ML20045D186

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LER 93-010-00:on 930519,SUT Became de-energized During Planned Calibr of Turbine/Generator Relays Lockout Test While Shut Down.Caused by Personnel Error.Discussion Conducted W/Personnel Re Attention to detail.W/930618 Ltr
ML20045D186
Person / Time
Site: Pilgrim
Issue date: 06/18/1993
From: Boulette E, Gay R
BOSTON EDISON CO.
To:
NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
References
BECO-LTR-93-75, LER-93-010, LER-93-10, NUDOCS 9306280072
Download: ML20045D186 (8)


Text

. _ . - . _ . _ . . .._. _ _ _ _ _ _ . . _ . _ . . . _ _ _ . _ _

9 10 CFR 50.73 2

[],

BOSTON EDISON ,

, Pdgnm Nuclear Power Staten Rocky Hill Road Plymouth, Massachusetts o2360 E. T. Boulette, PhD Senior Vice President-Nuclear June 18 , 1993 '

BEco Ltr. 93- 75 U.S. Nuclear Regulatory Commission  !

Attn: Document Control Desk Washington, D.C. 20555 i

Docket No._50-293 l License No. DPR-35 l

i The enclosed Licensee Event Report.(LER) 93-010-00, " Start Up Transformer Became De-energized During Testing While Shut Down", is-submitted in accordance with 10 CFR Part 50.73.

Please do not hesitate to contact me if there are' any questions regarding'this report. ,

bf hbu$>$

E. T. Boulette, PhD l

RAG /bal u

Enclosure:

LER 93-010-00 cc: Mr. Thomas T. Martin Regional Administrator, Region I

'U.S. Nuclear Regulatory. commission

( 475 Allendale Rd.

l King of Prussia, PA 19406 I

l Mr. R. B. Eaton l Div. of Reactor Projects I/II Office of NRR - USNRC One White. Flint North - Mail Stop 14D1 11555 Rockville Pike Rockville, MD 20852 Sr. NRC Resident Inspector.- Pilgrim Station Standard BEco LER Distribution 9306280072 93061s /j' I PDR - ADOCK'05000293

.S 'PDR

_ . _ .___ _ _ _ . _ _ _ _ _ _ _. __ ._. - ~ .

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l NRC FORM 366 U.S. NUCLEAR REGULAVORY COMMISSION APPROVED BY OMB NO. 3150-0104 t s.m .

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, EXPIRES 5/31/95

. ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS LICENSEE EVENT REPORT (LER) 1 lIs f"nEa % % % E E Z J f0 M "3's  !

%ia*" "SSC="#"o'C A"A",

TO THE PAPERWORK REDUCTION PRG.iECT p150-0104) OFFICE l

(See reverse for number of degrts/ characters for each bloem) OF MANAGEMENT AND BUDGET, WASHINGTON, DC 20503.

FACILITY N'AME (1) DOCKET NUMBER (2) PAGE (3)

PILGRIM NUCLEAR POWER STATION 05000 -293 1 of 7  ;

YlTLE (4) ,

I Start Up Transformer Became De-energized During Testing While Shut Down EVENT DATE (5) LER NUMBER (6) REPORT DATE (7) OTHER FACILITIES INVOLVED (8)

I SEQUENTIAL REVISION FACluTY NAME DOCKET NUMBER ,

MONTH DAY YEAR YEAR NUMBER NUMBER MONTH DAY YEAR N/A 05000 l F ACluTY NAME DOCKET NUMBER 05 19 93 93 010 00 06 18 93 N/A 05000  !

OPERATING THIS REPORT IS SUBMITTED PURSUANT TO THE REQUIREMENTS OF to CFR S: (Check one or more)(11)

DE@) N 20.402(b) 20.405(c) X So.73(a)(2)(iv) 73.71(b)

PO R 20.405(a)(1)(i) 50.36(c)(1) 50.73(a)(2)(v) 73.71(c)

LE  !

