ML20217D542

Forwards Partially Withheld Background Briefing Package in Preparation for 961203 Meeting Between Comed,Nuclear Strategic Services & Chairman Jackson

ML20217D542
Person / Time
Site:	Dresden, Byron, Braidwood, Quad Cities, Zion, LaSalle
Issue date:	11/27/1996
From:	Capra R NRC (Affiliation Not Assigned)
To:	Mccree V NRC OFFICE OF THE EXECUTIVE DIRECTOR FOR OPERATIONS (EDO)
Shared Package
ML20217D413	List: IA-97-178, Forwards Partially Withheld Background Briefing Package in Preparation for 970425 Meeting Between Comed & Commission ML20217D410 ML20217D426 ML20217D438 ML20217D453 ML20217D461 ML20217D466 ML20217D476 ML20217D517 ML20217D528 ML20217D532 ML20217D539 ML20217D542 ML20217D546
References
FOIA-97-178 NUDOCS 9710030276
Download: ML20217D542 (275)

Text

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LIMITED OFFICIAL USE ONLY t November 27, 1996 -

Commission Briefina Paoer i

MEMORANDUM TO: Victor M. McCree, Chief Regional Operations Staff Office of the Executive Director for Operations FROM: Robert A. Capra, Director Original signed by M. D. Lynch Project Directorate III-2 h D^bert A. Capra Division of Reactor Projects - m/TV Office of Nuclear Reactor Regulation

SUBJECT:

VISIT BY C00m0NWEALTH EDISON COMPANY EXECUTIVES, MR. JAMES O'CONNOR AND MR. MICHAEL WALLACE WITH THE CHAIRMAN AND C0fHISSIONERS On December 3,1996, Mr. James J. O'Connor, Chief Executive Officer of Connonwealth Edison Company and Mr. Michael Wallace, Senior Vice President for Nuclear Strategic Services are to meet with Chairman Jackson (9:00 a.m.),

Comissioner Diaz (10:00 a.m.), Commissioner nogers (10:45 a.m.), and Connissioner McGaffigan (11:30 a.m.). ,

Enclosed is a background briefing package in preparation for the meetings.

The following items are enclose 6:

Names and Resumes of the Comed Officials UBN m N d '.":: Ed Expected Topics for Discussion by Comed C XXr ' w J t M.cm of inictm: Son a Corporate Organization Chart ki, engtiera , 5

+ Background Information on Comed FOIA 4'l-I~K

• Sumary of Plant Performance and Issues ~ '

• Suggested Points for Discussion Most Recent Performance Assessment and Plant Issues Matrix for each Site

• Power History Chart for each Site Should you require any additional information, please contact either me (415-1395) or Mr. George Dick (415-3019).

Docket Nos. STN 50-454, STN 50-455, Distribution:

STN 50-456, STN 50-457,50-010, PDIII-2 r/f R. Capra 50-237, 50-249, 50-373, 50-374, C. Moore R. Assa 50-254, 50-265, 50-295, 50-304 G. Dick D. Okay R. Pulsifer C. Shiraki Attachments: As Stated J. Stang L. Rossbach M. D. Lynch P. Hiland, RIII cc: F. Miraglia/A. Thadani R. Lanksbury,RIII R. Zinnerman J. Grobe, RIII B. Sheton M. Dapas, RIII J. Roe J. Caldwell, RIII A. Beach, R-III M. Webb, 011B20 B. McCabe M. Satorius, 07H5 DOCUMENT NAME: G:\l096 COMED.VST im . , w mi. 4+.o 4 L r.m/

nt. m in m. we c - cooy .newsdt .nci..u,.A. c=v 44Jcd4all r - 44.,pfwEtw .ncio.ur.. w - No ewy 0FFICE PM:PDIII-f L F LA:PDill-2 i RIII:0:DRP l Ei , (Rtat n t IN NAME GDICK  %.d\ CM00RE & $' A JCALDWELL A C CWJ J DATE 09/M/96"

• 09/3/96 09/N/96 09 /75/T6V V 0FFICIAL RECORD COPY

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g oo g 6 970930 LIMITED OFFICIAL USE ONLY PARADIS97-178 PLR

i JAMES J. O'CONNOR Chairman and Chief Executive Officer EXPERIENCE l

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Unicom/ Commonwealth Edison Company l Present - 1980 Chairman and Chief Executive Officer

1980 - 1978 Member of Board of Directors

, 1978 1977 President 1977 - 1973 Executive Vice President 1973 - i970 Vice President 1970 - 1 % 7 Assistant Vice President 1%7-1%6 Division Commercial Manager at Chicago North 1966 - 1963 Staff Assistant to the Chairman of the Bear .ad o Chairman of the Executive Committee i

• United States Air Force 1 % 3 1960 Three years of active duty EDUCATION .

l

• JD - Georgetown Law School,1%3 MBA - Harvard University,1960 BS - Holy Cross College, major in economics,1958 PROFESSIONAL AFFILIATIONS a Director of Nuclear Energy Institute, Chairman of the Advance Reactor Corporation Director of Edison Electric Institute, past Chairman Board of the Institute of Nuclear Power Operation, past Chairman Memter of Board of Directors of American Nuclear Energy Council 1 .

(

k ATTACHMENT 1 l

MICHAEL 1 WALLACE Senior Vice President Nuclear Strategic Services EXPERIENCE

. Commonwealth Edison Company ,

Present - 1996 Senior Vice President Nuclear Strategic Senices 1993 - 1996 Senior Vice President and Chief Nuclear Officer 1993 - 1993 Vice President, Chief Nuclear Officer 1993 - 1992 Vice Pr.:sident, Chief Nuclear Operating Officer 1992 - 1990 Vice President, Nuclear PWR Operations 1990 - 1989 Manager of Engineering and Construction 1989 - 1987 Manager of Projects and Construction Services 1987 - 1982 Assistant Manager of Projects, and Braidwood Project Manager 1982 - 1981 Superintendent, Waukegan Station 1981 - 1979 Assistant Superintendent, State Line Station 1979 - 1978 Project Coordinator, Byron Project 1978 - 1977 Field Cost Engineer, LaSalle, Byron, and Braidwood Proiects 1977 1974 Quality Assurance Engineer, NSSS Programs

. United States Navy 1974 - 1969 Line Officer, Nuclear Submarine Force U.S. Navy EDUCATION

= MBA - University of Chicago,1978 BS - Marquette University in Electrical Engineering,1969 OTHER OUALIFICATIONS

. Registered Professional Engineer PROFESSIONAL AFFILIATIONS

. Advanced Reactor Corporation, Vice President Commonwealth Research Corporation, Vice President and Director

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LIMITED 0FFICIAL USE ONLY EXPECTED TOPICS FOR DISCUS $10N BY COMED

• Industry restructuring and economic deregulation.

- Projected effect of deregulation

- Key economic issues

- NRC's role in a deregulated industry

• Recently announced Illinois initiative o, deregulation.

- Description and overali objective

- Coned's strategy under the initiative

- Role of ICC

• Unicoe strategic planning.

Funding for_ nuclear generating capacity Long term pians

• Mixed oxide fuel project.

DOE initiat.ive

- CoeEd's program for MOX

- NRC's involvement in licensing M

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i . LIMITED OFFICIAL USE ONLY l BACK6ROUW INFORMATION ON COMED

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! Cosmionwealth Edison Company (Comed) underwent- a restructuring in June 1994, j whereby it became a wholly owned subsidiary of Unicos. The purpose of the *

restructuring was to permit other subsidiaries of Unicos to operate in an ,

! unregulated environment. Comed has 12 operating units at six sites and one  !'

unit in SAFSTOR.

! In recent years, the performance of Comed plants has been inconsistent and a  ;

j concern to the NRC. Comed had traditionally promoted from within and as a ,

i result benefitted little from outside experience. During its ambitious plant  !

! construction program during the 1970's and early 1980's, many of the company's  !'

L more talented managers were moved from site to site to complete construction i and get the units licensed and started up. Likewise, corporate attention and resources were focused on the newer units while they were-in the latter stages

of construction and licensing. As a result, the older i

fewer resources and less quality management attention. plants generally got Plant material i condition and operating stendards and practices declined.

SECY-92-228, ' Performance of Commonwealth Edison Company Plants," dated '

June 25, 1992, described Comed's major weaknesses. These weaknesses were: '

(1) lack of effective management attention and application of resources; (2) '

weak corporate oversight of nuclear operations; (3) poor problem recognit<on '

and failure to ensure lasting corrective actions; (4) lack of adequate engineering support; and (5) an-inability or reluctance to learn from experiences at other Comed sites and other utilities.

In recent years, the cyclical performance of Comed plants has concerned the Commission and NRC staff. Dresden was on the Watch List from June 1987 until December 1988 and was returned to the Watch List in January 1992. Zion was '

on the Watch List from January 1991 until January-1993; however, once removed from the watch list, the rate of improvement was not sustained. Declining performance at Quad Cities was discussed at the June 1991 and June 1993 Senior  :

Management Meetings (SP#is); a Diagnostic Evaluation Team (DET) assessaient was perfomed there in the fall of 1993. Both Quad Cities and LaSalle were issued Trending Letters in January 1994 and again in June 1994. Significant problems were even noted at Dresden, Unit 1, wh< ch was pemanently shut down in 1978.

In January:1994,.a significant freezing event on Unit I revealed a number of management oversight weaknesses. In January 1995, Quad Cities received a-third Trending Letter and LaSalle was removed from the Trending Category.

Braidwood has been an average perfomer; however, personnel and equipment 1

-problems are staff concerns. Syron's performance has been excellent and it was identified as a Good Performer at the January 1994, June 1994 and January

- 1995 Sigts. Presently Dresden is the only one of the Comed plants on the Watch List. However, the. performance at LaSalle, Quad Cities. Zion and Braidwood remains a staff concern.

i Only within the last several years has Comed begun to take significant steps e

I to improve perfomance. These steps included reorganizing to clearly establish responsibilities for plant operation and oversight; increasing the company's engineering capability; improving craft skills; benchmarking their performance against other utilities; and h' ring management individuals from ATTACHMENT 4

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outside the company. Among those hired were several corporate vice presidents, site vice presidents p level plant management individuals.lant A number managers of the managers andhired various earlysenior in and mid-this process had no experience in improving the performance of problem plants and were not effective in doing so at Comed. This resulted in numerous senior managemer.t changes at the poorer performing plants.

Comed has continued to make organizational changes. In April 1996. Thomas J.

Maiman was selected to replace Michael J. Wallace as Senior Vice President for oversight responsibilities of Connonwealth Edison C q ny's Nuclear Division.

He rerorts directly to the Chairman and CEO, Mr. Jane J. O'rpnor.

Mr. Wallace now has responsibility for nuclear strategic services, including nuclear fuel procurement, the storage of low-level and high-level radioactive waste and developing competencies for the decomissioning of Comed nuclear plants. He is also responsible for Comed's strategic nuclear alliance with other corporations and for operations at Cotter Corporation, the company's uranium and mill operation.

Mr. Maiman has held various senior management positions in the company's Fossil Division and Commercial Division. Prior management positions in the Nuclear Division included Vice President of PWR Operations and Vice President and Manager of Projects for construction of the Byron /Braidwood Stations.

Chief Nuclear Operating Officer, Harold W. Keiser, continues to be responsible for the day-to-day operations of all six Comed nuclear stations. Mr. Keiser joined Comed in December 1995 afte serving in a similar position as Chief Nuclear Officer and Executive Vice President of Entergy Operations Inc. In March 1996, Mr. Keiser accepted the position of Chief Nuclear Operating Officer thereby eliminating the Senior Vice President for BWR and PWR operation positions. Mr. Steve Perry, formerly the Senior Vice President for BWR Operations, is now the full-time Site Vice President at Dresden Station.

Functions that support day-to-day operations (e.g., engineering) report to Mr.

Keiser. Su) port functions of a planning and strategic nature continue to report to tie Senior Vice President of the Nuclear Division, Mr. Maiman.

One of Mr. Keiser's primary areas of focus is in assessing and improving management's effectiveness at each of the six nuclear sites and bringing in outside talent where needed. On May 25, 1996, Mr. H. Gene Stanley relieved Mr. Karl Kaup as Site Vice President for Braidwood Station. Priortojoining Comed Mr. Stanley was the Vice President for Nuclear 0)erations at the Susquehanna Nuclear Station. On August 5,1996, Mr. Join Mueller joined Comed to assume the position of Site Vice President for Zion Station, re>1 acing Richard Tuetken. Mr. Mueller was Chief Nuclear Officer for Nebrasta Public Power District's Cooper Station. Mr. William Subalusky, on loan froin INPO,

- replaced Robert Querio as the Site Vice President at LaSalle on August 18, 1996. Mr. Querto retired from Comed on August 31, 1996.

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Mr. David A. Sager, previously Vice President for Florida Power and Light's St. Lucie plant joined Comed in June 1996 as Vice President for Generation Support. Mr. Sager oversees functions that directly support slant operations, including maintenance support, regulatory assurance and healti physics.

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LIMITED OFFICIAL USE ONLY SUMARY OF PLANT PERFORMANCE AND ISSUES e Most Recent SALP Scores Elant SALPPer;2d SALPScores(1) .

Braidwood 02/94-09/95 2,2,2,1 Byron 08/94-08/96 2.1.1,2 Dresden 08/93-03/95 3.2.3.2 LaSalle 11/94-08/96 3,3,3,2 Quad Cities 12/93-07/95 (2) 2,3,2,2 Zion 05/94-12/95 3,2,2,2 NOTES: (1) Operations, Maintenance, Engineering, Plant Support (2) A SALP Board for Quad Cities covering the period 07/95

through 10/96 was held on 10/30/96; however, the results have not yet been published. Preliminary scores are 2,3,3,2.

• Plant Performance i Comed still faces significant operational challenges. During the last 3 years, the licensee has implemented both corporate and site reorganizations and has brought in considerable management talent from outside Comed. Older stations (Dresden, Quad Cities and Zion) continue to be challenged by longstanding material condition and human performance problems. These problems also exist at LaSalle.

Braidwood. Units 1 an,L2 Long considered a better than average performer, beginning about 18 months ago, Braidwood exhibited aerformance problems due to declining material condition, configuration controlproblems witi (control of mEintenance equipment craftengineer lineups), capabilityIng and corrective actions. Since then, the licensee has made several key management changes; specifically the selection of a new Site Vice President with previous nuclear utility experience and a plant manager with successful experience at Byron. This new management has initiated efforts to resolve material condition and configuration control problems. The effectiveness of these efforts has not yet been fully evaluated, but it appears that the downward trend may have stopped and the station may be in the initial stages of improvement.

Avron. Units 1 and 2 Historically Byron has been a good performer. While overall conduct of nuclear activities is still excellent, recently there have been indications of declining performance in operations and plant support, ATTACHMLHT 5

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LIMITED OFFICIAL USE ONLY due primarily to operator errors, examples of a less conservative safety focus, and weaknesses in the chemistry program. The licensee has acknowledged the staff's observations and has initiated steps to correct the weaknesses. The NRC will monitor the effectiveness of the licensee's actions.

In October 1996, the licensee identified that silt levels in the essential service water (ESW) cooling towers (ultimate heat sink) higher than the acceptance criteria may have rendered the ESW inoperable under certain conditions. Further review by the NRC disclosed examples of inadequate surveillance test acceptance criteria, inadequate test control, and inadequate control of the design basis (e.g., evaluaticn of the effect of silt accumulation on the volume of ESW available and inadequate maintenance of trash rack grating protecting the ESW pump suction). This event is being considered for escalated enforcement.

Etuden. Unit 1 3

Following a January 1994 pipe rupture /freating event in the unheated Dresden, Unit 1, containment, a special NR( team inspection identified a pattern of declining management oversight at the facility. Escalated Enforcement Action was taken and a $200,000 civil penalty assessed. in response to the event, Comed has taken a number of actions including forming a Dacomissioning Project Team to manage the plant activities and assure adequate configuration control, providing aeating to areas inside containment to ensure that the spent fuel pool would be protected from potential freezing incidents, draining and isolating fluid systems that entered the containment sphere, conducting an extensive cleanup of the spent fuel pool and improving the quality of the water in the pool by installing a new filtration and domineralization system. In response to N'tC concerns about the detection of tritium in the underground water at Dresden, Unit 1, from the spent fuel pool, Comed conducted an environmental evaluation of the pool's integrity and expanded its well monitoring program both onsite and offsite. Comed has infomed the staff that it intends to use dry cask storage for the Dresden, Unit 1, fuel.

Dresden. Units 2 and 3 Operation of both units at Dresden has continued to be a struggle.

Material condition problemt have contributed to both units being shut down. In M+y 1996, a feedwater control valve failed on Dresden, Unit 3 resulting in an automatic plant scram. The NRC conducted an AIT of the

, event. In June 1996, the licensee discovered a failed 4160 volt safety '

related breaker. Both units were shut down while the licensee refurbished all 4160 volt breakers in both units. Dresden, Unit 2, completed a 10 month refueling outage in April 1996, in which many safety-related material condition issues were resolved. The conduct of operations in the control room has been good; fuel load activities

,} during the Unit 2 outage went well. However, personnel perfomance outside the control room continues to demonstrate weak configuration

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i control indicatin that performance and expectations are still not fully .,

J understood and i lesented by the work force. Inadequate control of work activities ile performing modifications on the reactor feedwater level control system led to a manual scram on May 31 1996 Maintenance hasstruggledandeffortstoimprovetheworkcontrolproce.ss have not j been successful. Some improvement in Engineering support to the station j has been noted. Performance in the area of Plant Support has been good j with respect to emergency preparedness; however, wea( performance in l radiation protection continues.

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)- On October 26, 1996, Dresden Unit 3 experienced a trip of the 38 i Recirculation MG Set. Subsequent to the MG Set trip, the licensee shut

! down Unit 3 and commenced an investigation into the cause of the equipment failure. Testing identified a ground exists on the 'C' phase i of the 3B Reactor Recirculation Pums Motor. The motor disassembly and inspection have been completed. Tie licensee has completed a 10 CFR 1 50.59 evaluation on the recirculation pump motor repair / replacement.

1 Restart of the unit is expected imediately following motor

! repair / replacement.

