ML20046C850
| ML20046C850 | |
| Person / Time | |
|---|---|
| Site: | Quad Cities  |
| Issue date: | 06/22/1993 |
| From: | Chaffee A Office of Nuclear Reactor Regulation |
| To: | Grimes B Office of Nuclear Reactor Regulation |
| References | |
| OREM-93-022, OREM-93-22, NUDOCS 9308120305 | |
| Download: ML20046C850 (13) | |
Text
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JUN 2 21993 w
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1 MEMORANDUM FOR:
Brian K.
Grimes, Director Division of Operating Reactor Support FROM:
Alfred E. Chaffee, Chief Events Assessment Branch Division of Operating Reactor Support j
SUBJECT:
OPERATING REACTORS EVENTS BRIEFING JUNE 16, 1993 - BRIEFING 93-22 On June 16, 1993, we conducted an Operating Reactors Events Briefing (93-22) to inform senior managers from offices of the Commission, NRR, AEOD, RES, OE, ACRS, and regional offices of selected events that occurred since our last briefing on June 9, 1993. lists the attendees. presents the significant elements of the discussed events. contains reactor scram statistics for the week ending June 13, 1993.
One significant event was identified for input into the NRC performance indicator program (Enclosure 4).
Isl Alfred E.
Chaffee, Chief Events Assessment Branch Division of Operating Reactor Support
Enclosures:
As stated DISTRIBUTION:
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T. Murley, NRR (12G18)
C. Patel (PDIII-2)
F. Miraglia, NRR (12G18)
J.
Dyer (PDIII-2)
F. Gillespie, NRI. (12G18)
R. Woodruff (DSSA/SCSB) i J. Partlow, NRR (12G18)
R. Barrett (DSSA/SCSB)
S. Varga, NRR (14E4)
J. Calvo, NRR (14A4)
G.
Lainas, NRR (14H3) l J.
Roe, NRR (13E4)
J.
Zwolinski, NRR (13H24)
E. Adensam, NRR (13E4)
W.
Russell, NRR (12G18)
J. Richardson, NRR (7D26)
A. Thadani, NRR (8E2)
S. Rosenberg, NRR (10E4)
C.
Rossi, NRR (9A2)
B.
Boger, NRR (10H3)
F. Congel, NRR (10E2)
D.
Crutchfield, NRR (11H21)
W. travers, NRR (11B19)
D.
Coe, 3CRS (P-315)
E.
Jordan, AEOD (MN-3701) l G.
Holahan, AEOD (MN-9112)
L.
Spessard, AEOD (MN-3701)
K.
Brockman, AEOD_(MN-3206)
S.
Rubin, AEOD (MN-5219)
M. Harper, AEOD (MN-9112)
G.
Grant, EDO (17G21)
R.
Newlin, GPA (2G5)
E.
A. Bates,_SECY (16G15)
G. Rammling, OCM (16G15)
T. Martin, Region I W. Kane, Region I C.
Hehl, Region I S.
Ebneter, Region II E. Merschoff, Region II S.
Vias, Region II-i J. Martin, Region III j
E. Greenman, Region III J. Milhoan, Region IV 3
B. Beach, Region IV B.
Faulkenberry, Region V K.
Perkins, Region V bec:
Mr. Sam Newton, Manager Events Analysis Department Institute of Nuclear Power Operations 700 Galleria Parkway Atlanta, GA 30339-5957
a.
=_
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ENCLOSURE l'
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LIST OF ATTENDEES OPERATING REACTORS EVENTS FULL BRIEFING (93-22)
JUNE 16, 1993 i
NAME OFFICE NAME OFFICE R.
DENNIG NRR B.
LEFAVE NRR D.
GRAY NRR J.
DYER NRR S.
HUNEMULLER NRR B. GRIMES NRR R.
MARCUS NRR M. LEACH OCM/IS C.
BARRETT NRR J.
MURPHY
'RES S.
ROSENBERG NRR W. TROSKOSKI OE J.
HICKMAN NRR D.