O) 000 20.405(a)(1)(ii) 50.36(c)(2) 50.73(a)(2)(vii) OTHER 20.405(a)(1)(iii) 50.73(a)(2)(i) 50.73(a)(2)(viii)(A) ,

20.405(a)(1)(iv) 50.73(a)(2)(ii) So.73(a)(2)(viii)(B) yt;c{g 20.405fa)(1)(v) 50.73(a)(2)(iii) 50.73(a)(2)(x) Form 366A)

LICENSEE CONTACT FOR THIS LER (12)

NAME TELEPHONE NUMBER (!nclude Area Code)

Robert A. Gay - Senior Compliance Engineer (508) 747-8047 ,

COMPLETE ONE LINE FOR EACH COMPONENT FAILURE DESCRIBED IN TH!S REPORT (13) l CAUSE SYSTEM COMPONENT MANUFACTURER P CAUSE SYSTEM COMPONENT MANUFACTURER S SUPPLEMENTAL REPORT EXPECTED (14) ""'" U## #

EXPECTED YES X NO SUBMISSION (If yes, complete EXPECTED SUBMISSION DATE)

DATE (15)

ABSTRACT (16)

On May 19, 1993, at 1328 hours0.0154 days <br />0.369 hours <br />0.0022 weeks <br />5.05304e-4 months <br />, the Start Up Transformer (SUT) became de-energized during a planned calibration of turbine / generator relays, lockout test and associated annunciator verification while the plant was shutdown. The Start Up Transformer lockout relay was actuated instead of the Main Transformer lockout relay. The de-energization of the SVT resulted in designed responses including automatic actuations of the Reactor Protection System, Primary and Secondary Containment Isolation Control Systems and Emergency Diesel Generators. The Start Up Transformer was re-energized by 1421 hours0.0164 days <br />0.395 hours <br />0.00235 weeks <br />5.406905e-4 months <br />.

The root cause of the event was utility non-licensed Electric Lab Engineer error. The engineer mistakenly actuated the wrong relay while implementing the test procedure.

Corrective action taken included an immediate discussion with electrical maintenance personnel on attention to detail and self-checking. Preventive action planned includes review of the procedure for improvement to preclude recurrence.

The event occurred while shut down in a refueling outage. The Reactor Vessel (RV) head was installed. The reactor mode selector switch was in the SHUTDOWN position. There was no movement of a fuel assembly or fuel cask at the time of the event. This report is submitted in accordance with 10 CFR 50.73(a)(2)(iv). This event posed no threat to the public health an:1 safety.

NRC FORM 368A l5-92)

( 1 l NRC FORM 366A U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB NO. 3150-o104  !

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( s-m . EXPIRES 5/31/95 ESTIMATED BURDEN PER FIEJPONSE TO COMPLY WrTH THIS LICENSEE EVENT REPORT (LER) M#lEo d'o" "R# 3 *S J L %?iN # 2 2 1 "T^

TEXT CONTINUATION E5 TORY $u"u^Ys"EENaTc"N"" ""cSsU"o">oDN TO THE PAPERWORK REDUCTION PROJECT (3150-0104). OFFICE ;

OF MANAGEMENT AND BUDGET, WASHINGTON. DC 20503 FACIUTY NAME (1) DOCKET NUMBER (2) LER NUMBER (6) PAGE (3)

YEAR NUMB PILGRIM NUCLEAR POWER STATION 05003-293 93 --010- 00 TEXT (if more space is required, use additional copies of NRC Form 366A)(17)

BACKGROUND i The Auxiliary Power Distribution System (APDS) consists of six 4160 VAC buses. The APDS is divided into emergency service (Buses A5 and A6) and normal service (Buses Al, A2, A3, A4). Buses A5 and A6 supply power to essential loads required during normal operations and abnormal operational transients or accidents. Buses A1, A2, A3, A4 supply power to other station auxiliaries during planned operations. Power is distributed to the six 4160 VAC buses during normal operation from either the unit source (Unit Auxiliary Transformer) or the preferred offsite source (Start Up Transformer). The preferred power source is used to supply the 4160 VAC buses during normal startup and shutdown. After the main generator has been synchronized to the 345 kV transmission system, the 4160 buses are transferred from the preferred power source to the unit power source. The 4160 VAC emergency service Buses A5 and A6 can also be supplied from the standby power source PDG

'A' and 'B') or the secondary power source (Shutdown Transformer).

During conditions when neither the UAT nor the SUT are available, the emergency diesel generators are designed to power emergency Buses A5 and A6. If the diesel generators fail to pick up the emergency buses, the Shutdown Transformer is designed to automatically l power Bus A5 and A6 after a 12 second time delay. The station blackout diesel generator l may be started to power Bus A5 or Bus A6.

Non-safety related 4160 V Buses Al, A2, A3, and A4 are designated normal service system buses. These buses power loads necessary for normal plant startup, operation, and shut down. These buses can be powered only by the UAT or SUT.

4160 V buses A1, A3, and A5 are located in the Turbine Building Switchgear Room 'A'.

Buses A2, A4, and A6 are located in Switchgear Room 'B'.