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! During the June 1996 NRC Senior Management Meeting, the agency's senior managers concluded that an Inde>endent Safety Inspection (ISI) should be conducted to further evaluate tte performance at Dresden. The ISI began on September 30, 1996; the final inspection report is scheduled to be

- issued prior to the end of 1996. The overall goals and objectives of l i the ISI are

1 j action program  ; (2)(s)provide evaluate the effectiveness an independent of the assessment licensee's to of confomance corrective ,

e the design and licensing basis; (3) evaluate the conduct and '

j effectiveness of maintenance act<vities including work processes post-

maintenance testing and implementation of maintenance rule activities; i and (4) provide an independent assessment of operational safety l performance. The interim exit meeting with licensee management was held

on November 8, 1996. A public exit meeting is scheduled for December  :

l 12, 1996.

The preliminary results of the !$1 evaluation identified significant ,'

concerns with the Dresden Station's control of calculations and with the overall performance of site and corporate engineering activities. In response to the 15! c u cerns by letter dated November 8, 1996, Comed provided action plans which will be taken to provide confidence in the  :

adequacy of the design basis and engineering activities at the Dresden Station.- In res >onse to the ISI findings in the area of engineerin ,

the NRC on Novem>er 21, 1996 issued a Confirmatory Action Letter (C L). '

The CAL confirmed that Comed would provide documentation and meet w th the NRC on a monthly basis to discuss the findings from the action plan commitments described in the licensee's November 8,1996, letter.

The next SALP period ends in December 1996. The SALP period has been l extended to include input from the 151.

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LaSalle. Units 1 and 2 The biggest challenges at LaSalle are material condition, personnel performance and weak corrective action processes. LaSalle has brought in several managers with positive histories from outside Comed and generally there has been slos. but steady improvement in material condition. Inefficient work control processes and weak engineering support have hindered the pace of improvement. Both units shut down in June 1996 for 2 weeks as a result of the injection of foreign material 1,7to the service water tuanel with the potential for inoperability of all essential and non essential service water. The event was caused by poor work control and was complicated by inadequate engineering evaluations and poor safety focus. The NRC had to influence the licensee to take conservative corrective actions and subsequently issued two Confirmatory Action Letters to the licensee. The staff conducted an AIT as a result of this event and escalated enforcement is pending.

Both units have been shut down since mid September (Unit 2 for a refueling outage and Unit I for a maintenance outage). There are several NRC and licensee identified issues that must be resolved prior to restart including: modifications to install a keep fill system on the service water side of the residual heat removal (RHR) heat exchangers to prevent water hamer. modifications to the auxiliary electric equipment room to maintain a >ositive pressure for post accident habitability, replacement of the 1HR pump seal coolers which do not meet the design pressure of the system, and repairs to some air operated containment isolation valves due to a design deficiency. The expanded work scope, as well as two work stoppages had extended the length of the refueling outage by ap3roximately two weeks. Both units were expected to return to power in )ecember, However, the licensee has decided to keep both units shutdown pending completion of a design basis review of two selected systems RHR service water and control room and auxiliary electric equipment room ventilation. This review was initiated by the new engineering manager based on recent operability evaluations of these systems that raised concerns regarding the design basis. Restart is expected in January / February 1997.

Quad Citirs. Units 1 and 2 The overall conduct of nuclear activities is adequate. While overall performance has improved. persistent weaknesses in the work control process, material condition, engineering evaluations, and corrective actions have limited progress, Operations performance has been good with major plant evolutions conducted in a careful manner. Improvements include better implementation of performance standards by licensed and non-licensed operators, improved procedural adherence, better implementation of out of service (005) tagouts, and im and investigation of operations performance problems. proved However, sometrending personnel errors and 005 tagging problems still occur and some examples indicating a weak understanding and ap)lication of technical specifications and design information lave been identified. A few PRE DECISIONAL -

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l examples of operator knowledge deficiencies and >rocedure problems have

also been identified. Significant improvements save been made in

• J material condition over the past several years and a major effort was

focused on improving the work control processest nevertheless, overall plant performance has been challenged with continuing problems stemming i frm weaknesses in material condition, work control, supervisory oversight, and the quality of maintenance activities. Engineering i Perfomance hasexamples been adequate

, some significant of poorwith some imprc,vements engineering support have noted;beenhowever,

identifle.f. tramples include narrow root cause evaluations for multiple

failures of safety systems, inadequate corrective actions for long-

standing deficiencies with structural support of safety systems, and j weak understanding of plant design associated with proposed restart after a May 1996 tornado-at the site. Overall performance in the area of plant support has been good; however, challenges remain in all areas.

Radiation protection and chemistry performance exhibited continued improvement in ALARA planning, good int water chemistry and increased

availability of hydrogen water chemistry; however, station dose remains i high. Security program performance is good, but some decline has been

! noted in procedural adherence. The emergency preptredness program is I good; however, there were some problems with an Alert declaration on May 1 10, 1996, and with the 1996 exercise. Fire protection performance is

! adequate with some weaknesses noted with the maintenance and operability of the fire pumps.

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! Zion. Units 1 and 2 i

! Overall performance at Zion has been adequate. Phile performance has i improved from that in the 1990 time frame (when the NRC performed a DET  ;

assessment , performance has stagnated for the last few years. The conduct of) operations was correctly focused on nuclear safety; however, i a trend of personnel errors resulting from inattention to detail, lack j of a questioning attitude, and insufficient self-checking continues.

Both licensed and non-licensed operators continue to make errors. On l August 23, 1996, a Civil Penalty of $50,000 wt 5 assessed due to a series l of operational errors and unplanned changes to the status of safety-l related equipment that occurred between gebruary 8 and May 21, 1996.

The material condition of the plant often was a significant :hallenge to l

operators. In the maintenance area, inattention to detail and failure to follow procedures and work instructions were the primary causes of poor maintenance work. Recent engineering inspections identified significant weaknesses in 10 CFR 50.59 safety evaluations, control of the modification program, operability assessments, and engineering support to the plant. On November 11, 1996, a predecisional enforcement

! conference was held with Comed to discuss apparent violations associated

with these engineering weaknesses. Escalated enforcement action is pending. A notable decline continued to be evident in the radiation 3 protection area. Some improvements in ALARA planning were diminished by

inadecuacies in procedure and radiation work pemit adherence, control of ratioactive material, and the posting of radiological hazards.

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. LIMITED OFFICIAL USE ONLY In August 1996, John Mueller, formerly the Chief Nuclear Officer at

• Nebraska Public Power Richard Tuetken as the District's Site ViceCooper President Nuclear Station of Zion (CNS) Prior to, replaced Station.

assuming his responsibilities at CNS, Mr. Mueller was the Plant Manager of Nine Mlle Point, Unit 2. Since Mr. Mue11er's arrival, several san:gement changes have been made including the Operations Manager, the Maintenance Manager, the Work Control Manager, and the Security Manager.

Mditional Resources for Plant Doerations In mid 1996, Comed provided increased funding (OLM and Capital) for all six stations. The majority of funding was focustd on improving long-standing material condition deficiencies with a large fraction going to Zion and LaSalle to fix poor designs.

• COMMONWEALTH ENGINEERING INITIATIVES In a letter dated November 12, 1996, the licensee infomed the NRC that as a result of recent NRC inspections at the Comed sites, it has initiated several short-term and long-term corrective actions at all of the nuclear stations to improve the quality, maintenance, and accessibility of information.

Following the recent inspections and events at Zion and LaSalle, the following corrective actions were initiated:

Completed validating the UFSAR information for a minimum of two systems against the operating and surveillance procedures.

Established engineering oversight teams to review operability and safety (50.59) evaluations.

- Changed Action Request screening program to include a licensed operator and an Engineering Department representative on the screening comittee.

Completed a review of TS interpretations against the TS.

- Completed a review of Safety Evaluations of old modifications with partial implementation and established schedules to close them out in a timely manner.

- Comenced an Engineering Department safety system functional inspection at each Comed site.

Connenced effectiveness reviews of the PORCs.

The licensee stated that the recent ISI at Dresden identified some instances of missing infomation, lack of ready access to design infomation, and problems with control of design information. The

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LIMITED OFFICIAL USE ONLY licensee determined that the problems are present to varying degrees at ,

its other sites. As a consequence, the following short-tern actions were directed to be taken at all stations:

- Review top 10 risk significant systems to verify that current plant conditions are safe and support continued operation by February 1997.

- Establish an Engineering Assurance Group by February 1997.

- Revise Nuclear Engineering procedures to provide specific direction to engineers on steps to be followed whenever a potential design basis discrepancy is identified by February 1997.

- Expand SQV audits of major contractors. Action Plan to be completed by December 31, 1996.

- Define the set of calculations that are critical to maintaining design control and reconstitute them when they do not exist.

Further the licensee will develop, by December 31, 1996, a comprehensive glan to upgrade the quality and access to design information. It will a developed in conjunction with the response to the NRC's recent 10 CFR 50.54(f) letter on design basis control.

• Licensina and Technical Issues Steam Generators The tubes in the steam generators (Westinghouse Model D-4) at Byron, Unit 1, avd Braidwood, Unit 1, are subject to outside diameter stress corrosion cracking (00 SCC) at the tube support plates (TSPs). In addition, large numbers of circumferential crack indications were found in recent inspections in tubes in the tubesheet area in both units. All tubes with such indications were either sleeved or plugged. As a consequence, Byron, Unit 1, operating with an effective steam generator tube plugging value of 17%, is limited to less than 100% power.

Braidwood, Unit I will also be limited to slightly less than full power coming out of the present inspection outage which began on October 11, 1996. Byron, Unit 2, and Braidwood, Unit 2, have Westinghouse Model D-5 steam generators which have not shown evidence of accelerated tube degradation.

On November 9, 1995, the staff issued a license amendment approving a 3-volt interim plugging criteria (IPC) for one cycle for the Byron and Braidwood Unit I steam generators. The staff approved the 3-volt criteria based on the expansion of selected t' des into the TSPs.

Currently there are two licensee requests related to these issues: (1) on August 19, 1996, Comed submitted a request to extend approval of the 3-volt IPC for an additional cycle for Byron, Unit I and Braidwood, Unit 1; and (2) the licensee submitted a request on October 18, 1996, to

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! delete a Byron Unit I sid-cycle steam enerator inspection for the presentoperatIngperiod,therebyallowngittooperatewithoutany .

i planned outa9es until the steam generator replacement. These submittals i are under staff review. .

The licensee's long-ters solution is to replace the steam generators; I Byron, Unit 1, is scheduled to be done in the spring of 1998 and Braidwood, Unit 1, in the fall of 1998. In the short ters, the licensee '

is taking steps to safely maintain as high a power output as possible l with the degraded steam generators. At present, the licensee is .

required to repair or remove from service those tubes that have eddy current voltages greater than 3-volts and all tubes with circumferential .

crack indicat<ons.

Technical Snecification Unarades ,

All of the Comed sites are upgrading their Technical Specifications l (TS). Dresden and Quad Cities which had custom TS were recently issued

new TS which converted the plants to the old version of the Standard TS.

Implementation at Quad Cities occurred on September 23, 1996, and will I occur at Dresden by January 16, 1997. Zion is converting to the l l

Improved Standard Technical Specifications ISTS) with full implementation scheduled in early 1997. App (lication for the LaSalle l

conversion to ISTS is expected in January 1997. Submittal of the Byron and Braidwood application is expected by December 13, 1996.-

Status of Individual Plant Examinations (IPEs)

In a staff evaluation dated November 22, 1994, the staff informed Comed that although Zion's IPE responded to Generic Letter 88-20, the process i used in the IPE could mask potential vulnerabilities and lead to a false sense of security with respect to the likelihood of a severe accident.

l In res>onse to the staff evaluation, Comed submitted a modified IPE on Septem>er 1,1995. In a staff evaluation dated September 17, 1996, the

! staff infomed Comed that the modified IPE met the intent of Generic Letter 88-10.

On March 14,1996, the staff informed Comed that LaSa11e's IPE submittal met the intent of GL 88-20. However, the staff identified several weaknesses in the method for common cause and human reliability analyses in other Comed IPE submittals and recommended that the licensee consider those concerns in the update of the LaSalle IPE. On April 18, 1996, the 1 licensee informed the staff that it had addressed the concerns identified in the March 14, 1996, letter.

On November 9, 1996, the staff informed Comed that based on the IPE submittals for Dresden and Quad Cities, the staff could not reach the conclusion that Comed met the intent of GL 88-20 for those sites.

Responses in the NRC's concerns and revisions to the IPEs were submitted forDresden(June 28,1996) and Quad Cities (August 30,1996). They are

currently ut. der staff review. RAls were sent on February 1, 1996, for

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the Byron IPE and on January 26, 1996, for the Braidwood IPE, which i identified plant specific concerns as well as the ones previously '

relayed regarding human factors and comon cause. Revised IPE submittals for Byron and Braidwood are expected by March 1997.

UFSAR Conformance I

An initial assessment of UFSAR conformance at the sites was determined through sampling reviews. To date, one system review has been completed l for Quad Cities and three systems or topics were reviewed for each of I

, the other plants. The licensee has reported that numerous discrepancies l were identified; however, most have low safety significance. The findings will be resolved within the next several months.

Based on the results from the sampling reviews, selection and i prioritization criteria for additional reviews have been developed.

They are: (1) systems for which another site found problems in the sam)1ing reviews; (2) systems with features which contributed to pro)1 ems in the sampling reviews (e.g., locked valves, abandoned 4

equipment); and (3) ris( significant systems. Dresden, Quad Cities and Zion are scheduled to undergo 100 percent UFSAR reviews over ,

, approximately the next year. At least two more systems will receive i reviews and the findings will be resolved by June IW7 for Byron, Braidwood and LaSalle, imeroency Operations Facility (EOF)

In February 1996, the staff approved the use of the corporate EOF in Comed's headqua-ters at Downers Grove as an interim EOF until the nearsite EOF is activated. Because the corporate EOF is more than 20 miles from any of the Comed sites Comission approval was required for the change. The licensee now has requested approval to consolidate the nearsite EOFs into one single EOF located at Downers Grove. Approval of this change, if recomended by the staff, will also require Comission approval.

Use of Nixed Oxide Fuel Comed, in partnership with Duke Power has responded to DOE's request for expression of interest by expressing an interest in burning excess weapons plutonium as mixed-oxide (M0X) fuel. Comed has proposed using Byron, Braidwood, and LaSalle as sites for use of the fuel. Comed / Duce have aligned themselves with France's Cogena to study the burning of plutonium in PWRs and with British Nuclear Fuels to study burning M0X fuel at LaSalle. 00E is expected to issue a final Programatic Environmental Impact Stattment by the end of 1996 and a Record of

< Decision regarding its preferred method for disposition of plutonium during the first quarter of 1997. If the decision is made to proceed with the use of existing reactors, Comed is expected to participate in a test program followed by the use of MOX fuel at its sites. The NRC staff has informed the industry that the use of MOX fuel in a comercial

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LIMITED 0FFICIAL USE ONLY

- rnt-WLbl41VhAL -

LIMITED OFFICIAL USE ONLY reactor will require staff review and an amendment to the license. In addition to the normal safety analyses, licensees will have to address the sufficiency of the methods used to predict performance of M0X fuel, potential for interactions of M0X fuel with low enriched uranium, and methods to identify and respond to ancmalous performance of the M0X fuel.

• Mtt Draft policy Statement on Economic Deresulation On September 23, 1996, the NRC published in the Federal Reaister, its Draft Policy on the Restructuring and Economic Deregu'ation of the Electric Utility Industry. The policy statement addresses NRC's concerns about the adequacy of decomissioning funds and about the potential impact on operational safety as the industry moves into an era of deregulation and increased competition.

The policy statement declares the NRC will:

- Continue to conduct reviews of financial qualifications, decomissioning funding, and antitrust requirements involving nuclear power plants, using standard review plans currently under development;

- Identify all owners, indirect as well as direct, of nuclear power plants; Establish and maintain staff-level working relationships with state and federal rate regulators; Evaluate the relative responsibilities of power plant co-owners and co-licensees; and Re-evaluate the adequacy of regulations in light of economic and other changes resulting from rate deregulation.

In an Administrative Letter issued in June 1996, the NRC informed power reactor licensees of their continuing responsibility to inform the agency or obtain advance a transfer of their license.pproval The of anyalso letter changes that would reminded constitute licensees of theira responsibility to report promptly any new information affecting their financial resources for safe operation and decommissioning.

The NRC stressed that the Atomic Energy Act and NRC regulations provide tht no license may be transferred un ess the Commission consents in wW Mo. The agency has stated that NRC notification and prior approval are i M uired for mergers, formation of holding companies and the outri@t sales of facilities, or portions of facilities, to ensure that the transferee is appropriately qualified.

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9 ATTACHMENT 7

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PRE DECISIONAL SEMIANNUAL PLANT PERFORMANCE ASSESSMENT BRAIDWOOD ,

Assessment Period: April 1996 to October 1996 BALP Period October 1,1995 through June 21.1997 Previous SALP Ratings: OPS 2 MAINT 2 ENG 2 PS 1

1. Performance Overview Configuration control was a significant operational prcblem. Also, non-licensed operators failed to follow procedures on several occasions.,

Significant preventive maintenance programmatic weaknesses were observed early in the period. Maintenance communications were sometim9s week. Material cotidition appeared to improve. Sorres longstending motorial condition problems were addressed. .

Engineering backlogs were increasing, and some drawings were found to be outdated.

Radiation protection, security, and chemistry performanc.o were excellent.

l Braidwood operated throughout the period with one significant transient. Unit 1 experienced a 400 megawatt load rejection due to problems with mein turbine governor valve software. Unit 1 shut down once between September 6 and 9 to fix steam leaks coming from two steam generator foodwater drain valves. Unit 1 shutdown on October 11 for a midcycle steam generator inspection outage. Unit 2 completed a refueling outage in May.

II. Functional Area Anneanments A. OPERATIONS

1. current Performance Operator actions in response to most equipment problems were good. Non-licensed operators failed to follow procedures on several occasions.

Configuration control errors continued from the last assessment period.

2. Ammasament/ issues 1

- I Operator actions in response to equipment problems were good.

Reactor and senior reactor operator (RO, SRO) actions taken for secondary side equipment problems while starting up the reactor after the Unit 2 refueling outage were good. (9600g) .

- Operator response to a failed instrument channel (Teve) on Unit 2 was good, involving good communications between Ros, SROs, and the shift engineer.