TELEPHONE ATTENDANCE (AT ROLL CALL)
Recions Resident Inspectors Region I Quad Cities (Tom Taylor)
Region II Region III Region IV Region V Special Inspection Team Misc.
C.
Vanderniet 9
6
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ENCLOSURE 2 OPERATING REACTORS EVENTS BRIEFING 93-22 LOCATION:
10 B11, WHITE FLINT WEDNESDAY, JUNE 16, 1993, 11:00 A.M.
QUAD CITIES, UNIT 1 HPCI SYSTEM RUPTURE DISC FAILURE DURING TEST CAUSES PERSONNEL INJURY GENERIC CONCERN BWR SUMP CLOGGING PROBLEM 1
PRESENTED BY:
EVENTS ASSESSMENT BRANCH DIVISION OF OPERATING REACTOR SUPPORT, NRR
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93-22 QUAD CITIES, UNIT 1 i
HPCI SYSTEM RUPTURE DISC FAILURE DURING TEST CAUSES PERSONNEL INJURY JUNE 9, 1993 PROBLEM THE HIGH-PRESSURE COOLANT INJECTION (HPCI) SYSTEM RUPTURE DISCS BLEW DURING SURVEILLANCE TEST, INJURING FIVE WORKERS, BREACHING SECONDARY CONTAINMENT, AND RENDERING HPCI IN0PERABLE.
CAUSE PROBABLE CAUSE IS EITHER AGE / TEMPERATURE DEGRADATION OF RUPTURE DISC IN THE EXHAUST STEAM LINE OR A SLUG 0F WATER PASSING THROUGH THE HPCI TURBINE, INTO THE EXHAUST LINE.
SAFETY SIGNIFICANCE i
RELEASE OF STEAM IS HAZARDOUS TO PLANT PERSONNEL AND THE LOSS OF THE HPCI SYSTEM REDUCES ABILITY TO COPE WITH SMALL BREAK LOSS-0F-COOLANT ACCIDENT.
DISCUSSION e
BOTH UNITS OPERATED AT 100% POWER THROUGHOUT THE EVENT.
THERE WAS NO MEASURABLE RELEASE OF RADIATION FROM THE PLANT.
8:50 A.M. - WORKERS WERE PERFORMING QUARTERLY SURVEILLANCE TEST OF UNIT 1 HPCI PUMP WHEN BOTH OF THE EXHAUST STEAM RUPTURE DISCS RUPTURED, RELEASING STEAM INTO THE UNIT 1 HPCI ROOM.
CONTACT:
D. SKEEN, NRR/0EAB AIT:
NO
REFERENCE:
10 CFR 50.72 #25628 SIGEVENT:
O O
QUAD CITIES, UNIT 1 93-22 e
THE SUDDEN INCREASE IN ROOM PRESSURE BLEW OPEN THE FIRE D0 ORS CONNECTING THE UNIT 1 AND UNIT 2 HPCI ROOMS AND THE TWO SETS OF DOUBLE D0 ORS THAT ACT AS THE SECONDARY CONTAINMENT B0UNDARY.
e THE HPCI SYSTEM ISOLATED 35 SECONDS LATER ON HIGH ROOM TEMPERATURE.
ALL FIVE WORKERS IN THE ROOM WERE BURNED AND SLIGHTLY CONTAMINATED BY THE STEAM BUT WERE ABLE TO EXIT THE RADI0 LOGICALLY CONTROLLED AREA ON THEIR OWN.
AN UNUSUAL EVENT WAS DECLARED AT 9:18 A.M. DUE TO TRANSPORT OF CONTAMINATED PERSONNEL 0FFSITE.
o THE WORKERS WERE TAKEN TO A LOCAL HOSPITAL.
ONE OF THE WORKERS RECEIVED FIRST AND SECOND DEGREE BURNS OVER 20%
0F THE B0DY AND WAS ADMITTED TO THE BURN UNIT.
THE OTHER FOUR WORKERS WERE TREATED AND RELEASED LATER THE SAME DAY.
