRC Form 366A) (17)
PRIOR SIMILAR OCCURRENCES A review of LERs issued in the past two years did not identify any similar occurrences regarding the autostart of the auxiliary feedwater pumps SAFETY CONSEQUENCES AND IMPLICATIONS The Auxiliary Feedwater pump automatic start on Lo-Lo steam generator level functioned as designed. While steam generator level was dropping, the rate of decrease was relatively slow. The operators had ample time to react to the event prior to level in the steam generator reaching the extent (reaching hot and dry conditions) where damage could occur. Level in the other three steam generator levels remained above the autostart initiation level. At the time of the event core cooling was being provided by 11 Residual Heat Removal Loop. The steam generators were not being relied on for decay heat removal. Therefore, the health and safety of the public were not affected.
CORRECTIVE ACTIONS
- 1. The operators promptly established feedwater to all steam generators and restored proper water levels.
- 2. All steam generator water level narrow range chart recorders and program water level deviation console alarms were returned to operable status on February 21 , 1998.
- 3. The Reactor Operator and Plant Operator at the time of the event have discussed this event and lessons learned with all operating crews.
- 4. All on shift Operations Superintendents have discussed this event and have led a discussion with their respective crews regarding their responsibilities and the importance of safe operations.
- 5. All personnel involved have been held accountable in accordance with PSE&G's procedures and policies.
NRC FORM 366A (4-95)