- Operator response to a loss of automatic feedwater control on Unit 1 was good. (96014)

There was one significant example of poor operator response to plant equipment problems.

- Control room operators took actions that resulted in over filling the pressurizer and lifting a primary power operated relief valve on Unit 1 during a cooldown to enter a mid cycle outage. (96016) )

Non Licensed operators failed to follow procedures on several occasions, and l caused an operations incident on another occasion.

Two Unit 1 diesel oil storage tanks were overfilled when a valve was mispositioned because of a failure to follow procedures. (96012)

- The inspectors identified incorrect performance of procedurally required independent verification of valve position during a Unit 2 diesel generator surveillance. (96012)

- Non licent J operators failing to follow a procedure resulted in a valve misposition 4 on the Unit 1 boric acid transfer system. (96012)

- The failures by two equipment operators to follow a procedure, to self check, and to maintain good communications resulted in a valve mispositioning and the spraying of about 150 gallons of fire protection water into the Unit 1 diesel oil storage tank room. (96014) e Non licensed operators inadvertently created a loop sealin a reactor head venting tygon hose, causing a four foot error in reactor vessel level to develop while draining the reactor coolant system. (96019)

Configuration control errors continued from the last assessment period.  ;

- Six different problems with configuration control were identified by 1 the licensee or self identified in April 1996. (96006) l l

- A Unit 2 6.9 kilovolt breaker (non safety) was mispositioned fer six i 2

_ __ _. _ _ __ _____________..___b

days because of coor communications between operators and the lack of procedure adherence. (96009 and 96011)

• Operators inadvertently n%wed two trains of the Unit 2 reactor coolant leakage detection system to be rervbred inoperable resulting in entry into Technical Specification 3.0.3. (96009)

• Poor communications and procedure adherence resulted in a Unit 1 containment release without an operable containment ventilation radiation monitor. (96011)

3. Actions / Recommendations

, Continue with the routine core inspections for the operations area focusing on procedure adherence, non licensed operator valve manipulations, and configuration control.

No deviations occurred from the previously planned inspection activities.

B. MAINTENANCE

1. Current Performance The licensee continued to focus on material condition issues with a slight improvement observed by the inspectors. The preventive maintenance program exhibited programmatic weaknesses but has improved, inter and intradepartmental communications continued to be weak.

2. Assessment / Issues The licensee has continued to focus on material condition issues with quantifiable improvement observed by the inspectors.

The power block corrective, planned, and action request task backlog decreased by 3 percent between June 20,1996 and October 21, 1996. (96006)

Material condition in some longstanding equipment problem areas improved:

Repetitive condensate booster pump bearing failures on Unit 1 were resolved by condensate and condensate booster pump check valve repair; Residual heat removal pump seals were replaced; Unit 1 and 2 letdown heat exchanger leakage was repaired; Fuel pool cooling heat exchanger leakage was repaired.

3

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. e l

The preventive maintenance program exhibited progrommatic weaknesses.

- in March 1996, the inspectors identified that over 400 preventive maintenance items were allowed to go past their due dates (plus 25%) without engineenng justificatino. (96006)

• The inspectors identified that key personne) mil had different understandings of what meintenance had been performed and was scheduled for the condensato and condensets booster pump lube oil coolers; and had different understandings of the scheduling and tracking of the performance of preventive maintenance items.

(96009)

Inter and intradepartmental communications were week.

• The inspectors found that a work request to repair en auxillery steam valve was canceled in the belief that an engineering request had been prepared for the repair. An engineering request had not been written.

The inspectors considered this occurrence to be an example of poor communications between work control and englnosting. (96008)

- Rework on en emergency diesel generator was required when a nut was not properly tightened because of miscommunications between the offgoir>g and oncoming maintenance crews. (96008)

- Poor communications between offsite persormi (SMAD) and site personnel (fuel handling) and poor communicate?ns between fuel handling and other plant personnel resulted in a .nissed technical specification diesel generator fuel oil surveillance. (96009)

3. Actions /Recommandations Continue with the routine core inspections for the maintenance area focusing on work scheduline, execution, preventive maintenance, and surveillances.

No deviations occurred from the previously planned inspection activities.

C. ENGINEERING

1. Current Performanca Engineering exhibited several programmatic weaknesses. However, performance to resolve other engineering problems was good.

2. Assessment / Issues Engineering exhibited several programmatic weaknesses.

4

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Significant backlogs of engineering requests still exist and appest to be increasing, (e.g. in February 1%k6 the a wew 797 open ERs, in October 1996 there wve PC20 operiins, m increase of 26%).

(96006)

The inspectors deterrnmed that the untimOy revision and updates of the resistance temperature detection bypses elimination modification design drawings and the licensee's lack of current status of drawing revisions for completed modifiestions was a significant weakness in the modification process. (96012)

The NRC identified that overdue PMs were allowed to go past their due dates (plus 25%) without engineering justification (approx. 400 tasks). System engineers were given lists of overdue PMs but most were not aware of this condition. (96006)

Oversight of system engineers' weekly system walkdowns was not effective in ensuring that the system engineers were identifying instances of equipment degradetion. The NRC identified severalleaks not identified by the licensee. (96006)

System engineers were to ensure that deficiency tags were removed for canceled Action or Work Requests. However. during the week of February 12,1996, several examples were identified by the NRC where work had been either completed or canceled, but the deficiency tags associated with the action requests (ARs) had not been removed. (96006)

Engineering performance in regard to other known problems was good.

The licenses shutdown Unit 1 following the failure of a capacity test on a second individual cell of the bus 112 battery. The inspectors concluded that overall, the testing and root cause evaluation of the 112 battery issues were good. The licensee assigned an experienced team leader and group of engineers to direct the troubleshooting which was conducted well. (96006)

A minor leak developed on the Unit'2 n;setor cavity boot seal. The inspectors concluded that the preparation and performance of the special test procedure to measure sealleakage with the boot deflated was good. The inspectors also concluded that the decision to replace the boot seal was conservative. (96006)

3. Actions / Recommendations Continue with the routine core inspections for the Engineering ares focusing on engineering programs (e.g. operability evaluations and design basis validation). The last E&TS inspection was in the fall of 1995. Another 5

l E&TS inspection is recommended before the end of the SALP period.

. No deviations occurred from the preimuvy planned inspection activities.

1 D. PLANT SUPPORT

1. Current Performance i Radiological housekeeping was excellent. Ra$stiori protection technician performance was good. Security performance torneined excellent. No regional reviews of the emergency preparedness program were conducted during this assessment period.

2. Anannament/lanuas

a. Radiation Protnetlar l Radiological housekeeping was excellent.

I - The Inspectors observed during frequent routine tote that i contaminated and high radiation areas were clearly marked, i that general areas and emergency core cooling pump rooms were clean and free of debris, and that leekoge of potentially contaminated liquid was minimal and properly contained.

! (96012) 1

• During frequent tours of the radiologically protected area the inspectors observed that good radiation worker practices were followed and that radiological housekeeping was good.

(9600g)

Performance of radiation protection techniciens was good.

• Performance of radiation protection technicians (RPTs) during maintenance activities in the Unit 2 containment during the 1996 Unit 2 refueling outage observed by the inspectors was excellent. However, RPTs did not challenge other workers within the containment missile barrier to ensure that exposures were maintained as low as reasonably achievable (ALARA).

(96008)

• An extremity overexposure occurred during this assessment period; however, the source strength of the hot particle which delivered the dose to a plant worker was less than the 75 micro curie / hour limit. The inapoctors noted good response by the radiation protection staff in assessing and evaluating the hot particle exposures and NRC independent dose calculations were in agreement with the station's dose evaluation. (96008) 6 l

b. Easwhy Performance in the area of security was erement.

• The inspectors determined that the licensee's identification and .

assessment of a failure of the Biometrics access control system was excellent. (96007)

• Security management demonstrated good team work in the implementation of the blometrics system and the installation of the new security computers. (96007)

• Security personnel demonstrated a 9ood questioning attitude l by identifying a degraded protected area barrier. (96007) l

' The licensee completed a technically complex accurity computer replacement project without incident. (96007 and (96013) l

- The problem investigation of an adverse trend identified with l inadequate human performance of the Braidwood Station Security Department and proposed corrective actions appeared to be thorough and timely. (96013)

3. Agllpps/ Recommendations Continue routine inspection of the Radiation Protection, Chemistry, and Security programs. An Operational Safeguards Response Evaluation is recommended to be performed in July 1997. The next routine EP inspection is scheduled for Merch 1997. The next evaluated EP exeraise is scheduled for December,1996.

IV. Attachments

1. Plant lasues Matrix

2. AEOD Performance indicators

3. Average Daily Power Level 7

PLANT ISSUES MATRIX BRAIDWOOD l DATE l ID BY l SALP f DESCRIPTION l CAUSE l REF l 10/23/96 NRC Maint Commwdestions weeknesses identHied: Huraan 96006 Inspection reports 96006,96008, and 96009 Performance 96008 identified poor intra and inter departmental 96009 communications.

10/12/96 Self ID Ops U1 pressudrer PORY Nfted: during cooldown Human 96018 operations lost control of charging / letdown Performance operations and raised pressurizer level until the PORV lifted.

09/11/96 Self ID Ops Dlow generator fuel eE tank reem aproyed Human 96014 down dWng fire protection surwelRence: poor Performance '

communications and self-checking resulted in a failure to follow p uciniures that sprayed .

150 gallons of water into the 18 and 1D fuel oil tank room.

09/11/96 Licensee Ops Fuel pool cooEng pump found tumed off for 5 Persor.nel 96014 hours. Fuel poci temp went up 7 degrees Error (below sierm satpoint). The lice.w's investigation demonstrated that the switch could have been bumped &cck; diy by painters in the eres.

03/30/96 Self ID Ops 1C condenseta booster pump destroyad: Human 96012 operatcr inedvertently shut the suction valve Performence instead of the discharge valvs during pump shift.

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l PLANT ISSUES MATRIX BRAIDWOOD l DATE l ID BY l sal.P l DESCR!PTION l CAUSE l REF l 01/24/96 NRC Ops Both Unit 2 Hydrogen Monitors Inoperable: Human dos to mispositioned vsNes. Performance 12/26/95 Ucensee Ops Tdpped Power Seppfr to 2A SIG PORY: with Material re control room indication. Condition 12/15/95 Ucensee Ops EDG t I.C.L Starts: while ettempting tc Personnel Error place the ~2B" EDG control switch in the pull-to-los position. Tir: operator inadwatently i

. pieced the switch in the start position when j

$e switch did not turn for enough to the left den he pulled it out.

12/13/95 hlf ID Ops 125V.112 battery charger failed-24 hr. l.CO. Meterial I i

Condition 12/07/95 Ucensee Ops FaRure to Start C::?-.g for the Unit 1 Hurr.an feedwater pump lobe oil cooler during startup. Performance 12/04/95 Ucensee Ops High noiss protMrm on the N31 source rare Material monitor. Cc d ion 11/25/95 NRC Ops Severe sealleek on 1 A cent. charging pump. Meterial Condition 11/18/95 Ucensee Ops 1 A CCW pump breaker demoged because of Human broken cubicle chutters. Performance 11/06/95 Ucensee Ops Unit 1- OOS togs hung on wrong diesel Personnel Error generator.

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_9 PLANT ISSUES MATRIX 1 BRAIDWOOC l DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF l 09/30/95 NRC Ops With one of two source range monitors Human inoperable and the shutdown margin not Performance calculated because the appropriate curves were not available, operators deoded to cool down the plant (addeng positive reactivity) until questioned _by the resident 'mspectors.

09/08/95 Licensee Ops Operators failed to take the required action to Human swap control room ventilation to the high Performance radiation mode or the other traivi within one hour after a red monitor became inoperable.

Failure was due to distractions and poor teamwork. This was the second similar event  !

within about six weeks.

08/22/95 Self ID Eng Instrument Technician failed to follow a Human surveillance procedure and plugged test Performance equipment into the wrong jacks. This caused an unexpected opening of a pressurizer PORY l and a plant pressure transient.

l

PREDECISIOH;.L BRAIDWOOD 1 PI EVENTS FOR 95-3 NONE .

PI EVENTS FOR 95-4 ' '

SSF 10/19/95 tEtt 4 M95014 50.728: 29475 PWR MIST EWLRT OCCuttED DURING REFCLING GROUP

EMERGENCT AC/DC POWER SYSTEMS 080UP SYSYEM : EERGENCY ON$lTE POWS 3rPLT ST5ffm Mst a s0TN anGs wat IROPERAsLE stTwfN 10/3/95 Am 10/19/95. TNE OuTrui stEAcEt Was NOT FULLt RAC :tD IN FOR 10/3/95.ONE EDG FOLLOWING TESTING ON 10/2/95. TME OTNER EDC WAS OUT OF SERYL 2 PI EVENTS FOR 96-1 88F ct/29/*6 Lt e 4 W 96002 50.ne:

PWR NitT EVENT OCCutta DutlNG OPERATleN AT 140E POWER tt0UP CONTROL ROM EsERGENCY VENTILAfl0N SYSTEM Gt0UP STSTEM t CONit0L SulLDING/ CONTROL COMPLEu ENVibONENTAL CONTROL SYSTEM OTN UNIT: Tuts EVENT WS AS$10NED 70 UNITS 1 Am 2.

DESC 80TN TRAINS OF CXINTROL ROCM VENTILAfl0N WERE IN0PERASLE ElftJLTANEOUSLT. W SERVICE FOR MAINTEauueCE, POWER WAS LaET TO TRE OTNER TRAIN WNEN A WORGR TRIED 10 CNANCE AN INDICAtlWG LIGHT SoccET.

PI EVENTS FOR 96-2

( SSF 04/23/96 LEtt 4 M96005 50.ns: 30348 PWR Mllf GROUP CONDITION EMERGENCY Cutt COOLING SYSTEMS CROUP EXISTED IN ALL MODES UP TO 1001 POWR SINCE INITIAL OPERAfl0N SYSTEM : LOJ PRES $Utt SAFETY INJECTION SYSTEM OTN UNIT: Tuls EVENT WS AS$1GNED TO UNITS 1 AND 2.

DESC  :

TNE PLANT NA5 OPERATED WITN ftATIPLE SAFETT INJECTION ACCudutA10t$ CROS$

LESS TNAN A310CIATED WITN TNE afoultED TNE CROSS tRMett et TIED ACCutJLATOts. amman ATots INJECTING IF A LOCA OCCuttED ON ONE SSF 06/04/96 LEte 4 H 95013 so.ne:

PWR MIST:

GROUP  : CON 0lfl0N EXISTED l- ALL ftODES UP TO 1001 POWER $1NCE INITIAL OPERAfl0N CONTROL totm EMERGENCY VENTILAfl0N sitTEM GROUP ST31EM :

CONTROL SulLDING/ CONTROL COMPLER ENVlt0NMENTAL 00NTkOL ST5 TEM OTN UNil: TNil EVENT WAC ASSIGNED TO UNITS 1 AND 2.

DESC  : Cowit0L 800M VENTILAflok 20NE$. TNll EVENT WA$ CAU$tD COAD 31 NAVE BEEN RENDERED lu0PERABLE tv A titt IN SEVERAL istsetttw1 tit!

thADEGUATE ELEC1tlCAL SEPARAfloh of CABLES.

4

t PREDECIStoNAL Legend BRAIDWOOD 1 5""'"*""**'"'"""', 5""' C Refueling R Operation tlll:lll1 913 to W Industry Avg frend Ouertedy Det shutdown m Not shown t/ung 00 Cycle 15Ngis g

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o -

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0 Significant Events - o -

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-0.10 Cause Codes (All LERs)

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r .

L BRAIDWOOD 1 eReottis10NAt

{

PREDECIS70NAL PI EVENTS NOT INCLUDED IN THE 96-2 REPORT e o ne . . .

MANUAL SCRAMS ennen .

ACCIDENT SEQUENCE PRECURSDR DATA P 1986 AND 1988 DATA PREUREINARY *)

EWENT DATE: 09/29/90 CSPt  : 2.1t 5 MSC SSPs 3 ftlPS REACTOR, AFV PUMP A TRIPS IVENT DATE: 10/16/08 EDPt 1.N 4 MSC 3 LOS$ Of 0FFSITE Pedte F04 APPeculMAftLT 2 INamt OUTAGE DATA EQUIPMENT FORCED STAaf Daft 09/07/96 ER/TAGE 1148: 44.4 (2.0 Days)

MSC snU1 pedu TO ttPAlt LEAttuG f tST 1 APS Of f tnt 'C' AND 'D' STEAM GtuttATOR$. TN( VALVES WERE ttPAIRED AND VISUALLY INSPECTED Pilom 10 attunutWG THE UNIT TO SERVICE FORCED STAtf Daft 03/06/96 0UTAGE sets: 451.5 (18.8 pers!

MSC SATTit 112 ms MCLARC3 luoptRABLE AND fut UNIT WAS teIUT00w. so0ST PeOSA8LE CAUSE 15 A CEpsihAfl0N Of REPEAT DISCNAAGts Am Tiet tWueult of attnARCING.

SCHEDULED 5TAti DATI: 09/30/95 OU1 AGE teR$3 1905.0 (75.2 Deys)

MSC affuttihG CUTAGE.

EVENTS AEOD CONSIDERS IMPORTANT tytNT Daft: 06/17/96 Dest t Ltt 96 007 00: on 960617 Isepeopta PLActeetwT Of SPttl fUtt. CAUSED tt Pttsomatt t##081 PROCEDutAL AND seG1 Mfltitutits. etPostilomtD futt in luoPROPI ATE ConflpJeaf ton &

CouwstLED PitsometL tuvolvtD. W/960717 LTR.

BRAIDWOOD 1 PREDECISIONAL EVENTS AE00 CONSIDERS IMPORTAN7 IVtut Daft: 03/06/96 ..

MSC Lit 4 003 00: ou 960308, BAfftRT 112 MCLAREp fewitAstt postimG unti 130. CAUSED ST 88UIMNT MG8ADAtl0N Sut 10 IUCCC%S!VT $10mlFICANT SISCNAtsfS. TEstlWG PftFORMED TO VERIFY MetADED CAPACITY 8 SAfif tf #EPuno, U/960408 tid.