SECONDARY CONTAINMENT WAS REESTABLISHED WHEN THE OUTER e
SET OF D0 ORS WAS CLOSED.
THE UNUSUAL EVENT WAS TERMINATED AT 11:59 A.M., WHEN o
THE WORKERS WERE DECONTAMINATED.
FOLLOWUP o
THE LICENSEE QUARANTINED THE HPCI AND RCIC ROOMS PENDING INVESTIGATION.
o PRELIMINARY INVESTIGATION FOUND N0 BLOCKAGE IN THE EXHAUST LINE.
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QUAD CITIES, UNIT 1 93-22 i
e LICENSEE POSTULATES TH/.T WATER IN THE TURBINE CASING MAY HAVE PASSED THROUGH THE TURBINE AND COMPRESSED A SUFFICIENT AMOUNT OF AIR TO RUPTURE THE DISCS.
REGION III DISPATCHED A SPECIAL INSPECTION TEAM TO THE SITE.
e THE VENDOR AND ARGONNE LABORATORY ARE EXAMINING THE RUPTURE DISCS AND PRELIMINARY RESULTS INDICATE FAILURE WAS MOST LIKELY DUE TO OVERPRESSURE RATHER THAN CORR 0SION.
e UNIT 2 SCRAMMED ON 6/13/93 DUE TO A TRANSFORMER FAILURE.
THE UNIT 2 RUPTURE DISCS WILL BE REPLACED AND THE REMOVED DISCS WILL BE TESTED TO SEE IF THEY RUPTURE AT LOWER THAN RATED PRESSURE.
e DRESDEN PERFORMED A RELIABILITY-CENTERED MAINTENANCE ANALYSIS OF THEIR HPCI SYSTEM A YEAR AGO AND SUBSEQUENTLY IMPLEMENTED A PREVENTIVE MAINTENANCE PROGRAM FOR THE RUPTURE DISCS.
THERE HAVE BEEN 3 PREVIOUS EVENTS INVOLVING THE RUPTURE OF BOTH HPCI RUPTURE DISCS. IN 1985, WATER BACKED UP IN THE EXHAUST LINE DUE TO A BLOCKED DRAIN LINE AT HATCH 1 AND IN 1982 AND 1983, FAULTY TORUS VACUUM BREAKERS AT PEACH BOTTOM 3 ALLOWED WATER TO BE DRAWN INTO THE EXHAUST LINE.
e O
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93-22 BWR SUMP CLOGGING PROBLEM GENERIC PROBLEM DEPOSITION OF THERMAL INSULATION ON THE EMERGENCY CORE C0OLING SYSTEM (ECCS) STRAINERS AND SUBSEQUENT FILTERING 0F FINES CAN CAUSE LOSS OF NET POSITIVE SUCTION HEAD.
CAUSE LOSS-0F-COOLANT ACCIDENT (LOCA).
SAFETY SIGNIFICANCE LOSS OF THE ECCS AND CONTAINMENT SPRAY SYSTEM CAN CAUSE A CLASS 9 ACCIDENT.
DISCUSSION e
BWRs WERE DESIGNED FOR BLOCKAGE OF 50% OF THE STRAINER SURFACE AREA WHICH MAY NOT BE CONSERVATIVE.
e RESOLUTION OF A-43 PROVIDED A CORRELATION OF AP WITH APPROACH VELOCITY AND THICKNESS OF AGGLOMERATED FIBERS FOR FORWARDFIT.
BARSEBkCK HAD EXPECTED THAT THE STRAINERS WOULD NOT e
CLOG DURING THE FIRST 10 HRS.
AFTER ONSET OF LOCA, CLOGGING OCCURRED AFTER 1 HR.