Just prior to the event, plant system status was:  !

l l o The reactor mode selector switch was in the REFUEL position. The control rods were fully inserted for the core locations where fuel was installed. The RV head was i installed with RV pressure at zero psig. The Reactor Vessel (RV) water temperature was approximately 91 degrees Fahrenheit. There was no movement of a fuel cask or irradiated fuel . The Residual Heat Removal (RHR) System Loop ' A' was in service in the Shutdown Cooling (SDC) mode.

l e The 345 kV switchyard ring bus was energized via transmission lines 342 and 355. Air circuit breakers 102, 103, 104 and 105 were closed. Bus B6 was being powered from Bus 81. 4160 VAC buses that were in service were energized via the SVT. The Shutdown Transformer was in standby service.

o The Emergency Diesel Generators (EDGs) 'A' and 'B' were in standby service. The APDS

was energized by preferred offsite power via the SUT. The 23 kV distribution system l was energized.

NRC FORM 366A (b-92)

NRC FORM 366A U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB NO. 3150-0104 o-m . EXPIRES 5/31/95

. ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS LICENSEE EVENT REPORT (LER) ETE"0 1 3$'S?u'J, E Jk % 5M"*^2 TEXT CONTINUATION ^"Su"'A RE CC M75 CN?[C W OC 3,1="*T =S'."r~Ka##? ""

FACILITY NAME (1) DOCKET NUMBER (2) LER NUMBER (6) PAGE (3)

YEAR R'^ NU PILGRIM NUCLEAR POWER STATION 05000-293 93 -010- 00 TEXT (tf more space is required. use additional copies oi NRC Form 366A)(17)

  • The RV was vented to the Drywell via RV-203-4B flange (valve removed for ILRT).

Located at the end of this report is a Figure that depicts a simplified single line diagram of a portion of the APDS.

EVENT DESCRIPTION i On May 19, 1993, at 1328 hours0.0154 days <br />0.369 hours <br />0.0022 weeks <br />5.05304e-4 months <br />, the Start Up Transformer became de-energized. The SUT i became de-energized because the SUT lockout relay 86X/ST was actuated instead of the Main Transformer lockout relay 86X/MT, which caused ACB 102 and ACB 103 to trip open and  :

eliminate line 355 and line 342 as sources of preferred off-site power to the SUT. The ,

loss of sources of power to the SUT'resulted in the following:

  • The APDS, energized by preferred off-site power via the SVT, became de-energized and '

resulted in the following:

  • De-energizing / actuation of the RPS, PCIS and RBIS that included: '
  • Multiple concurrent RPS scram signalc. The control rod drives remained i in the inserted position. '

The Group 2 valves, except for A0-5035 A/B that were jumpered open for ILRT, were closed and remained closed.

  • The Group 3 valves MO-1001-47 and -50 that were open and jumpered for ILRT remained open. Valve M0-1001-29A, open for Residual Heat Removal / Shutdown Cooling, remained open because MO-1001-47 and -50 remained open.
  • The Group 6 valves M0-1201-2, -5, and -80, closed for ILRT, remained closed.
  • RBIS actuation that resulted in the automatic closing of the inboard and outboard Reactor Building /SCS ventilation supply and exhaust dampers and

, automatic start of the SGTS Trains 'A' and 'B'.

  • EDGs 'A' and 'B' started automatically and re-energized Buses A5 and A6 and related AC powered load center buses, motor control centers, and distribution panel s.

NRC FORM 306A @ 92)

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NRC FORM 366A U.S. NUCLEAR REGUI.ATORY COMMISSION APPROVED BY OMB NO. 3150-o104

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(s-m . EXPIRES 5/31/95 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS

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j LICENSEE EVENT REPORT (LER) L"E'1f" "'

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TEXT CONTINUATION ^ETORY c"$"ME"'W2sHYNoTO7Dc MsEfAN$

R TO THE PAPERWORK RLDUCTION PROJECT. (31504104), OFFICE )

OF MANAGEMENT AND BUDGET, WASHINGTON, DC 20503. I

)i FACILITY NAME (1) - DOCKET NUMBER (2) LER NUMBER (6) PAGE (3) ,

YEAR B M "H 4 Of 7 PILGRIM NUCLEAR POWER STATION 05000-293 93 -010- 00 i TEXT (if more space is requeed, use additional copies of NRC Form 366A)(17) 4 After initial investigation, Bus A5 was loaded on the SUT at 1405 hours0.0163 days <br />0.39 hours <br />0.00232 weeks <br />5.346025e-4 months <br />. RHR System Loop.