EVtaf Daft: 10/19/95 MSC 3 LEt M 014 00: ou 951019 DG OUTPUT attACEt nsAAb mal CLost M TO EeulPMENT FAILutt.

EeJIMNT OPERAfots itSTauCTED is A00L lettAff or Tc garsag nerarsts Futty RACKED IN.

W/960311 Lit. .

tytNT DATE: 10/19/95 MSC

Ltt 95 014 00: ou 951019 DE OUTPUT satAttt %ENLD WDT CLOIE M TO E4WIPIENT FAILUtt. FS

& E0 PERFORMED Yllukt Cutt 0F Ofutt CUIICLES Ou SUB 142 FOR ANT assaries acT RACEID*lN.

W/951120 LTR.

(

i

' PREDECISIONAL BRAIDWOOD 2 PI EVENTS FO.R 95-3 NOME e PI EVENTS FOR th 4 NONE PI EVENTS FOR 96-1 SSA 01/18/M MSC LIRt 457M 001 50.72e 29052 M NisT: POWER OPERATIOWs AT 1001 SOTN D48 $ TARTED Age LOR 09 FOLLOWING A L0tt OF 0Ff tlTE POER. FattlGN MATERIA FROM THE SERVIE SUILDING 900F, CRMED A PNAst TO NOLAS AAC ON AN AUKILIART TRAN8

• • SSF el/ nrm Late 454e6002 50.7as:

• M BIST: tytsFT OCtamRED SURINC CPERAflou AT 180E FebER WIRAP  :

SYSTtM : CONTROL 300N tsERENCY WWTILAfl0W 578 TEN anaJP OTN tef tf: CONTROL tulLDING/CONTt0L tmPLtx tuvitoutNTAL CONTROL SYSith DESC  : TNil tvtNT 48L8 ASSleNED TO UNITS 1 Am 2.

001M SERVICE TRAINS OF CONTROL FOR MA!KTENANCE, R013I PSER INLS Lost WNTILAfl0N to itE 01NER TRAINWEtt INOPERASLE WNiu SIMUL A WORCER TRIED TO CR l e lCATING LIGNT 80CEti.

88F 03/05/M Late 45796002 50.728: 30064 PWR NisT:

MOUP  : EvtNT occurred DURING OPERAll0N At 911 POWER SYSTEM CONTAlleeENT AIS CONTAINNENT 190LAT10N WOUP REACTOR CONTAIINENT SulLDING MSC  : DECAUSE OF AN INAD80uATE 140001, 1

Is0LATID FROM TNE OPERASLE si TRAIN. CabfTROL R0t>

DURING A StA.

PI EVENTS FOR 96-2 SSF- 04/23/96 PWR MIST: Lets A5696005 50.72s: 3e34s GROUP CONDITION IMERGENCY COREEX15ftD IN ALL GROUP COOLING SYSTEMS RODEs UP TO 1001 POWER 51NCE IN111AL OPERAfl0N STSitM LOW PRESSURE 5AFETT INJECTION ST$ TEM 01N DESC UN11: TN15 EVENT WA5 AttlENED TO LadlTS 1 Am 2.

LESS TNAN THE REQUIRED IUGtt OF ActWRAA10R$ INJECilN ASSOCI ATED WITN ONE OF TNE Cross 18E0 A*.CWLfLATOR$.

SSF 06/04f96 LERs A5695013 50.728:

M GROUP Witit CONOlfl0N

tul51ED IN ALL MODES Up 101001 Pon4R SINCE tulflAL OPERAllow CONTROL 80134 EMERGENCT vtWilL ATION SYSTEM Group STSIEM OfM UNil: CONTROL SulLDINC/ CONTROL Ca>

1Nis tytMT Was 45$1GNED 10 Units 1 AND 2.

PLEX ENVIRONMENIAL CONIRh $IIIEM DESC ,

20Nes. TNIS EVENT WAS CAUSED If INADEcuATE ELECTRICAL Separa

l i

PREDECISIONAL L*9end BRAIDWOOD 2 5""*"**"**'",

""' C Refwenng R o Industry Avg. f rend Operation m Quartedy M Shutdown M Ops. - - - hot Snown Using Op. Cycle R22i5S

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t Year . b5 7 96 f '

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, Safety $ystem Failures 1.5 -

3.

W 1 12 . ' w gg 2.

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9 BRAIDWOOD 2 e

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OPERATIONAL PERFORMANCE DATA FOLLOWS e

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MANUAL SCRAMS ACCIDENT SEQUENCE PRECURSOR DATA

(* 1986 AIS 1998 DATA PREURAINMtY *)

000ME OUTAGE DATA

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DESC REFutLING CUTAGE.

94n EVENTS AE00 CONSIDERS IMPORTANT EVtui DATE: 03/05/96 Dest

LtR 96 002 00: ou 960305. e0tu taalus of tCCs twontRasLt Out to IvetoJAtt 001 Causto SY PER$0mWEL ERROR. CLOSED 28 51 TRAlk Ol5CNARGE CROS$ Tit 150L Af tou WALyt. 21186218 10 150Latt DRAIEACE PATM FRt>t RW57. W/960404 LTR.

I

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PRE DECISIONAL SEMIANNUAL PLANT PERFORMANCE ASSESSMENT BYRON Assessment Period: MARCH 1996 TO OCTOBER 1996 SALP Period: AUGUST 18,1996 through AUGUST 29,1998 Previous SALP Rating: OPERATIONS: 2 MAINTENANCE: 1 ENGINE 'alNG: 1 .

PLANT SW$ PORT: 2

l. Performance Overview in general, the licensee's performance duritt thb eight month assessment was good.

During this period, a Unit I reactor trip occurnJ due to a turbine trip. Unit 2 operated with no reactor trips or major ESF failures. Early in this assessment period, Unit 1 performed a 89 day refueling outage. Unit 2 was shutdown later in this assessment period due to a primary to secondary leak in steam generator A. After a one week forced outage to investigate the leak, Unit 2 begon a 47 day refueling outage.

Byron's overall performance was characterized by excellent communications, and by active teamwork to solve plant' problems. Self assessments and site quality verification assessments were generally penetrating and self critical. Control room teamwork and use of emergency procedures during plant transients and events was excellent. Material condition was, with few exceptions, excellent; equipment was reliable and available; work planning was thorough, systematic, and effective. Engineering provided excellent support for extensive steam generator inspections, and aggressive followup on generic issues.

However, examples of operator errors and less conservative safety focus and risk considerations were noted. Operators transferred water to incorrect locations; misoperated an emergency diesel generator and repeatedly diluted the reactor with inadequate formality and controls. Risk assessment for a station auxiliary transformer repair and for emergency diesel generator work during an outage, was less rigorous. Also, several weaknesses in the chemistry program were indicative of insufficient management oversight of this program. Late in tne period, an apparent failure to address fouling of the essential service water cooling towers was indentified.

N. Functional Area Assessments A. Operations

1. Current Performance i_

Performance in Operations continued to be good overall; however, personnel errors and examples of a less conservative safety focus were noted during this assessment period.

2. Assessment / Issue }

Continued emphasis on communications and teamwork was evident and operator response to plant problems and transients continued to be excellent.

e The inspectors observed examples oi good shift tumovers and high level activity briefings. The licensee stressed attention to detail, procedure usage ind self-checking during these briefings (96 03,9647).

o Operators and system engineering demonstrated good communication and coordination during Unit 1 control rod testing. Operators performed numerous complex evolutions without error during the Unit 1 shutdown (96 04).

e The licensee identified their unanalyzed and potentially unsafe orectice of cross connecting two or more safety injection accumulators (96-04).

o Operators performed wellin mitigating the dual unit event (loss of offsite power on Unit 1 concurrent with a Unit 2 reactor trip due to a loss of service water and -

complicated by a loss of instrument air). The operators expeditiously and safely placed the plant in a stable condition (96 05).

o Operator performance in dealing with the emergent equipment problems during a Unit 1 startup was good. Operators conservatively tripped the main turbine and took appropriate and expeditious action to manually trip the reactor on decreasing feedwatar flow inJd etion (96 05),

e The licensee shutdown Unit 2 due to a steam generator tube lesk. Operators and chemists performed well during the initial identification, trending, and shutdown of the unit (96-06)~

e Operators responded promptly and effectively to a Unit 1 turbine trip and the equipment failures subsequent to a resulting reactor trip (96-07).

Occasionally, a less conservative safety focus was demonstrated.

e Safety related electrical systems, which supplied emergency and control power to one of the two residual heat removal pumps was removed from service, as part of planned mair* aance. Removal of the emergency and control power sources was perf' .ned during a period of reduced reactor cooling system water inventory. (in this reduced inventory condition, two operable trains of residual heat removal are required.) Although the license requirements for operation during this evolution were met, no quantitative risk evaluation was performed prior to the activities to assess their impact on risk (96-04).

o Operators repeatedly diluted the reactor, with the reactor coolant loops isolated, V in one evolution with inadequate formality and controls (96-04).

Performance errors throughout the period indicated a lack of attention to detail with

< 2

respect to procedural adherence. Aoditional focus by licensee management to eliminate operator errors have yet to be consistently effective.

• The 1B control rod drive motor generator and the 2A diesel generator were inadvertently tripped by operators, in separate instunens, due to wrong switch manipulati ons (96-03).

• An operator inadvertently added boric acid to the reactor coolant system while the spent fuel pool transfer canal was being filled from the Unit 1 boric acid blander. A RCS temperature decrease of 0.7 degrees resulte0 (96-03).

• A non-licensed operator inadvertently manipulated the wrong turoine lever during a monthly surveillance, which tripped the Unit 1 turbine (96-07).

Two inadequate corrective action concerns were noted during the period.

• The licensee was week in identifying a technical specification violation associated with reactor coolant system controlled leakage rate limits. Although the operator questioned the slightly high controlled leakage rate indications, the technical specification time limit to correct the violation was not met. Effective corrective action from an earlier event, would have reasonably prevented the event two months later (96-03).

• Corrective actions resulting from the discovery of an open watertight door on February 22,19g6 were ineffective in preventing a recurrence on July 15,1996 (96 03).

3. Actions / Recommendations Continue the routine core inspections for the operations area. The inspectors will concentrate on reviewing valve lineups, procedure adherence, and surveillance observations.

B. Maintenance

1. Current Performance Performance in the Maintenance area was considered good. The licensee's coordination of routine surveillance and maintenance activities continued to be good; however, weak configuration controls during the conduct of surveillance tests were noted during the latter part of the assessment period. Maintenance continued to display good work control, planning, and team effort with other departments.

Maintenance activities during the Unit 1 and Unit 2 outages were well performed.

Areas where improvements were needed included the scheduling of risk significant maintenance taeks and consistently implementing foreign material exclusion controls.

3

2. Assessment / Issues Overall, work control and maintenance activities were good.

• The taaintenance activities to restore the Unit 1 station auxiliary transformer bus-ducts after the loss of offsite power and the associated root cause investigation were well performed (96-05),

e Maintenance and surveillance activities were completed thoroughly with maintenance supervisors and system engineers monitoring activities. Activities observed included an essential service water valve replacement, motor operated valve inspections, and six routine surveillance observations (96-07).

Some examples of week communications and foreign material exclusion practices were noted.

e Weak foreign material exclusion (FME) work practices were observed by the inspectors during the emergency diesel generator overhaul; licensee FME procedures for this work were weak (96 04).

e Poor communications between operations and maintenance allowed installation of a strip chart recorder on the B auxiliary feedwater train while the A train was inoperable for a routine surveillance. This resulted in both trains of auxiliary feedwater being inoperable for eight minutes (96 06).

e An operator ran the 2A chemical and volume control pump without essential service water to the pump's lube oil cooler; the surveillance procedure and the operator's skilllevel was inadequate (96-07).

3. Actions / Recommendations Continue with the routine core inspections for the maintenance area. Additional attention will be focused on maintenance performance (personnel errors, procedure adherence) and configuration control.

C. Engineering ,

- 1. Current Performance Engineering performance was very good during the previous semi-annual assessment period and remained very good during this assessment period. Good engineering programmatic efforts and specific programs continued to identify and correct engineering problems. In general, the engineering support provided to operations, maintenance, and other plant functional areas continued to be of high quality and included good coordination with the corporate offices and other sites.

However, some examples of weaker engineering efforts were noted, including an apparent failure to properly address fouling in the essential service water cooling 4

l

towers.

2. Assessment /lasues Good engineering programmatic efforts and specific programs were in place to -

identify and correct engineering problems.

o The motor operated valve program effectively established the design basis capability of motor operated valves, and was acceptable for Generic Letter 89 10 closeout (96-03),

o The licensee detected and conservatively evaluated steam generator tube degradation and effectively executed oddy current testing of the Unit 1 steam generators (96-04). -

e After identification of the cause of the Unit 2 steam generator tube leak, the licensee's search for additional forelen objects in the Unit 2 steam generators was good (96-06).

e Engineering department personnel provided sound and thorough safety evaluations regarding the Unit 2 steam generator (SG) A and SG C loose part retrieval plan and the evaluation of all four Unit 2 SG tube inspections (96 07).

Some examples of weak engineering efforts were noted, o The licensee identified that its methodology for water flow measurement of the containment spray additive system was incorrect. This made both trains of Unit 1 and Unit 2 spray additive systems inoperable (96-03),

e The safety evaluation prepared to remove the station auxiliary transformer from service did not adequately justify that no unreviewed safety questions existed 196-05),

e Apparently inadequate evaluations were done for excessive slit levels and trash in the essential service water cooling towers. Under certain conditions, these sitt levels rendered the essential service water system inoperable. These conditions were discovered in 1993, but not evaluated adequately (96-09).

3. Actions / Recommendations Continue with routine core engineering inspections, with particular attention on verification of design basis conformance and operability assessments.

D. Mont Support

1. Current Performance Performance in radiation protection, security, and emergency preparedness b

4 i

l-d continued to be strong. Although radiation protection performance was strong overall, some minor weaknesses were observed in control of radioactive material 4

and posting of radiation areas, and the material conen of radioactive waste

systems and storage containers. Weaknesses continued to be identified in the chemistry program.

4

2. Assessment / Issues 1

Radiation Protection:

Radiation protection performance continued to be strong.

• Although licensee dose has been relatively high, strong ALARA ple:'ning was

, offective in minimizing dose expended during Unit 1 steam generator repairs.

Shutdown chemistry and system flushing have reduced dose. However, during Unit 2 re fueling outage projob ALARA briefings, the NRC identified weaknesses concerning worker preparation and the lack of contingencies (96 04,96-08).

! e The licensee effectively implemented the I; quid and gaseous radioactive waste programs and met the revised transportation requirements for radioactive materials (96-05).

• The licensee effectively used lessons learned from the Unit 1 RTD bypass project to improve worker performance during the Unit 2 evolution (96-08).

Weaknesses in the control of radioactive material and posting of radiation areas was observed.

e On September 5,1996, the NRC identified a radiation area (RA) in the Auxiliary

Building with dose rates above 5 mrom/hr beyond the boundary. Licensee i

personnel had left radioactive materials in a position which created radiation areas outside of the posted RA boundary (96-08).

During the 1996 Unit 1 outage, radiation protection support and oversight was good, with some minor exceptions. Radiation workers had an acceptable i

understanding of radiological conditions, but did not remove protective clothing correctly (96-04).

The NRC identified some weaknesses in the material condition of radioactive waste 1 j systems and storage containers. l 4

• NRC inspectors identified severalindications of boric acid leaks on radioactive I waste system components, which had not been identified by system engineers (96-05).

• NRC inspectors identified air leakege on the control room emergency air filtration system (96-05).

b 6

0 Several c:ntainers cf steam g:nerater " sludge" had indicati:ns cf leakage, which had been earlier klentified by the licensee but had not been resolved (96 05). ,

Chemistry:

Problems in chemistry performance continued to be identified concerning self assessments and corrective actions.

• During training on the high radiation sampling system (HRSS) on May 27 31, 1996, the chemistry staff identified a problem concerning the procedure purge times. However, the staff failed to identify that the same deficiency was also present in the routine reactor coolant sampling procedure, which contributed to the June 12,1996 boron dilution event (96-05).

e During the June 12,1996 boron dilution event, the chemistry staff failed to provide good support to operations (accurate reactor coolant system volume, expected change in boron concentration, maximum amount of water to be used for dilution, etc.). I.essons learned from the October 1995 hydrogen addition event failed to prevent similar weaknesses whien contributed to the boron dilution event (96-G5).

Security:

Security performance continued to be excellent. One minor weakness was observed concerning maintenance support for one security component, o Management support for the security program was very good. Self assessment efforts are strong. (lR 96006) e Few errors caused by security force, consistent good performance and trends.

(IR 96006) e One security component required compensatory measures for several months.

(IR 96006)

Emergency Properedness:

Overall status of the EP program continued to be excellent.

e The overall effectiveness of the licensee's emergency preparedness facilities, equipment, training, and organization was excellent (96-06),

e Audits and surveillances of the emergency preparedness proc..m, including the Peer Review, were effective in evaluating the program and identifying program problems (96-06).

e During the routine inspection, interviews with several key response personnel 7

indicated they had very good knowledge of their emergency responsibilities, actions, and procedures (96-06).

Fire Protection:

No regionalinspec' dons were conducted during the assessment period.

C. Actions / Recommendations The core inspection program should continue as scheduled, with a regional initiative inspeedon in chemistry scheduled for February,1997.

The next routine EP inspection will be scheduled during 1998. An evaluated exo.:ise is next scheduled for April of 1997.

Bt. Future insoection Activities

• Routine Resident inspections

? Security inspection (October 21 25,1996) e Radiation Protection Inspections (January 1317,1997 and May 19 23,1997)

• Chemistry inspection (February 24 28,1997) e EP Evaluated Exercise (April 1997)

IV. Attachments

1. Plant issues List

2. AEOD Performance Indicators

3. Average Daily Power Level 8

1

%w PLANT ISSUES LIST BYRON l DATE ID BY SALP DESCRIPTION CAUSE REF l 10/15/96 Lic Eng Essentiel service water potentleNy Material 96009 inoperable r%e to excessive sitt in the Condition cooling tower basins. l 09/04/96 Lic Eng - Missed steem generator swweRience from Personnel Error 96006 1994-95 at Unit 2 was discovered.

09/22/96 Lic Ops Both source range monitors 005: due to Human 96007  ;

an inadequate shift turnover during an Performance I SSPS surveillance.