CONTACT:
R. W. WOODRUFF, NRR/SCSB AIT:
NO
REFERENCES:
10 CFR 50.72 #24256 AND SIGEVENT:
- 25415
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o y BWR SUMP CLOGGING PROBLEM 93-22 PERRY DEMONSTRATED THAT FIBERS AGGLOMERATED ON-STRAINERS FILTER FINES.
e SKI SHUT DOWN 5 OLDER BWRs PENDING RESOLUTION AND INITIATED A RESEARCH PROGRAM WHICH INCLUDED:
DISLODGEMENT (KARLSHAMN),
TRANSPORT (KARLSHAMN,.0SKARSHAMN, ABB-ATOM),
FLOTATION AND SEDIMENTATION (ABB-ATOM),.
STRAINER PERFORMANCE -(BARSEBnCK, ABB-ATOM, VATTENFALL).
o APs ARE LARGER THAN EXPECTED BECAUSE:-
STRIPPING OF INSULATION IS UNDERESTIMATED, FLOTATION AND SEDIMENTATION ARE OVERESTIMATED, FILTRATION AND COMPRESSION ARE NEGLECTED, TESTING DID NOT INCLUDE FINES.
SWEDISH RESOLUTION FOR:
ALL BWRs:
LARGER FILTERS (80 TO 120.M2),
AUTOMATIC _BACKFLUSHING SYSTEMS, HIGH CLEANLINESS STANDARDS; SOME BWRs:
METALLIC INSULATION ON LARGE PIPING, ALTERNATE WATER SOURCES.
a CONDITION OF BWRs IN THE UNITED STATES:-
2 SMALL FILTERS (APPROX 4 TO 14 M ),
BACKFLUSHING MAY BE AVAILABLE BUT IS NOT
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ENGINEERED, CLEANLINESS STANDARDS ARE LOWER, 1
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BWR SUMP CLOGGING PROBLEM 93-22 INSULATION:
21 UNITS HAVE FIBROUS PIPING INSULATION, 8 UNITS HAVE METALLIC INSULATION, OTHERS HAVE A COMBINATION, ALTERNATE WATER SOURCES MAY BE AVAILABLE BUT ARE NOT ENGINEERED.
FOLLOWUP THE STAFF IS EXECUTING AN ACTION PLAN THAT WILL INCLUDE AN ASSESSMENT OF ECCS RELIABILITY.
ENCLOSURE 3 REACTOR SCRAM Reporting Period: 06/07/93 to 06/13/93 YTD YTD ABOVE BELOW YTD DE PLANT & UNIT power IyP1 CAUSE COMPLICATIONS ji)
S E
06/08/93 SALEM 1 100 SA External NO 2
1 3
06/10/93 CALVERT CLIFFS 2 0
SA Equipment Failure NO O
1
'1 06/10/93 CALVERT CLIFFS 1 100 SM Equipment Falture No.
1 0
1 06/11/93 CALVERT CLIFFS 1 16 SA Operating Error NO 2
0 2
06/12/93 MCGUIRE 1 0
SM Equipment Failure NO O
'1 1
06/12/93 CATAWBA 1 2
SA Equipment failure NO O
1 1
06/13/93 QUAD CITIES 2 57 SA Iquipnent Failure NO 4
0 4
i i
I 1
hote: Year To Date (YTD) Totals include Events Within The Calendar Year Indicated By The End Date Of The Specified Reporting Period E15-10 Page:1 06/15/93
o O
O COMPARISON OF WEEKLY SCRAM STATISTICS WITH INDUSTRY AVERAGES PERIOD ENDING 06/13/93 NUMBER 1993 1992 1991*
1990*
1989*
OF WEEKLY WEEKLY WEEKLY WEEKLY WEEKLY SCRAM CAUSE SCRAMS AVERAGE AVERAGE AVERAGE AVERAGE AVERAGE (YTD)
POWER GREATER THAN OR EQUAL TO 15%
EQUIPMENT FAILURE
- 2 2.0 2.6 2.9 3.4 3.1 DESIGN / INSTALLATION ERROR