} 'A' was returned to service for Shut Down Cooling at 1412 hours0.0163 days <br />0.392 hours <br />0.00233 weeks <br />5.37266e-4 months <br />. ~ Bus A6 was loaded on the '

1 SUT at 1421 hours0.0164 days <br />0.395 hours <br />0.00235 weeks <br />5.406905e-4 months <br />.

,! Problem Report 93.9260 was written to document the event. The NRC Operations Center was l j notified in accordance with 10 CFR 50.72 on May 19, 1993, at 1508 hours0.0175 days <br />0.419 hours <br />0.00249 weeks <br />5.73794e-4 months <br />.

i  !

j CAUSE 1

! A critique of the event was conducted on May 19, 1993, d was attended by applicable  !

] personnel including the Electric Lab engineer who was one of three individuals involved in

performing the test. '

i j The root cause of the event was utility non-licensed Electric Lab engineer error. The j engineer mistakenly actuated SVT lockout relay 86X/ST instead 'of Main Transformer lockout

relay 86X/MT. The error occurred at Step [12 (b)] of Procedure 3.M.3-39 (Rev. 14), y
Attachment 1, " Calibration of Turbine / Generator Relays, Lockout Test and Associated  ;

! Annunciator Verification".  :

! A factor contributing to the error was that the rear board sections for the Main 4

Transformer and SUT are mirror images'of each other and are physically mounted back-to- ,

j back, with a working aisle separating the two. The manual actuation of relay 86X/ST was ,

performed at the rear of the relay panel. In addition, the lockout relays were

~

i individually labeled only as 86X at the rear of their respective panels.

)

CORRECTIVE ACTION-i Immediate corrective action taken included terminating the performance of Procedure

3.M.3-39 and stabilizing plant conditions in accordance'with Procedure 2.4.16 (Rev. 11),

j " Distribution Alignment Electrical System Malfunctions".

A PREVENTIVE ACTION 1 An immediate discussion was conducted with Electric Lab personnel on attention to detail i and self-checking. The discussions were completed prior to recommencing the performance j of Procedure 3.M.3-39 on May 19, 1993.

, Procedure 3.M.3-39 " Turbine / Generator Calibration of Relays, Lockout Test and Associated Annunciator Verification", will be reviewed for improvement to preclude recurrence. The focus of the review is to perform the applicable procedural steps from the front of the panel.

4 The rear of the Main Transformer and SVT board sections will have their labeling enhanced l i to make the two relays (86X/MT'and 86X/ST) more distinguishable from one another. i a (

} l NRC FORM 366A @92) i

I I NRC FORM 366A U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB NO. 3150-0104 a-m . EXPIRES 5/31/95 ESTIMATED BLh0EN PER RESPONSE TO COMPLY WITH THIS l LICENSEE EVENT REPORT (LER) 1"T5 biRo'3 0 & s LTUO O M Ts M l l TEXT CONTINUATION EEcEsI"$ leos""oE$sSs"$oNS l

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FACILITY NAME (1) DOCKET NUMBER (2) LER NUMBER (6) PAGE (3)

YEAR NJ PILGRIM NUCLEAR POWER STATION 05000-293 93 --010- 00 l TEXT (If more space is required, use additional copies of NRC Form 366A)(17)

DISCIPLINARY ACTION l The Electric Lab engineer involved received a written reprimand identifying the apparent l cause of the incident and informing the engineer that any further problems would result in  ;

more severe disciplinary action. 1 SAFETY CONSE0VENCES This event posed no threat to the public health and safety.

There were no component or system failures that caused or resulted from this event.

The Standby AC Power (4160 VAC) System consists of EDGs ' A' and 'B' that are self-contained and independent of the off-site power sources. The safety objective of the 1 Standby AC Power System is to provide a single failure proof source of onsite AC power l adequate for the safe shutdown of the reactor following abnormal operational transients and postulated accidents. A loss of all off-site power is described in the UFSAR Chapter

14. The Chapter 14 analysis bounds the analyses in the UFSAR Appendix R that includes a i loss of all off-site power to station auxiliaries. The EDGs started and provided power to Buses A5 and A6 and the related electrical system in response to the loss of power to Bus A5 and Bus A6.

The RHRS/SDC mode of operation has a power generation design b:tsis only. The SDC mode of operation functions to reduce the RV water temperature to 125 degrees Fahrenheit approximately 20 hours2.314815e-4 days <br />0.00556 hours <br />3.306878e-5 weeks <br />7.61e-6 months <br /> after a shutdown for refueling or servicing activities.