09/14/96 NRC Ops S- --r-to cooRng to CV pump krbe oR Human 9600?

coolor: due to inadequate surveillance Performcace procedure / skill of the craft.

09/11/96 Self- Ops Unit 1 roects tdp: due to a non-licensed Human 96007 Identifying operator man;pulating the wrtm2 turbine Performance trip lever during a monthly surveillance.

08/96 NRC ' Ops Unit 1 aumulary feedwater treins (2) Human 98006 inopereMe: "A" train was inop due to a Performance surveillence when the "B" train was made inop due to the attachment of a strip chart recorder 1

07/02/96 Self-identifying Maint Unit 1 menueNy tripped: (n response to e M eterlei 96005 loss of feedwater to the B steem generator. Condition The stortup feedwater supply valve failed closed due to a faulty solder connection on the instrument air line to the valve control.

06/30/96 Self4dentifying Maint Urdt 1 mein turbine trip: due to failure of Material 96005 the teflon oil seat between the generator Condition and the exciter. The reactor did m;t trip becat se power was below the 30 percent interixk.

~ ~

PLANT iwdES LIST BYRON l DATE ID BY SALP DESCRfPTION CAUSE REF l 06/12/96 Self- Identifying Ops Unit 1 reactor coolant systsm excessive Perse met Error 96005 dilution: siter a refueling outage with reactor partially drained; and with the reactor isolated from the steam generators.

05/96 Lic Eng Unit 1 steem generators each c.t;J ed Meterial 96004 es C-3: eddy current inspections found Condition more then one percent of the tubes in each generator to.be defective.

05/23/96 Self-identifying Ops Surge tank overflowed 7000 geBone into Procedures 96005 the floor drains: due to loss of station air, the makeup water supply valve to the component coolmg water system surge tank failed open as designed.

05/23/96 Self-identifying Ops Operators -cc. ", trip Unit 2: due to loss Meteris( 9S005 of offsite power to Unit 1. Plant Condition configuration had al" non-essentiel cooling service water pumps and station air compressors powered from Unit 1.

05/23/96 Self-identifying Maint Complete loss of offsite power to Unit 1: Material 90005 ,

because of moisture intrusio . .ato one of Condition  ;

i the bus ducts which caused a ground fault.

i

! 04/96 Lic Ops Inoperatie oefety injection occumuletors: Procedure 96004 when occasionally cross-connected dudng periodic fill or pressurization operations.

03/22/96 Lic Enginee-ing Containment rprey chemical addition Material 96003 system: set to provide sodium hydroxide Conditai at a rate greater than allowed by TS.

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PLANT h. JES LIST BYRON

'l DATE ID BY SALP DESCfWPTION CAUSE ftEF l l

03/13/96 Self-identifying Cps 2A diesel generator tdyped: when en Personnel Error ' 96003 l operator inadvertently opened the DG output breaker instead of the governor ediust switch during the routine montidy surveillance.

03/13/96 Self-identifying Ops NSO inedvertendy adds bode ocid to the Personnet Error 96003 reector coolant system: during fillirig of the spent fuel pool transfer canal from the Unit 1 boric acid blender, resulting in a 2 ppm increase and a correspondmg 0.7 degree F decrease in reactor temperature. i 03/05/96 Self-identifying Ops Operator tdps the 18 Control Rod Ddve Perseewwl Error 96003 IWIotor generator set: when he I inadvertently opened the breaker control switch instead of the voltmeter selector switen during a toutine voltage check.

02/19/96 Lic Ops Inedvertent trenefer of 1000 geEene of Persortoel 6eror endi3 RWST water to the spent fuel pool: during and fotse to the purification volve kneup of the f1WST, use persedures the operators failed to close one valve (FC 053, spent fuel pool discharge). The 1000 gallons of water reised the spent fuel pool approximately one inch.

02/14/96 Lic Maint 18 safety injection pump casing could not Material 96003 be vented: because the drain line was Condition discovered plugged during a routine venting surveillance.

9 i-.__.._...- ..

PLANT h. ,JES UST BYRON DATE IDBY SALP DESCIWPT1084 CAUSE ftEF 01/30/96 Lic Ops Unit O Boric Acid Transfer pump was not Fish and 95013 electrically shgned to Unit 1. The volve personnel error lineup was correct and the Unit O pump's power ~atde was plugged into Unit l's switch box, but the switch had not been shut. The procedures evadable et the time mode no mention of the electricot lineup.

The volve lineup and .4ectricallineups were done es

• skill of the craft."

01/25/96 Lic Maint Technicians steer does en survemence Personnel 95013

^

record to coverup their suistoire: during Errors

. performance of a quarterfy chonnel check on the Unit 1 containment purgs effluent process radioten monitor, the conversion factor for the morator was not retumed to l Its original vain. The incorrect setting caused on inodvertent high level radiction alarm during a centsinment vent 15 rsxt day even though a high radiation condition did not exist. One technicien resigned and the other was given 5 days off without pey because he had a good work record.

01/11/96 Self40 Maint IIIschenical nestneenence fened to inoess e Personnet error 95013 gesliet: on a temporary vent volve on the CARDOX system leading to e CO, leek and I precautionery evacuetion of the turbine  !

building.

12/95 Self-ID Eng SG i:1, loosee: seven sleeves Personnel Error 95011 improperly welded due to inedequate OC: .

two defective welds on plugs not identified l prior to leeking donng e leek test.

l a

t PLANT bdES UST BYRON l DATE ID BY SALP DESCIWPTION CAUSE REF l 12/95 NRC Ops Operator logs for DG improperly Human Perf meinteined, is goven.or oillevel logged as SAT when Out of Sight High.

12/24/95 Self-disclosing Eng (Mt 1 Unit Aux Transformer bus feeder Meteriel l breaker 1431 failed to shut during startup. Cc,r.J;i; ,si I

Levering-in device thrust bearing not in place, cousing breeker to rock hard.

11/16/96 Self-Identifying Maint After scheduled maintensnce of auxillery Personnel error 95013 feed pump 18 discharge heeder isolation and lock of volve to the 1C steem generator, several materiel receipt problems were identified. An ;rsmewct inspection

• • e stem was insteWed wbch lead to

- demoge of tree volve backseet. The incorrect stem was identified prior to installatier: but was not reported.

11/08/95 Lie Eng Om t500 SG tubes with cire cracks Meterlei repaired with a cw. tsnation of sleeves and Condition pisgs.

11/95 Lie Eng Three DG Agostet relays had felled in a one Meterial year period. Aggressive trouble shooting Condition identified cold soldered Johts. Repaired approx. 50 affected relays.

10/26/95 Se% identifying ops U1 in Mode 5.1400 gelbns of water Human dispieced from vessel to pzr when N2 used Performance for draining loops escaped into vesset.

Disk pressurization was intentionally not in use for rusmerous reasons.

. _ _ . _ _ . _ mil

M. ANT imams UST BYRON l DATE ID BY SALP DESCRIPTION CAUSE REF l 10/25/95 Self-identifying Ops Unit 1 in Mode 5. During de-ecerviration Human of a penet for work, auto control of Perferrnanco chorgmg flow (CV121) was lost. Ouick operator action prevented major pressure transient. Auto control of CV121 was not indicated on a de-energization crocedure and thus not on the OOS prepared. See 1CV8105 above, occurred during this tr&.L .s.

10/25/95 Self-identifying Eng Unit 1 in Mode 5.1CV8105 (cherging Meterial header containment isolation) stripped Cs.-4%.

motor pinion gear while operating.

10/23/95 Self-disclosing Cps Unit 1, both Source Range Nis, N31 and Meteriel i N32, inoperable due to noise, spiking, and Co.-Ji;e.n i ege. Both Nis detectors replaced during l outage.

10/13/95 Self-identifying Ops During PRNI calibration, rods inserted 23 Human steps when gain ediust locking device was Performance tightened. Procedure should have had rods in menuel.

10/10/95 Licensee Eng The NRC identified en additione design Human Perf 95011 configuration problem foBowing the licensee's identification of an inadequate design configuration of two devisions of equipment required for safe shutdown (2 App. R. Violations) 09/13/95 Lic Ops Unit 1. TS 3.0.3 was entered Human 09/15/95 inadvertently on two occasions die to Performance

" misunderstanding" of LCO action requirements for containment leek detection systems.

PLANT k..,JES LIST BYRON l DATE ID BY SALP DESCfWPTIOff CAUfd I4EF l 8/95 NRC Maintenance A maintenance person was noted to be in a Personnel error 95008 material exclusion (FME) cleanimess zone & training who did not meet the requirements for control of personst articles. The meintenance person was not aware of the FME requirements.

S/29/95 Lic Eng A recent procedure revision was being Procedure 95008 used to perform a surveillence on the fire review and suppression system at the River Screen personnel error House IRSH). The new revision required two sierms to be actuated, however, for the zone being tested at the RSH only had one storm. This error in the procedure csused confusion. A second try of the test created a potential personnet hazard.

, possible carbon dioxide asphyxieticn.

8/21/95 Lic Eng The 18 Hydrogen monitor was identified as Procedures and 95008 being inoperaNe because the dreirt lines to personcei error the water trap were found disconnected and capped. The inoperable condition may l have existed since construction. A eview I revealed three occurrences when 'coth monitors were cut of service for more then 72 hours8.333333e-4 days <br />0.02 hours <br />1.190476e-4 weeks <br />2.7396e-5 months <br />. Escaleted enforcement resulted its a level 3 violaten.

PREDECIJICNAL BYRON 1 FI EVENTS FOR 95-3 NONE .

• PI EVENTS FOR 95-4 NONE FI EVENTC FOR 96-1 NONE FI EYE 3tTS FOR 96-2 .

SSF e4/23/w Lita 454N005 50.728: 30349 .,

PWR Nists (melflON trilip la ALL setts UP TO 1901 Pewt simCE lulflAL OPitAfl0N meur s tMitotNCf Cott C00Lisc tfstguis encup ST8ttM LOW Petl8Utt SAf ttf INJECfl0N 1,8 FEM tifu UNif t full EVENT WS Attl0NED TO UN!?81 Am 2.

M SC 4 tnt PLAmt staf hAVE OPitAfD Wifu staLilPLt IAFtif INJtCfioW ACC180LA10t$ CR0ll* TIED. TMll COULD RESULT IN Ltli 1RAN THE kleultp ILMBit OF ACCL80LA10R$ INJECflWG 17 A LOCA OCCURRED ON ONE OF ikt LOOPS AltoCIATED WifN INE Cacal f tp naam 810t8.

SSA 05/Z3/w Lies 454N007 S0.77s: 30531 PWR Nist COLD Sm1700WN DISC THE EDG1 STAtitD AND LOADD TNtit DUlts f 0LLOWING 4 Loss of Of f $ lit Part at3ULilWC f t0M A FAULT DN A 51Afl0N AuxlLI ARY f tAkspotsER. Am IntVLAfot FAILD DUE TO Witt INTRU*l0N INTO A DUS DUCf.

S5F w/04/w Lete 45495005 Sc.72s:

, PWR al51: CONDifl0N ExilfD 18 ALL IWDtl UP TO 1001 PCWER ll#C1 IglflAL OPERATION

\ et0UP CONfp0L totM EMttetNCY VEWilLAflON Sf$ FEM thauP STETEM 4 CONit0L BulLDlWG/ CONTROL CIMPLEX (WVitoesENTAL EX*1ROL ST5 FEM Ofn LMits TNil IVENT WS Attl0NED TO UNIf 81 Am 2.

M EC Cohit06 ROON VINilLAfl0N COULD hAVE BEEN tiettp IN0PitABLE ST A Fitt IN SEVERAL Dif fletNT Flat 20Ntl. TMll tytNT WS CAust0 Of InADieuett ELICitlCAL 9tPARAfl0N OF CA8Lt$.

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PRE 0ECISIONAL BYRON 1 te no si.esir, s.,<*,:.ne. w. n M888Wm Ellllll2 Peer Group Wesb6phouns Now 3 and 4-Laop C

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OPERATIONS (including startup)

Automatic Screms While Crteloal - 0 0

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BYRON 1 PREDECISIONAL EVENTS AEDD CONSIDERS IMPORTANT tyget DAff 08/18/95 DESC Les 95 002 00: ou 950818, W111 ftAlt 8 m esiulfse mt PMD luorteAttt DA 10190 LATED mitt faAP. Deuwtb Wulf 1 feAls 8 N noulf0R LIE CAPS. W/950913 Lit.

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OPERATIONAL PERFORMANCE DATA FOLLO'tS 4

W

BYRON 1 PREDECISIONAL PREDECISIONAL PI EVENTS NDT INCLUDED IN THE 96-2 REPORT -

SCRAM s9/11/M Lens M 7as: 3o9PI M Wlli a PGdit CPt4Afilut$ AT ME MSC A RX ftlP OCCWatG tbl A 115t015E ftlP tsIEN AN IPt4ATOR letalPULATID TM WacuG Livil DutlNG A fnstelE OIL filPS IIoriNLY RatWIILLANCE.

. , MANUAL SCRANS SCRAM of/s2/96 Lane su M0tt M.fae: 30700 M b!ff t PO W R OPetaflCBil At 15E MSC Test er at sqAanJALtf talPPED nells A Fatomfte PeCIEAftt 190LAfl0N VALVE CLOOG Al TM MIUtf Of A St0GW lWlf ttpENT Alt LIM JOINT. PetLINihART AmALT818 IslCATES flitt! W5 thAMeuAff leMtiltbi 0F A glPPLt INTO AN ELBOW At TNE 80LMet0 Alt LINL J0luf.

ACCIDENT SEQUENCE PRECURSDR DATA

(* 1986 Afe test DATA PP88 MA8tY 9 08000E OUTAGE DATA i

SCHEDULED STAlf DATE: 04/05/96 RITAGE satt 2157.0 (89.9 Ders)

MSC htFutLibG OUVAGE.

SCHEDULED START DATE: 10/2 V95 inJTAGE Ints: 1531.0 (63.8 Days)

M gam 01P02 lus>ECil0N Of 5ftAM M M RA10ts.

MBC EVENTS AEOD CONSIDERS IMPORTANT fvtW1 Daft: 11/M/95 M SC Lit M*01100: ou 951105 Dittovttic luCatASED fust MCAADAtl0N IN $GS. CAusto 1101 s

MittalutD. MFECTIVE TuMS WILL M ttseovt3 FROM Svt ST PLUGGING OR SLttvluG 1 SUPPL

etPT ou 800f CAust WILL M EusMIfits. W/M1204 Lit.

I tytut Daft: 10/78/95 MSC a Ltt 95 0% 00: ON M1G28. suevtiLLautt was allH0 DuttsC SC Tust las>. causto of COGul1lvt Pf aSouett titot. CalatstLLED COGNitAsi (NGIMit ON atS8045181Lif tts at SG WORE.

W/951121 L18

PREDECISICHAL BYRON 2 FI EVENTS FOR 95-3 SSF e4/15/95 tets 455950m 50.72s: .

PW #151: CONDitt0N tallit0 stfWttu 12/90 AND 3/f2 an0VP : MGMNCY AC/DC POWit sf 5f tml StaAP 875f84 : MAGENCY Omslit POWit SUPPLY tilitM MBC AN EDG WOLTAGt atRALATOR W5 INSTALLED 12/90 AND REPLACEO 12/91. utlfNtt VOLTAGE tt0VLATOR WAS Adieu 4TILY ftlf te taett itANSitNT LQtDialC Coelfl0NS IN fut MtGtWCY MODE Will 3/92. TNE RDueANT EDG MS INOPERA8tf (Ni SivitAL OCCASIONS DLEING TMAT flHE.

FI EVENTS FOR 95-4 NONE FI EVENTS FOR 96-1 NONE FI EVENTS FOR 96-2 SSF e4/23/96 Lfte 45496005 50. Tass Muf PWR Group N15ft CONDifl0N EXI5ftD

tutRGtWCT Coat COOLING sittens enoup IN ALL NODES UP 10 1001 POWit $1NCE lulflAL OPftAfl0N Sf8 TEM LW Pettsut! SAf ttf INJttfl0N STSitN OfM UNIT full EVENT W$ All10NtD TO Wif t 1 AND 2.

MSC Tut PLANT MAT hAVE OPinATED WITN ftALflPLE SAPtti INJECfl0N ACOMAAf 0Rt CR06tefitD. TNil Co ktsuLT IN Lttl TRAN fut treultG Nuete 07 ACQ8MAf0R$ INJECflNG IF A LOCA OCCLatap ON ONE OF tnt LOOPS Alt 0CIAf tD WifN ONE OF fut CR088* Tit 0 ACCLDEAATOR$.

SSF e6/04/96 Late 45495005 S0.72e:

PWR Ntst tcNDifl0N trisitD IP ALL N0Dts UP TO 1001 POWit SINCE tufflAL OPftAfl0N et0UP : touttel 800m (MitGtWCT VENilLAtl0N BffitM QRoup Of8 TEM : 00 Nit 0L DUILDINC/CENit0L CDEPLit GNVit0MNTAL CENTROL SYSTEM OfM UN!!: fNil tytNT WS AttlGNED 10 UNITS 1 AND 2.

Mlt  :

CONTROL 000M VENTILAfl0N COULD NAvt titN ti etat 0 !N0 Pita 8LE ST A Fitt IN StVttAL DlFFlathf Fl touts. TNil IVENT W 5 CAULED Bf INADieuaff ELECitlCAL StPARAfl0N OF CADLit.

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• 5 3- 2 0 - -

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                                                                                                                                                      ?

PREDECISIONAL BYRON 2 -;. - w n . w .c.no, men - Wedium m PeerCrote h p m ;3 ,.c 4. @ g kNI 1 D3 to 96 2 Trote, andlesaewes.'

                                                                                     .-.1       _             ... -                                                              *
           * *              * *-                                                                                                             Devotions From Meef                                      Peer Group

w .1ter.o Meden

                                                                                                .Short To m                                     Long Term w                    meern.d                          ww.e                ese.<'

OPF. RAT 1ONS j Automatic Sorams While Critical - . o o_4$ Estety System Actuations - o 0 Signifbcont Events - o o Safety system Failures - 0 68

                                                                                                                                             -010     .