- 0 0.1 OPERATING ERROR
- 1 0.4 0.2 0.6 0.5 1.0 MAINTENANCE ERROR
- 0 0.5 0.4 EXTERNAL
- 1 0.2 OTHER*
O 0.0 0.2 0.1 Subtotal 4
3.2 3.4 3.5 3.9 4.2 POWER LESS THAN 15%
EQUIPMENT FAILURE
- 3 0.5 0.4 0.3 0.4 0.3 DESIGN / INSTALLATION ERROR
- 0 0.0 OPERATING ERROR
- 0 0.2 0.1 0.2 0.1 0.3 MAINTENANCE ERROR
- 0 0.0 0.1 EXTERNAL
- 0 0.0 OTHER*
O 0.0 0.1 Subtotal 3
0.7 0.7 0.5 0.5 0.6-TOTAL 7
3.9 4.1 4.0 4.4 4.8 1
i 1993 1992 1991 1990 1989 NO. OF WEEKLY WEEKLY WEEKLY WEEKLY WEEKLY SCRAM TYPE SCRAMS AVE R AGE AVERAGE AVERAGE AVERAGE AVERAGE (VTD)
TOTAL AUTOMATIC SCRAMS 5
2.6 3.1 3.3 3.2 3.9 TOTAL MANUAL SCRAMS 2
1.2 1.0 0.7 1.2 0.9 TOTALS MAY DIFFER BECAUSE OF ROUNDING OFF
- Detailed breakdown not in database for 1991 and earlier
- EXTERNAL cause included in EQUIPMENT FAILURE MAINTENANCE ERROR and DESIGN /lNSTALLATION ERROR causes included in OPERATING ERROR j
- OTHER cause included in EQUIPMENT FAILURE 1991 and 1990 J
ETS 14 Page: 1 06/15/93 T
r IEb W
1 liOTES 1.
PLANT SPECIFIC DATA BASED ON INITIAL REVIEW OF 50.72 REPORTS FOR THE WEEK OF INTEREST.
PERIOD IS MIDNIGHT SUNDAY THROUGH MIDNIGHT SUNDAr.
SCRAMS ARE DEFINED AS REACTOR PROTECTIVE ACTUATIONS WHICH RESULT IN ROD MOTION, AND EXCLUDE PLANNED TESTS OR SCRAMS AS PART OF PLANNED SHUTDOWN IN ACCORDANCE WITH A PLANT PROCEDURE.
THERE ARE 111 REACTORS HOLDING AN OPERATING LICENSE.
2.
PERSONELL RELATED PROBLEMS INCLUDE HUMAN ERROR, PROCEDURAL DEFICIENCIES, AND MANUAL STEAM GENERATOR LEVEL CONTROL PROBLEMS.
3.
COMPLICATIONS: RECOVERY COMPLICATED BY EQUIPMENT FAILURES OR PERSONNEL ERRORS UNRELATED To CAUSE OF SCRAM.
4.
"OTHER" INCLUDES AUTOMATIC SCRAMS ATTRIBUTED TO ENVIRONMENTAL CAUSES (LIGHTNING), SYSTEM DESIGN, OR UNKNOWN CAUSE.
OEAB SCRAM DATA Manual and Automatic Scrams for 1987 ------------------ 435 Manual and Automatic Scrams for 1988 ------------------ 291 Manual and Automatic Scrams for 1989 ------------------ 252 Manual and Automatic Scrans for 1990 ------------------ 226 Manual and Automatic Scrams for 1991 206 Manual and Automatic Scrans for 1992 ------------------ 212 Manual and Automatic Scrams for 1993 --(YTD 06/13/93)-- 90
ENCLOSURE 4 OPERATING REACTOR PLANTS SIGNIFICANT EVENTS SORT > Event Date QUERY > Event Type SIG & Close Out Date >= 04/21/93 h
PLANT & UNIT N
'MB R DESCRIPTION OF EVENT SIGNIFICAWCE BRI ING PRESENTER INDIAN POINT 3 03/18/93 0
ENTERING INTO AND OPERATING AT MID-LOOP WITHOUT Safety-Related Cooling System 93-18 KOSHY T.
HIGHLIGHT FUNCTIONAL LEVEL INDICATION.
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ETS-11 Page:1 06/16/93