If the actuation had occurred when the decay heat generation rate was greater, a gradual increase in the RV water temperature could have occurred. However, alternate means for heat removal are available and described in procedure 2.4.25, " Loss of Shutdown Cooling",

including methods for feed and letdown using the Condensate System, RWCU System, and the Main Condenser.

I This report is submitted in accordance with 10 CFR 50.73(a)(2)(iv) because the automatic actuation of EDG 'A' and 'B' was not planned.

SIMILARITY TO PREVIOUS EVENTS A review was conducted of Pilgrim Station Licensee Event Reports (LERs) submitted since January 1984. The review focused on LERs submitted in accordance with 10 CFR 50.73 (a)(2)(iv) involving automatic actuation of the Emergency Diesel Generators due to personnel error. The review identified related instances reported in LERs 50-293/84-012-00, 84-017-00 and 92-011-00.

l l

NRC FORM 366A (5 92)

NRC FORM 366A U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB NO. 3150-0104

'N* EXP!RES 5/31/95 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH TH:S LICENSEE EVENT REPORT (LER) 1""0RGA;s'S!" "!!"L*LnO,~<%"=

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FACILITY NAME (1) DOCKET NUMBER (2) LER NUMBER (6) PAGE (3)

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YEAR B 7U B 6 Of 7 PILGRIM NUCLEAR POWER STATION 05000-293 93 --010- 00 l VEXT (It more space is required, use additional copies of NRC Form 366A)(17)

For LER 84-012-00, while shut down for refueling, the EDG 'B' was inadvertently started during Procedure 8.M.2-2.10.1-8 " Logic System Functional Test of the ' A' Core Spray System  ;

- High Drywell Pressure Auto Initiation Trip". The event occurred when a non-licensed I&C '

Technician inadvertently actuated relays 14A-K5B and 14A-K6B simultaneously. These two

relays are located side by side in Panel 933. This action completed the logic required to ,

start EDG 'B'. Corrective action included counselling the non-licensed I&C Technician on '

I attention to detail.

For LER 84-017-00, while shut down for refueling, a temporary loss of off-site power was experienced. Both emergency diesels automatically started and picked up the emergency j buses as required. The event occurred after a test of the turbine trip to 345 kV breaker i trip logic. Cause was determined to be utility non-licensed personnel error. The error i which occurred when two stuck breaker protection switches were activated without first  !

resetting the corresponding stuck breaker lockout relays. Corrective action included l counselling of personnel to prevent recurrence.

For LER 92-011-00, while operating at 100 percent power, an unplanned actuation of a portion of the RHR System logic circuitry occurred during a functional test of the HPCI System logic circuitry. Emergency Diesel Generator 'B' started but did not load onto the respective 4160 VAC bus because the bus remained energized from the UAT. Cause of the event was utility non-licensed I&C Technician error. The error occurred when The RHR System Channel 'B' relay 10A-K10B was actuated instead of relay 10A-K88. Corrective action included counselling the responsible I&C Technician and revising Procedure 8.M.2-2.10.4-2 to preclude recurrence.

ENERGY INDUSTRY IDENTIFICATION SYSTEM (EIIS) CODES The EIIS codes for this report are as follows:

COMPONENTS CODES i

Circuit Breakers (ACB-102 & 103), AC 52 l Transformer (SUT) XFMR I Relay, Lccking-Out (86X/MT, 86X/ST) 86 SYSTEMS l Containment Isolation Control System (PCIS/RBIS) JM l Engineered Safety Features Actuation System (PCIS,RBIS,RPS) JE I

Emergency On-site Power Supply System (EDG ' A' & 'B') EK Medium-Voltage Power System 4.16 KV EA Plant Protection System (RPS) JC Reactor Water Cleanup (RWCU) System CE Residual Heat Removal (RHR) System B0 Standby Gas Treatment System (SGTS) BH Suitchyard System FK l

l NRC FORM 366A (5 92) l

l NRC FORM 366A U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMD NO. 3150-0104 i s.en EXPlRES 5/31/95 ESTMATED BURDFN PER RESPONSE TO COMPLY W8TH THrs INFORMATON CO REQUEST: 50 0 HR$ FORWARD COMMEm, Res..LLECTION LICENSEE EVENT REPORT (LER) Nao m ~Es1. m TO we,.OsM.To~

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FACILITY NAME (1) DOCKET NUMBER (2) LER NUMBER (6) PAGE (2)

SEQUEMIAL REVmiON YEAR NUMBE R NUMBER P!LGRIM NUCLEAR POWER STATION 05000-293 93 010 00 7 of 7 l

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