Cause Codes (All LERs) a- __ _ e sw pi.en -

                                                                                                       ] cas                       -

am7 [ k u n omnew enen - 0 - D o20 a os= >w ==m >w - 4.21 [ - l026 e- p an-.. - I .c.s4 -

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                                                                           -                            0                          -                              10A5 SHUTDOWN Safety System Actuations -                                             o 0.38 Significant Events -                                        0 0

Safety System Failures - o 0.60  ; l Cause Codes (All LERs)

                                     **-           a caew w -                                           0                           -                               IcA7 k useaume eserunw sr.we -                                    0                          -

4 05 ( t emar ewesumes triws - 0 - 0.15 [ s-  : p.eenses - 0 -

                                                                                                                                                             ] 0.29 n_       -

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                                                                            -                            0                           -                        0 FORCED OUTAGES Forced Outage Rate ' -                          -0.26 0 40 Equipment Forced Outagest

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• 10 05 00 0.5 to .t .0 45 o'o os 7 0

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BYRON 2 PREDECISIONAL PREDECISIONAL PI EVENTS NOT INCLUDED IN THE 96-2 REPORT - m . . . . . . MANUAL SCRANS SC M M/13/96 La w 6H M 007 M.F3fs 30531 PWR WIST pa st staAtless AT 100E M9C  : TM au ms 3:4faAALLT ftl ppg 8 05 A Lett W lWSim8Ef 51 Alt Aae MWim Wita. latitLBENT . Ala Ane gravitt mitt Wat Nist sumPLIN Pam Lasif OW mitz LO67 ALL Nflift Pest Miss A BfAfl0N Atarill4RT faAsstensEn FAULT, ACCIDENT SEQUENCE PRECURSOR DATA (*** 1988 AMD 1906 DATA PMELMINAptY *) g fvtti M fts 97/14/M E388 t 4,W $ MBC a LMV AND 1 ftAls W APW TalPPED fvtsf Mits 10/02/87 CDet i 1.5t 4 . NBC talP

• Loop fvtuf Mits M/04/87 83*a 3.7t.$

MSC twyttite FAILLatt FAILS but. RPS PALM 181P. Wil/LWW.1 APWP OW. OUTAGE DATA SCHEDULED START patt: et/19/M OUTAQt uts: 312.0 (13.0 Deys) MSC M futtime Ou1AM . EQUIPMENT FORCED 51AA1 M its 08/04/M CU1ASE mRS: 253.3 (10.6 Devs) MSC FORGD CUTAgt M 70 INCatAtt0 Lthr RAff le TIII 1A $/G. FORCED

     $1Atf Daft: M/23/96
 $   OufAGt met 162.9         (6.8 Ders)

MSC h4D A MLUGC ACTUAllou 62f16 CAust0 et wita tuttuslow luto int A tv won.stGAEGAf t0 Bu$ DUCT.

mu ul e 4 e BYRON 2 e AEOD DID NOT PERFORM A DETAILED PLANT ANALYSIS - ( OPERATIONAL PERFORMANCE DATA FOLLOWS h e 4 ( e

BYRON 2 PREoEcIStoNAL EVENTS AEOD CONSIDERS IMPORTANT tvtui DAfts 08/15/95 * * * +- MDC 3 Lee 95 00&*003 sur 964015 M Post aislet tal ineDetLaft SW to teGT MFICituCT. 80tLOPED P90CDudt Wits vtalffW PEstomanCE Of VOLiest NBAAfDR 8 acWlason Welt ACCIMNT 19Adrsfluf LaseleG Coelilluss. 44/950816 LTE. e

7 j DRESDEN

                                           ?..

C 4 4

PRE-DEC1510NAL SEM1AleWAL PLANT PERFORAANCE ASSE5SMLWT DRESDEN LalITS 1, 2, and 3 Assessment Period: June I thrc3gh August 30, 1996 '

        $ ALP Period: March 19, 1995 through December 28, 1996 Previous SALP Rating:                                ops    1 Raint 1 Eng    1                                                .

Ps 1 ..

1. Performance Overview As discussed at the last Senior Management (Smi) meeting Unit 2 (U-2) was returned to service in April 1996 following an extended refueling outage (D2R14). Extensive feedwater level control system (FWCS) testing was conducted during the startup and the unit achieved a maximum power level of 60 percent. On May 31, a manual trip was initiated in response to a reactor vessel level transient during FWCS testing, in addition to taking corrective action for the feedwater controller problems, the licensee maintained U-2 in shutdown to address electrical circuit breaker problems. The unit was returned to service on August 27.

On May 15 a Unit 3 feedwater regulating valve (FRV) stem separated from the valve disk resulting in a complete loss of feedwater to the reactor and subsequent reactor tri). Following repairs to the FRV, U-3 was restarted on June 11. Unit 3 was siut down on June 22 following the identification of 4160 volt (4kV) safety related circuit breaker problems. Unit 3 remained shutdown during the remainder of this assessment period to repair the 4kV breakers and a generator stator water cooling leak. The licensee also repaired the low pressure coolant injection (LPCI) heat exchanger corner room support steel and the control rod drive (CRD) gallery steel. The conduct of plant operations has remained good. The licensee's commitment to a conservative operating philosophy and focus on safety was demonstrated by the Jecision to shut down U-3 and maintain U-2 shutdown while repairing the 4kV circuit breakers. The operators' adherence to performance standards and expectations declined slightly. Performance in the maintenance and survelliance areas was adequate. The majority of attention was' focused on large projects like the 4kV breaker refurbishment and the U-3 corner room steel modifications. The overall work control process has improved and remains adequn o. However, weaknesses in work planning, adherence to industrial safety standards, and corrective actions continued. Engineering support to the station continued to improve.' While the engineering organization's ability to. produce good technical work products has improved, substantial variability in the quality of individual products

 ;     remained.          The plant's material condition problems continued to be resolved.

However, latent problems in the feedwater system and the 4kV urcuit breakers continued to impact plant performance.

Dresden PPR 6/96 - 8/96 Pre-Decisional Performance in the area of Plant Support war atxed. Radiation protection showed improvement in the As low As Reason sly Achievable (ALARA) program and a reduction in the number of personnel r- 'minations. However, some poor surveys and job coverage continued. F s.mance in the security area was - adequate, but a decline from past pertu ance was noted. Examples of the decline were weak interface between stat n departments, workers' lack of sensitivity to security requirements, and .neffective oversight to ensure proper implementation of the security program. Good performance in the Emergency Preparedness program continued as evidenced through the effective implementation of the program when an Unusual Event was declared in late May. II. FilNCTIONAL AREA ASSESSRDff - A. Operations

1. Current Performance Performance of facility operations has been good. The Operations department exhibited a conservative operating philosophy and continued to focus on safety. .

Since both units were shutdown for most of the assessment period, there were few direct challenges to the plants. However, a decline in performance regarding adherence to expectations and performance standards was noted.

2. Assessment / Issues ,

Operators were knowledgeable of plant conditions and continued to exhibit a conservative operating philosophy and questioning attitude during maintenance activities and special procedures. Example of continued conservative operating philosophy and questioning attitude included the following: Unit 3 startup was delayed until the U-2 feedwater control system investigation concluded there were no concerns with U-3. (6/96) Unit 3 was breaker problems. shut down and U-2 remained in shutdown due to 4kV circuit (6/96) While repairs to the safety related busses were in progress, an operator stoppcd work in the switchyard which could have effected the off-site

   ,,           power supplies.                               (7/96)

Non-licensed operators assured that correct procedures for ' racking" circuit breakers in and out were followed even when the Electrical Maintenance Department (EMD) personnel thought the procedures were unnecessary. (7/96) Operations department rejected work packages that appeared inadequate. Work Execution Center (WEC) Supervisor rejected 3B CRD pump circuit breaker for lack of acceptance criteria. (8/96) The WEC issued a Plant improvement Forms (PlF) for work packages lacking Plant Impact Statements being continually sent to WEC. (8/96) 2

Dresden PPR 6/96 - 8/96 Pre-Decisional Operations department personnel assured other pe m ime? were following plant procedures and adhering to perfompre Aincarnt. Contract Iron workert, were est.orted out of t.hr reactor building . for not wearing safety glasses. (8/50 Contract worker was escorted out of the plant int not wearing hard I hat. (8/96) ' Contractor workers leaning on vibration sensitive equipment were escorted out of the plant. (8/96) Operations department management assured ' Heightened Level of Awareness * (HLA) briefs prior to significant evolutions were thorough. (6/96-8/96)

              -                                                                                               i Operator questioned confined space requirements during HLA for U-2                       '

4 drywell closecut. (8/96) i I l \ Several events demonstrated a decline in attention to detail and failure to i follow the Itcensee's 'Stop, Think, Act, and Review" (STAR) principle: I The NRC identified loose fibrous material in U-3 drywell during closeout inspection after the itcensee's inspection. (5/96) i

• D eing a U-3 shutdown, Intermediate Range Monitors (IRMs) were not

' calibrated when required (repeat). The root cause was poor comnunication between the' Unit Supervisor and the Instrument Maintenance d<partment supervisor. (6/96) The NRC identified that a special undervoltage test procedure was performed which had not received a required on-site review. (7/96) Tne NRC observed that strict adherence to 3-way coanunications and repeat-backs declined both in the control room and in the field (e.g.

             *Put valve to normal

• instead of "Open valve xx-yyy"). (6/96-8/96)

The NRC observed that control room annunciators were not promptly cleared after the alarming condition cleared (e.g. period alarus and area radiation alarms). (8/96) Poor performance in the operator training program indicated a lack of understanding of all program requirements. - An NRC initial license examination was compromised. The exam was' canceled and an 01 investigation initiated. (7/96) The NRC identified that since 1994, several licensed operators had been removed from or reinstated into the "requalification program" without prior NRC notification and appropriate amendment to the operator's license. (8/96 identified)

3. Actions / Recommendations Continue with current routine resident inspections.

3

Dresden PPR 6/96 - 8/96 Pre-Decisional

8. Mainterance/ Surveillance

1. Current Performance Performance in the maintenance / surveillance area was adequate with the majority of attention over the quarter focused on large projects like the 4kV breaker refurbishment and the U-3 corner room steel modifications.

2. As sessment / Issues The backlog of non-outage work requests remained stable or slightly increased due to emergent work activities diluting the licensee's resources to reduce -

the backlog. Control room corrective action work requests have continued to receive good attention. The overall work control process was adequate to ensure that non-outage maintenance activities could be effactively prioritized and planned. However, the following weaknesses continued te impact an efficient work process: System engineers did not consistently provide gatly schedule input to the work planning process. This frequently resulted in schedule changes and work scope growth (e.g. N, tank and U-3 fuel pool filter work not in schedule; system engineer requests out of service (005), work not performed. 005 cleared). (6/96&8/96) Maintenance work packages did not always contain the correct information or procedures. Incorrect part number resulted in the installation of improper line.

                  -       solenoidinreactorwatercleanup(RWCU)lantinje(5/96)

Incorrect weld size in high pressure coo ction (HPCI) drain line package . (5/96) Package re operated non-electrical) (quest DO remove-limits from valve motor on an air-valve. (6/96) IMD perfomed work using wrong rev9sion of a procedure. (7/96) Numerous package problems and omissions were noted by 005 group

      ,                   for work on U-3 standby liquid control system.                                            (8/96)

The 005 group failed to have all tagouts prepared, resulting in delays in the start of maintenance activities. Daily status report listed it jobs that failed to start because 005 were not ready (6/3) Daily status report 19sted 3 jobs that failed to start and 4 that failed to finish because 005 were not ready. (6/10) Daily status report listed 2 jobs that failed to start and 2 that failed to finish because 005 were not ready. (6/17) Several maintenance personnel were slightly injured or had near misses during the last quarter. In response, plant management stopped all maintenance activities for 4 days to provide training and encouragement to perform work correctly and safely. Examples included: 4

Dresden PPR 6/96 - 8/96 Pre-Decisional A mechanical maintenance worker received burns while using a tn'azing torch during maintenance on a service building air conditioner without depressurizing the freon system. (7/23) An EMD supervisor performed an inspection of energized 4kV breaker

• cubicles and received a minor flash burn. The supervisor was not following electrical safety procedures or using safety equipment.

(7/25) Maintenance continued to demonstrate ineffective corrective actions for previously identified problems. Examples included: Safety related 4kV breaker failures due to hardened grease. Inade maintenance and failure to assess vendor and industry information.quate (6/96) The NRC id1ntified errors were again made regarding calculations on specific gravity for a 125 Vdc battery test. This was previously identified as a problem by the NRC last quarter. (C/96) Rework continued to be a g,roblem that station management was addressing. The containment cooling service water (CCSW) vault door reworked due to overpainting. (5/96) A CC5W bearing damaged while checking locking on rotor. (6/96) Incorrect lin(age installed in 4kV breaker. (7/96) Numerous compressors.PIFs on rework for U-3 Service and 3A instrument air (8/96 & 9/96) Performance in the surveillance area remained adequate. However, some examples of poor personnel performance were identified. The NRC identified that individual cell voltages and voltage stabilization was not recorded as required during 125 Vdc surveillance. (6/96) The NRC identified that the licensee attempted to perform emergency diesel generator (EDG) fuel consumption surveillance with a broken diesel fuel transfer pump flow indicator. (6/it6) As noted above, a required surveillance on IRMs during a U-3 shutdown was missed. (6/96) During the last 3 months NRC field observations included sev6 cal EDG surveillance tests, several CCSW tests, several LPCI tests, CORE spray testing, and SCRAM time testing. In general, tests were performed in accordance with procedural requirements.

3. ' Actions / Recommendations Continue with routine core inspections by the resident inspectors with assistance from regional specialist inspectors.

5

Dresden PPR 6/96 - 8/96 Pre-Decisional C. Engineering

1. Current Performance Strong engineering management efforts over the past cou)le of years have improved the technical qualification and knowledge of tie engineering staff.

The ability to produce good technical work products has been demonstrated numerous times. However of some engineering work, substantial variability still exists in the quality increased engineerin - material condition (ge.g. focus CRDcontinued to have sample line, a positive anchor impactnumerous bolting). While. on plant material condition problems were effectively resolved over the last few years, others continue to impact plant performance (e.g. M0V hot short). Engineering backlogs that accumulated in earlier years, coupled with emerging issues, frequently detracts from the time available to ensure a thorough approach to resolving concerns. The first line supervisors fail, in some cases, to provide resolution is produced. sufficient overview to ensure a consistent quality Engineering management is aware of these impediments and continues to take actions to reduce backlogs and further improve material condition. Although a slow process, these improvements could result in engineering being comprehensive in awork. routine less reactive mode and allow more time for quality and

2. Assessment /1ssues '

Engineering improvement initiatives continue. The Engineering Manager reorganized the department to gain closer personal oversight. New engineering self assessment initiatives are proving capable 'of accurately identifying problem areas. (e.g. performance colored windows program view on calcu ations, departmental self assessments such as IST and 10 CFR 50.5g, and overdue preventive maintenance and surveillance problem.) Licensee currently trying to rectify 3 year system plans with budgeting process. .. Special outside engineering assessment (partial SSFI) is ongoing. Several CCSW issues were identified. Substantial variations in engineering work quality remain. Engineering personnel observed by the NRC appeared technically quhlified and experienced with majority of work products adequate to good. (E&TS Inspection IR 50-237/249-96004) The initial licensee approach to several important technical issues appeared to lack depth until NRC involvement (e.g. 4kV breakers, 6 ____-__m__ - - - - - -

Dresden 7PR 6/96 - 8/96 Pre-Decisional 480 volt breakers, special General Electric service advisory letters and under-vessel insulation). A narrow scope approach was observed with respect to some engineertrig evaluations resulting in some problem areas such as post-modification , testing and docueentation of justifications and thought processes in design documents. (e.g. FRV sealant injection, emergency core cooling system test return valve function) Engineering action items receiving higher management overview tend to be addressed thorhughly more routine, less cr(e.g. reduction in Inferisation Notices). However, itical items sometimes resulted in inferior products (e.g.systemreviewboardactionitems). Quantity of engineering work and backlogs remained an impediment to improved engineering quality and thorough approach to issues. Increased etaphasis on resolving engineering backlogs resulted in some marked decreases in several categories (e.g. Operability Evaluations, UFSAR open issues), although considerable work remains. Although immediate safety concerns were resolved quickly, work still remains to be completed on several old (1991) major regulatory issues, such as the EDSFI findings. Constantly evolving higher priorities make it difficult to focus resources to resolve old issues. Insufficient time for thorough approaches was a major factor in the variations-in engineering work quality noted above. Engineering's ability to improve and maintain equipment material condition continued to improve. However, as identified by the on-going material condition improvement project (27 systems , a number of improvement initiatives were still in the evaluation s)tage. Major material condition improvement actions continue with planned 03R14 activities similar to last U-2 refuel outage. Licensee indicators such as operator work arounds, temporary alterations, and cutstanding control room work requests continue trending downward or remain at a low level. Material Condition leprovement Project review of 27 systems identified 496 specific recommendations that were subsequently incorporated into 3 year system plans. Engireering continued to identify and resolve older design and process deficiencies (e.g. CRD line check valves, structural steel anchor bolts). Engineering management focused on improving plant system engineer involvement and acco'untability in system outage work selection and ' implementation. Efforts to improve system en direct involvement early in the work process,gineer performanceininclude direct involvement system WINDOWS for the outages, and specific training on outage responsibilities. 7

Dresden ppR 6 # 6 - 8/96 pre-Decisional Latent material condition problems continued to impact plant performance. Both units had forced outages because of feedwater system deficiencies. Extensions of the forced outages were needed to address various material condition Some problems were previously known (e.g.FRV problems (e.g.but 4kVimbreakers). reliability) prior to implementation of scheduled modifications.pacted the licensee Increased emphasis on Updated Final Safety Analysis Report (UFSAR) continued with some UFSAR or plant changes required. Extensive post-structural steel issue reviews respited in about 30 UFSAR changes and 5 plant changes. ,., , Followup r.omparison of UFSAR to plant operating procedures for first 3 systems resulted in another 30 minor UFSAR clarifications and changes to operating procedures for CCSW pump operation. Sensitivity to more implicit aspects of licensing basis was still lacking (i.e. knowledge and availability of NRC SERs.)

3. Actions / Recommendations Several engineering related issues warrant continued NRC attention:

Work loads and quality - The amount of work due to emerging issues and backlegs is an impediment to quality engineering products. The size of the current engineering staff appears on par (and in some cases quite a , bit larger) with other R111 plants. Although the licensee's current course of action and level of resources is designed to eventually break this cycle, the process is slow. Material condition improvement program (MCIP) implementation - Pihnt engineers were required to fold the MCIP recommendations into their 3 year system plans. However, there was no assurance that the reconnendations would be implemented since funding was a key component. The licensee was evaluating the proposed 1997 budget. Special coming outside engineering out of this review assessment (Reduced Scope SSFI) - Results continue to be followed sely. clo(atInspection both Dresdenefforts and to theQuad same Cities) should technical depth have not been performed for several years at these plants. The NRC should ensure findings on the s' elected system are extrapolated problems on other for general conclusions regarding possible design approach systems. Upon completion of the itcensee's review and final report, the NRC should evaluate the need for an independent NRC inspection (siellar to 40501) to ascertain the reliability of the iteensee's engineering assessment. Equipment performance monitoring and trending - This area was the subject of escalated enforcement (1994) for which the licensee implemented corrective actions. However the NRC has not re-examined this area in any depth. The licensee's m,aterial condition improvement progrn report earlier this year identified this area as a significant 8

Dresden PPR 6/96 - 8/9f PrG-Decisicnal programatic issue and recomended inrediate management attention. , Related licensee actions and effectiveness should be closely followed. Drawing quality - Numerous discrepancies in electrical wiring diagrams have been known to exist since the late 1980s (previous SSFI finding). The compensatory approach taken by the licensee was to fix wiring diagrain discrepancies only as they were discovered during the course of normal work. Implementing a program to identify and correct the drawings was not considered necessary. In addition, the licensee implemented a process to conduct detailed walkdowns of wiring prior to implem2nting modifications or maintenance to preclude any adterse occurrences. While these compensatory actions may be a reasonable approach, the licensing or regulatory basis was not well defined. Some related issuta it. elude cubicle wiring diagram discrepancies identified during the 4kV breaker work, and the NRC identification of inaccurate air flows on controlled HVAC drawings (including those in the UFSAR) for which the licensee indicated the data was not required to be maintained. D. Plant sunoort

1. Current Assessment Performance in the Plant Support functional area has been mixed. Radiation Protection and Chemistry has been adequate with improvements noted in the As Low As Reasonably Achievable (ALARA) program, maintaining a low number of Personnel Contamination Events (PCEs), and maintaining limited plant contaminated areas. Good performance in Emergency Preparedness (EP) has continued as evidenced through the effective implementation of the program when an Unusual Event was declared on May 15,1996 A declining trend was noted in the sccurity arsa. Security problems were identified regarding interdepartmental communications, general workforce sensitivity to security requirements, and ineffective management of certain program responsibilities.

2. Assessment / Issues

a. Radiation Protection and Chemist-v .

   .Prograncatic improvements hava continued involving procedure enhancements and ALARA involvement with maintenance work package development. However, arogrammatic probless identified by the NRC regarding failure to analyze autred tritium samples and adequately maintaining records of contaminated Is.

Some poor surveys and job coverage' performance by radiation protection technicians (RPTs) remain a challenge to the program. Training to enhance the skill level and decision making of the RPTs was completed in August; however, the full effectiveness of this training has yet to bb realized. 9 m_..

7 . Dresd:n PPR 6/96 - 8/96 Pre-Decisional Contaminated treas and PCEs have remained low. Currently about 8.8 percent of the radiologically protected area is controlled as contaminated (8 percent of which is the U-2 and 3 torus basements). Throu " period 44 PCEs had been recorded for the year.(102 gh the endinof1995 PCEs the and assessment 300 in 1994.) Self assessments have been routinely performed by the RP department ard corrective actions for long standing problems have been generally effective. The Sne Quality Verification organization has increased auditor staffing in the RP area and has been more actively involved in identifying problems. The number of PIFs generated by SQV has noticeably increased. Interdepartmenth1 support for the F,P program improved at the management level. However, the work force has yet to fully embrace the program.

b. Security Performance in the security area was adequate. This reflects a decline from the previous assessment period. Examples of the decline in performance were weak interface between security and other station departments, workers lack of sensitivity to security requirements, and ineffective oversight to ensure proper implementation of the security program. The decline in performance resulted in failures to:

Maintain an effective vehicle barrier system. Conduct appropriate search activities of some containers. Effectively maintain a vital area barrier. Failure to recognize a programmatic deficiency in the access authorization program which resulted in the granting unescorted access to an inadequately screened individual.

c. Emeroency Preparedness Overall status of the EP program was good. Response facilitics, including the control room, Technical Support Center, Operations Su Operations Facility, Field Monitoring Team Vehicles, pport Center, Emergency and equipment were well maintained and in good operational readiness. Audits and a self assessment by corporate EP staff were of good scope and depth.

resigr.ed in March 1996, cnd a new EPC started in April.The EP Coordinator No performance issues (EPC) have been identified regarding the changing of EPCs. One Unusual Event was properly declared on May 15, 1996. The event classification and notifications were made appropriately. . s

3. Actions / Recommendations Continue regional inspection initiatives in the areas of radiation protection and security. Radiation protection inspections r.hould focus on RPT performance especially during D3R14. Security initiatives should be focused on ti.e resolution of performance problems noted during this assessment period.

S 10

Dresden PPR 6/96 - 8/96 Pro-Decisional Routine core inspection activities are recommended in the areas of Emergency Preparedness and Fire Protection. III. Future inspection hetivities . Special Independent Team Inspection begins September 30, 1996. The inspection schedule to have a pub ~eic Exit on December 12, 1996. Portions of the team will return to Dresden to assess the licensee's maintenance and work control processes during U-3 refueling outage. The outage was scheduled to begin in early 1957. The goals and objectives of the inspection are: Evaluate the effectiveness of,the corrective actions progrtas. . Provide ao independent assessment of conformance to the design and licensing basis. Evaluate the conduct of effectiveness of maintenance activities including work processes, post-maintenance testing, and implementation of maintenLnce rule activities. Provide an independent assessment of operational safety performance. Other Activities: NOV Inspection - October 1996 IST During U-3 Refueling Outage 14 - February 1997 Maintenance Rule Inspection - May 1997 IV. Attachments 1.

2. Assessment of Dresden Fundamental Issues - ATTACHED Plant Issues Matrix - ATTACHED

3. Power History Charts - ATTACHED

• O e

4 11

DRESDEN FMAMD(tat ISSUES JUNE - AUGUST 1916 COMUCT OF PLANT OPERATIONS During the last quarter, no significant operational problems occurred and plant startups on U-3 (6/96) and U-2 (8/96) were perfomed well. Some minor deviations from operating practices and expectations in the area of comununication and control board attentiveness were noted. Due to an extended dual possible. unit outage, an evaluation of this area with operating units was not Operators decision to insert a manual U-2 trip when reactor vessel level dropped to predetermined level during feedwater system testing was conservative. (5/96) The NRC identified that failure to conduct proper drywell closeout (loose fibrous material). (5/96) Licensee decision to shut down U-3 and maintain U-2 in shutdown following the identification of 4160 volt (4kV) breaker problems was conservative and focused on plant safety. (6/96) Licensee decision to delay U-3 startup until the U-2 FWCS trip investigation determined that there were no concerns with U-3 was conservative. (6/96) . WRAN Dut0RS Hinor significant human errors events were have still noted (e.g. procedural adherence); however, no resulted. A non-cited violation for failure to follou procedures. Result was inadvertent startup of U-3 EDG during breaker maintenance. (5/96) Out ofduring panel service 4kVerrors work.continued. Placement of tag on wrong unit control (8/96) Licensed service, SRO (WEC supervisor) prematurely removed an electrical out of

     -                                         Individual's SR0 license was terminated by the licensee.

(8/96) WORKFORCE MERSTAMING Am IMPLDIENATION OF STANDARDS Concerns still exist in this area as several personnel safety events occurred over the last 3 months, some with potentially serious consequences (e.g. 4kV flash burns to an electrical supervisor). Plant not adhering to station safe work practices (e.g. personnel are still wearing safety observed glasses). Licensee management continues to emphasize general standards to the workforce through meetings and various documents. Although these efforts have been effective in some instances, workers do not always grasp how these standards specifically apply to their individual jobs. First-line supervisors do not I 1

Dresden Fundamental Issues Attachment 1 6/96 - 8/96 Pr4-Decisional necessarily understand the neer 'e ninfma 'O ese standards in the field. ' Narrow thinkin.g and M c' quutWnup attst7Je prevent workers from extrapolating exaeples to nther potentia! prelems areas. Adverse occurrences such as comunic.it10:, sishapf :nd . electrical thocks result. In July, a station wide stop-work wn conducted because of personnel safety problems. PLANT MTDtIAL ColeITION Housekeeping improved over the last 3 months and the trend appears to be continuing. Equipment performance and availability has been adequate; i however, significant issues still occur (e.g. 4kV breakers), and rework is still an issue (e.g. instrument air compressor). Engineering's ability to improve and maintain equipment material condition continues to improve. Howeve,r, a number of improvement reconnendations still exist with regard to material condition. Major material condition improvement actions continued with planned D3R14 activities similar to the last U-2 refuel outage. Indicators such as operator werk arounds, temporary alterations, and outstanding control room work requests continue trending downward or remain at a low level. The licensee's material condition improvement project review of 27 systems identified 496 specific recommendations that were subsequently incorporated into the 3 year system plans. Engineering continues to identify and iesolve older design and process deficiencies (e.g. CRD line check valves). ,. Engineering management appeared focused on improving plant system engineer involvement and accountability in system outage work selection and implementation. Material condition problems continue to impact plant performance with a trip (1 auto, 1 manual) on each unit due to feedwater deficiencies, and long extensions of forced outages to a'd dress other material condition problems. Some problems were previously known but impacted the licensee prior to implementation of scheduled fixes. 2

7 Dresden Fundamenta' Issues 6/96 - 8/96 Attachment 1 Pre-Decisional U-2 RPS 'B' bus lost due to EPA breaker trip. (5/96) ' U-3 trip signal due to trip of RPS MG trip. Thermal overloads and high ambient temperature. 5/96) 4Kv breakers - 3A LPCI pump (breaker not open from control room on first attempt. (6/96) STATION ENGINEERING SUPPORT AW DESIGN C01fTROL Strong engineering management efforts over the past couple of years have improved the technical qualification and knowledge of the engineering staff. The ability to produce many good technical work products hts been demonstrated, increased engineering focus has had a continuing positive impact on plant material condition. However, substantial variability still exists in the quality of engineering work and a considerable amount of work remains to ensure qua'3ty plant performance. In teased emphasis on UFSAR continues with UFSAR and plant changes made when required. WORX PLANNING, SCHEDULING, AND EXECtTTION Problems continue in the area of work planning as work packages are still found lacking in meeting all requirements for the timely initiation of work. Scheduling and execution of the schedule remain a challenge for station personnel, particularly in the recognition of the impact of expanding scope. Personnel, including management, appear reluctant to discuss not meeting the schedule until the fact becomes self-evident.

         .The work control process was effective in reducing the backlog of non-outage corrective and planned maintenance work requests. However, preventive
       , maintenance task rescheduling and weaknesses in the vender re-contact program                      ,

appeared to have contributed to 4kV breaker failures. SELF ASSESSMENT / CORRECTIVE ACTION During this(SQV) Verification periodgroup a significant has been increase noted. in the activity of the Site Quality This has been evident by an increase in thepersonnel. SQV number and quality of Performance Improvement Forms (PIFs) initiated by Site Quality Verification personnel were routinely seen in the plant and at most staff meetings where issues regarding day-to-day operations, maintenance, and engineering of the facility were discussed. The licensee continues to improve its problem identification abilities. However, corrective action implementation and effectiveness continues to be a problem. A significant number of Plant Improvement Forms (PIF) continue to be generated. 3

Dresden Fundamental Issues Attachment 1 6/96 - 8/96 Pre-Decisional New engineering self assessment actions are proving capable of accurately identifying problem areas (e.g. performanc.e colored windows . program view on calculations, departmental self assessments such as IST and 5D.59, and overdue preventive maintenance or surveillance problem). The licensee's Corrective Action Review Board (CARB) was observed to be very critical, rejecting many PIF investigations, mostly for root cause deficiencies. However this aggressive approach has not transitioned uniformly to the lower,line organization (note: the licensee's SQV group recently identified problems arith CARB's ability when certain participants were absent). The licensee was evaluating possible improvement actions for root cause analysis. Due to previous corrective action implementation deficiencies, the licensee was routinely performing effectiveness reviews to ensure the quality of corrective actions. Many of these reviews continued to identify ineffective corrective actions. S 4

PLANT ISSUES LIST 174-M .- Dresden DATE ID BY SALP DESCRIPTIOfC CAUSE REF 9/10/96 Self-Revealed Mehmenena U-3 Oroup I isoladon Due to Falling Object Bumping Main Seena Line Personnel ENS Call 00989);IR Flow Instnument. Widle hoisting equipment through an open Door plug A.L.  :-- 96013 OPEN in the reactor building (in one of the LPCI/ Core Spray corner reorms) s Deficiency stanchion, that was support a safety barrier rope, fell through the opening. The stanchien strudt the high steam flow instrument lines and e Orcup I Isolation occured. All valves operated as designed. 9/9/96 Self-Revealed Maintenance U-2 Control Rod J-13 Fully Scramed During Surveillanz Testing. U-2 Equipement ENS Call 00984) OPEN was at about 84 percent power during main steam line radiation nasaher MalAmetion 1/2 scram Asnctional testing. %1 mile testing RPS channel A, control rod J-13 Adly laserted into the core hem position 48. Power dropped to shout 81 percent. ne laa --=> meed that no thermal limits were , e=wwbut Scram solenoid pilot valves replaced and rod tested satisfactorily. Small amount (9 grasns) of foreign neaterial found in diaphram. Licensee considers this an isolated event., 9n/96 Self-Revealed Maintenance Thee Delay Relays Apr U-31444 IAvel ATWS Signal Failed to Trip Equipment ENS Call (30978)OPEN within Required TS Tolerance. Three of four time delay relop fidled MalAmetion the surveillsace. De relaye were replaced. The licensee concluded that U-2 was not subject to the same failure. U-2 relays lessed about I year ago. During the treuue shoodng, aner the time delay seapoint was adjemed, the relays wadd not -:_

• 4, trip wkhin the requhed tolerance. ne root cause investigsten was continuing.

9/3/96 "******"* " " * * " * " INPO Onshe for Two Weelt Plant Evaluation. "********* INPO 8/U D6 *****"*"* *"**"**** U-2 STARTUP. Minor prabisms during startup included two control " " " " "

• IR 96009 rods declared leperablee due to sticking (i.e. required high drive presure to move), HPCI peep discharge teniperahme high due to check valve ,

leakage (repeat problem), and turbine trip dering EllC oil trip test due - tofailed Asse. 8/27/96 Licensee Engineering U-3 Corner Room Support Steel Anchor Bolts Missing Since Original Other/NA IR 96009; OPEN C.wo.ci, Anchor bolts not installed on main supprot beams in each of the rooms as designed. A bolt tend was " tack welded" to the

• corner angel." Purpose of bolts was to restrain lateral movement.

Licensee repairing the connections. Pageret1s

PLANTISSUES LIST 17-Sere - i Dresden DATE ID BY SAI P DESCRIPTION cat!SE REF 8/23/96 Self. Revealed Maintenance Unexpected Opening ofTwo LPCI Mininen Flow Vavies While FilHag Inadequate ENS Call 00916) 3 A HX. Root esuse was failed check valve in keepfill system. Valves FiC 1nstr were reopened within 3 to 5 minutes. acuan 8/19/96 Licensee F=-i=aing Accident Analysis fer RWCU HELB Outside Containment. The Enineering/Desi IR 96009;OPEN concern is that Part 100 dose limits may be exceeded during worm case gn Deficrency conditions (i.e.1-131 dose euguivalent at maximum TS limit). Dresden

                                         ,          and Quad Cities do Not have setomatic isolation of RWCU on room
                                                    - ..r._.

a or flow, only low reactor vessel level and high drywell pressure. Licensee's compensatory actions incinded developing adednistrative procedures to manually isolate RWCU iflocal area tersperatures e=== tad ISO deg. F within 10 minutes. 8/9/96 Self-Revealed Maindeamar* 120 Vac Electrical Shock During Maintenance on Bus 23. Maintenance Personnel IR 96009;OPEN personnel not wearing proper protective safety equipment. Cause was Te ',. .._2

                                             ,     expectations not clearly underwood to verify that terminals were de-     Deficiency energized prior to cleaning and meineenance activities and to wear P'*Per safety equipment. Tagout was correct.

8/8/96 L!censee Melatenance Foreign Material Discovered in 2A SDC Isop. During inspection of 2A E;*, _./ IR 96009;OPEN EDC pump discharge check valve, licensee determined that several Malflanction pieces of the valve were missing. Also iderdfied debris in piping near the valve. Lir-a* perforneing a loose parts analysis for U-2 operation. U-2 recirculation systern is not in senice. On 8/20, licensee identified hinge pin and lock washer missing from 2B SDC pump discharge check valve. 8/8/96 Licensee Engineering Through-Wall teak en Inlet Nozzle of U-3 A-RWCU leop, B-NRHX. Equipment IR 96009;OPEN Leak identified during asbestos removal project of U-3 RWCU system. MalAnneuen Licensee later identified indications on U-3 B-RWCU Loop, B-NRHX, but no leak. Probisble cause is IGSCC. Licensee plans to perform weld overlay ASME Code repairs on leak. N, O 8 OO

PLANT ISSUES LIST 17496.- Dresden l DATE IDBY SALP DESCRIPTION CAUSE REF sn/96 NRC Operations Inadequate Admamaarrative Contrais in Licensed Operator inadequase IR 96009; NOV 7777 Requahfkation Prograre. Multspie w..yk. (5) ofSRO:being Proceduredaser removed hone requalincation prograse and later reinstated without NRC action notincation. Licennee required to anunend individual license if person was seniowed Rosa program. An exarnple would be for a rotation to INPO. NRC identined one exasaple and licensee reviewed reconis and identlSed seemindw. All SROs had remived appropeiste reResher training and congdeced re activation watches prior to performing floensed SRO duties. 8/6/96 Self-Revealed Engineering Containnicat Coollag Service Waeer (CCSW) Flow Through 3A 17CI 4 Deal IR 96009;OPEN Heat Enchange Not Achievo Required flow of 7000 spin with 2 CCSW gn I'- hi - pumps. ( USFAF Section 6.2.I.3.2) Actual was 6900 spen. Also, the 3A CCSW pump packleg overheated during test. U-2 and U-3B LPCI ,' HXs all grenser than 7000 GMP flow with 2 CCSW pumps. IJcensee cleaned tubes and a$ naled HX sutlet flow control valve. Flow test S/23 resulted in 6975 gysn. ENS cau retracted 8/28. Licensee decennined that since one train of LPCI was capable of 7000 gym flow (3B HX) and was operable when 3A train failed, U-3 was within design basis. NRC K,k ".; the evaluation. 7nI/96 """**"* Operations INPO letter to Comed CEO J. J. O'Connor pohted out long standing *

• f * * * *"" INPO Leher w Comed weaknesses in training e(mecirer work force. Training shortfalls at all CEO Usted v'l/M stations (except Byron) and were saast prevelant at Dresden.

7/25/96 Self-Revealed Maintenance Electrical Shock During Maintenance on Bus 34 (a 4KV safety bus). Personnel IR 96009: OPEN During inspection of Bus 34, syntesa g'.u.ing received minor Performance electrical shock due to not following electrical safety pida and Defkk..cf using proper safety equipernt, Tagout of bus was correct. Liansee stopped all onsite work due to concerns with personal safety. Page 3 of 23

PLANT ISSUES LIST 17 4 '8 - Dresden DATE ID BY SALP DESCRIPTION CAUSE REF 7/23/96 Self-Revealed Maintenance U-3 480 VAC Circuit Banker Failed to Remotely Close on First Equipment IR 96006/URI Attempt. Cause appeared to be stiff grense on roller latch bearing. MalAmrtion Several of this type of bersker (GE model AK-75) had been overkseled by OE when the *RM-9 trip circuit

• sodincation was perfonned. This breaker had not had the ===diarmelon. Identified when licensee was re-energiaeing Bus 33-1 (aner cubicle & br sker overhall). Iast pM was 1994. 'this issue is reassed to the 4kV becaker problems 7/23/96 Self-Revealed Maintenance Electrical h Without Proper Work Package or Equipment  !=adap=se IR 96009 Resehs in Small Fire. Electrkal meineenance personnel removing air Oversight condetsoning compresser hem service building roof wing torch. Not

                                                         % eve work package, compresser not depressurized, and no fire
                                                      . =' ; ' ' . smait oil are occured wkh n=nor injenes to personnet.

Work centret process failed and poor personnel performance. 7/23/96 Licensee Engineering Potential IAsk Path to Bypass Cash (post Aaident) and 8' ;'- ".-#Je LER 30-237/9502142 PotentialIncrumme in Part 100 Dese Rases. Licensee was re,. ' " ; signILhy - IN 90-73 and decennised a potential backleakage path front reactor recirculation seals Ilwough CRD system to HCUs. Prelinumery evelustion 8=dicusad that the Centret Roon Dose Limits. Part 30, App. A. General Design Crieere 19 may be esceeded. Licensee plans so - modify the precedures se isolate this potentiel fkyw path by reducing the tesponse nom 4 hears en 1.5 hours 7/23/96 Licensee Maineennoce Degraded Security Barrier temi U 2 Hester Boy F. AW Ana) to Inadequate LER 50-237/SO3 Radweste Tank Ana (Vital Ane). Maineenance renoved the security Oversight henter se inspect the pipe tunnet between the two ar-as. work package , had see, to inform secuny prior so removing the barrier. Seemey was not infonned when benter was renewed. Appropriese compensaiory necesares were taken. ____m._____

                                                                                                              ~ . - - - .                                  .   .. . . . . . . . . . _ .

PLANT ISSUES LIST 17@'8.- Dresden CATE ID BY SALP DESCRIFFION CAUSE REF 7/20/96 1.icensee Operations U-2/3 EDO Olven Manuel Start Signal in Error During Special Test. , Personnel LER 50-237/96-012 During a special test of U-2/3 EDO, aperator inadvertandy moved the - Perfonnance control switch to the Start position via the Auto position as required by Denciency 1 the procedure. The EDO had been running unloaded in the cooldown cycle when the enor occused. The EDO remained unloaded and was seqsequently placed back la the coidown cycle. "There was w, apparent damage to the EDO or control circuit. 7/13/96 1.lcensee Operstions U-3 and U-2/3 EDGs Out of Service'st the Same Time. U-2/3 EDO was inadequese 1.ER 50-249/9H@. IR inoperable to bus 33-1 during; 4KV swhchgear maintenance (begining Oversight 96009 on 6/23/96). The U-3 EDO was taken out of service for 4 hours to perfonn routine montWy operabliky surveillance while U-2/3 EDO was still inoperable. TS 3.9.D requires that one EDO remain operable with the plant in cold shutdown. Cause was _ " Wed increase en 4 KV breaker work scope. 7/12/96 NRC Engineering SDC pump roose electrical penetrations exceeded the temperature theits F ' _ Q")egi at 96006/IsJ specinedin the UFSAR. gn Denciency 7/12/96 NRC Engineering Unit 2 and Unit 3 Reactor Building Ventilation does not meet the now EmineerhqDesi iR 96676/U86 regi.irements in the UFSAR. gn De%k-y 7/I2/96 NRC Plant Support Psychological evaluation of on-she contractor e...,1,,w and site hired Personnel rR OWS licensee -_ _ f s was not performed in actmedance with procedure- Perfonnancz NCV for failure to follow peacedure. Deik-i Plant Support I h failed to take monthly tritiumi samples on Unit i Main Personnel IR 96006/NOV 7/12/96 NRC Chimney and the Units 2/3 Main Chimney and Reactor Building Vent Performance Stack between July 1993 and May 1996. NOV for violating TS 4.8.A.2 C;".ekwy (Unit 1) and TS 4.8.1 (Units 2 and 3). Plant Support Weaknesses noted in HRSS surveillance i,.d..c regarding acceptance Inadequese IR 96006/IFI 7/12/96 NRC enteria and actions to be taken if a surveillance test fails. Procedure / instr action Operations Special Report Concerning inoperable Recombiners was issued. Other/NA IR 96006/IFl 7/12/96 Licensee vs s er n

PLANT ISSUES LIST 17478 - Dresden DATE ID BY SAIE DESCR1FTION CAUSE REF 7/1/96 Self-Reveakd Plant Support Internal Contandnation of 2 Contract Personnel Working I; Radwesse Inadequate IR 96009/NOV Stock Bay. Licensee was perfbnning cleanup of meterial in redwesee Oversight stock boy. During a " slow thne" the licensee decided to do some i additional cleanup in the aren. Personnel opened a couple of begs of meiertal that were not coveralby the originaljob RWP Not sure if the bags were pmperty marked as contaminseed material. Personnel not - use properRPcontrolsor _11::..g when opening begs 7/1/96 Licensee Operations Possible Operseer IJeense Exam C1, . _ l_ Licensee found copies of Other/NA RJ Observatson NRC exarn in training building copier. Exarn was under security . agreement and should have been ander lock and key. 01 and Rit! OLS condacting investagstion. 6/28/96 Self-Revealed Engineerlag taas of U-2 Annunicssors apr g sminutes due to a fealt on Line 1207. ",' r  ; IR 96006/IFI When power restored, " loss of annunicolor power" slarm for control - h4alflancdon beant 902-4 and 902-7 remained. Unit 2 was shutdown at the ihne. 6/21/96 Self-Revealed Operations l'-3 taal=*Aa= Condsaser Group Vlealstion Valves Automaticly Dosed Egedpment IR 96'06 LER 30-due to spurious signal. Root cause ankonwn. Isolation occured during MalAnnetion FWS6 re-aNgnment ofsyseem during normal U-3 sheedown. 6/2I/96 Licensee Operations Failure to Pertunn T8 SurveNinace en Nuclear Instruments During U-3 Personnel i.ER 50-7896640? Shutdown. Duringthepowerh the Unit Supervisor (US) Perfbnnenm inibnned Instnenest Maiseenance department of shuidown. The US DeSciency did not dhect the IM staff to prefona the surveillances that were requhed during a plant shutdown. Remnt SRM and IRM calibrations had been , / . - satisibceerflyon6/5/96. 6/20/96 Licensee Eng3=aaing U-3 SHUT DOWN. 'Ibe unit was shut down due to licensee's eencerns Conservative IR 96006 with retalbility of 4KV safety reisted breakers. Decision 6/12/96 ""*"*"* "*"****" U-3 Synchronized to the Orid. ********* ....u....... u..**.. l Page 6of 23

1 PLANT ISSUES LIST - . UNM : Dresden DATE ID BY SALP DESCRIPTION . CAUSE REF 6/lI/96 Self. Revealed Maintenance 3A LPCI Pump Breaker Not Open on First Attempt. Pony running ihr Ins e g amee IR 96006/LRI

                                                   .                 torus cooling. Breaker not open on Srst two anempts Rosa control            Procedure / Instr tooni. Trip solenoid had been energized. Opened on third steempt.                 mction Cause for the specine breaker Miure was the trip latch roller bearing was benans due to hensemed sresse. Generic cause was i+

snaineemance of4kVbreakers. 6/ItV96 ******** * *** * ***** * * * * * * * * **** DRESDEN UNIT 3 STARTUP , sn/96 t.seensee Plant support Licensee Wied to take aquhed servlee water grab sample widle the Personnel R 96006/NCV, I.ER 50-servlee weser session monitor was inoperable. per#br==-- 231/9600s i c=, . 5/3I/96 Self-Revealed Engineering U-2 Manuel Senus Durlag Feedwater Control Syseeni Testing. While Emineering/Desi IR 96006/NOV;1.ER 50- i modiftflag the logic on the new "Balley" Feedwter Control system (i.e. gnD#A i 237/96009 to make a change es a gain rearmention) the 2B FRV --a , J "i closed. Operators manually tripped reactor when vessel level dropped below predeteremined point. A violation for failure to follow precedures waslessed  : Sn8/96 **** ** U-2 STARTUP. ** Sn5/96 NRC Plant Support A contractor employee was authorized ====ted access to the thenity l@ R 96004/IFI based on previons ==== The laspector concluded that a Mi Procedure /Inser badground check was sequhed in acczedence with the security plan. uction

   $n5/96            Self-Revealed           Engineering          U-2 SHUTDOWN. De unit was shusdown to repair feedwater control                  Equipment                 IR 96006 system power supply. no amed power apply was identined during 3                Maubaction element level control testing.

Sn5/96 NRC Plant Suppen Security equipment maineenance Im* log appears excessive. WOntsight R 96004/IFI Sn5/96 NRC Plant Support Inadequese RP Reconis. The licensee Wied to keep adequase reconis Personnel IR 96004/NOV and information important to the safe and effective decommissioning of Performance the facility, y-E' ' l1 with regard to spills and the spread of DeSciency contaminmion in and around the facility. NOV for railure to follow 10 CFR 50.75(g). Page7of2y

PLANTISSUES LIST 17&E ' . Dresden DATE ID BY SAlf DESCRIPTION cat!$E REF f 5/25/96 NRC Plant Support Inadequate Radiological Surveys. Several items in the radienceive weste Personnel R 96004/NOV

                  ,                            tank ruous and ineequendy acessed high radiation areas in the              ,  Pertmnanz radiaardve weses building were not identined on the survey map br                DeSciency entry; therefore, no survey information was available for these. NOV for fhilure to perfbem surveys to identify radiological harents lacedme to workers.

5/21/96 NRC Operations lasse PRuous Material in U-3 Drywell. The inspectors identified lease Inadequese R 96004/NOV filwees i==daden la the U-3 drywell which had been instaned as a Oversight I temporary heat shield as early as 1986. Station procedures required followleg Reg Guide 1.33, Revision 2, Appendix A which r=r======da

                                                                                                      ~

the removal of all loose fitwees insulation Bosn the ilrywell. The i=-and== .a. mam.ed. Nov for ramme io fonow precmhaa. Self-Revealed Eachumring U 0 Rancour Sevent Signal Whlie Shutdown Due to Trip of 38 Rammer Egsdymest LER 50-249/96006 S/20/96 Protection System MG. A thennel overload in the 3B RPS MO *fve beaubaction meest had tripped susuking in the less of RPS Bus A, a lbli scrase, and the auto start of the A SBGr train widi the associated reactor bulleng isoladam The muse was detredned to be high ambient tesnperususe and less than epthnum design appucation of the thermal overload ses.-;,,,,, nesser. Unit 3 Diesel C- . Aute-Start Due To ElectriA Maintenemoe Personnel R 96004/NCV; LER 50-S/18/96 Self-Revealed Maintenance , Departsment Perm w. Electrkat snaineerace department Perfonnance 249/96005 contract personnel took ===d==hy sendings on the wrong terminal C Wy peines for Bus 34 sumin feed breaker. These contacts are cmanected to the DG asso-esert circuitry. The U-3 EDG ran successndly, and no

                                            %             - damage resuhed. NCV for failure to follow yearwsh=e.

38 Feedwater Regulating Valve Failure, Reactor Trip, and Emergency Equipment R 96008; LER 50-5/15/96 Self-Revealed Engineering CmeCoolingSyseesa Acsuasion. Reactorvesselleveltransient dueto Malfianction 249/96004 FRV vehe seem a---- . i_ HPCI:_,'_ ^'_ _ and Group I(MSIVs) isolation. Two op. I vehes - -

                                                                                         , ,,,.c.: due to failed relays

• when Gp. I signal was reset. Augmented I..vch Team was despeeched. NOV for inadequale conectsve actions for failed releys and .'

NCV for ;-4 A operating pecedures in R 96009. rene8of23

PLANT ISSUES LIST 17498.- Dresden DATE ID BY SAIE DESCRIPTION CAUSE REF S/6/96 Self-Revealed Maineenance 2B SFP Pump Tripped Due to IBgh De in Demin-Rher. Cause was C *, -.; RI Observation inlet AOV not opening when required. Concerns with SFP system MalAmetion were previous:y identined in as URI 30-237;249/ 95014 01 and closed in R 96002. S/1/96 Lkensee Operations U-3 Syseem Checidists. I i==== began a detailed review and Involved R 96004/NOV wagulown of U-3 syness checkhsts. 10 person team. Part of curreceive . ,. _ -; ar*an Ihnu NRCidentined probleses with U-2 checklists. NOV 30-237;249/96004-01 4/26/96 Self-Revealed Maineenance U-2 HPCIInsperable. HPCI was inoperstde doe to a leak in the sumin  !==d-r-sa LER S0-237/96-007 00 steam supply drain Ilme. The drain line goes to the main condenser. Oversight Cause ofleak viss Sow accelermed corrosion. Hissory ofleaks in this line (U-3 also) since 1980s. 4/22/96 Lkensee Malmeenance Falkne to Follow h Work Procedures A body 4o bonnet Personnel R 96004/NOV leak was repaired as a minor work hean on feedwater check valve 2-220- Perfonnancz 628. Minor work is peradtted only os components which do not Denciency

                                                                                     - the AMSE or ISt ynneure boundary and which how Ikde posential for personnel h(ury. This valve was under fhit reactor feed preware. NOv So-237:249/9s004 Ois was issued for failure to fosion Pretzdure.

4/20/96 **** ***** U-2 RESTART. **** **** 4/18/96 Self-Revealed Malmenance UNIT 2 SHUTDOWN. The unit was shutdown becewee ofinsidilty to Egulpsment LER 50-237/96002 meet aNowed LCO thne abrIFCI system testing. Unit 2 HPCI Malfanction discharge line woudd cool to less than ISO F as required by procedure due to leakage past the 2-2301-7 check valve. 4/17/96 Licensee Operations Impsper 2 ^- , ^ "_ : oft 3 ServeNiance Interva'. Licensee personnel Perssenel R96004/NCV

                                                                      , -,.Q appued a 25 percent " grace period" to a service weser          Perfonnance          -

grab semple ".,_y. The grab sample was reqerred as part of a T3 CJhy action statement foe an inoperable service water radiation monitor,

                                                           ^14 a NCV (30-237;249/9600444) was issued for violating TS 3.2.F.3.                                                                                               -

L-PLANTISSUES L ST 17-ser.96 , Dresden DATE ID BY SALP DESCRfrTION CAUSE REF l l 4/17/96 NRC Plant Support Chemical Agent Canisters (A Response Weapon) Inoperable. Sixty-six R_'; - - 2 IR 96004/NOV percent ofchermical agent canisters issued to the station security force Malfunction were inoperable. The security plan requires that all canisters be operable. Aviolation(NOV50-237;249/96004-10)wasissuedfor failure to follow the security plan. 4/15/96 *a* ***** *** U-2 RESTARTFROM D2 Rid. * * " i 1 4/10/96 Self-Revealed Plant Support Isw level Intake During Maintenance. One radiation worker recehed Personnel IR 96004/NOV l a low level intake af radioactive material during U-2 drywell basement Perfonnance cleaning. The root cause was determined to be poor radiation preeection  !=i.q technician coverage. A violation (NOV 50-237;249/96004 08A) was . Issued for falhare to perforrn surveys to determine the rasbological hazards incident so workers. 4/10/96 Self-Revealed Maintenance APRM Circuit Cent Malate ===re Licensee canabilized resistors that I- '_,_ _ IR 96004 were thought to be spares to replace failed resisitors on the same APRM Procedure 4nstr  ! card. The resisters were in feet in ese and the result was in a larger action than expected APRM gain change. The root cause was determined to be a publem with the vendae drawing which ha. been i.wp . 'into the surveitlance procedure. This item was considered an addstional example of electrical drawing deficiencies (URI $0-237;249/95015-07). 4/4/96 Licensee Operations U-2 Recirculation Imops Cross-Tie Valve. The 2 inch valve in the f "a __2. IR 96004/NOV equalizing piping was found about 10% open during checklist review in Procedure 4nstr response to NRC Anding. License requires that valve is shut. Unit 2 oction was not in cr ration at the thne; however, had the licensee not re-performed the system MHat a license violation could have occurred. This was one of the findings that led to a NOV for inadequate Corrective Actions for deficiencies in system checklists. (50-237;249/96004-01) 3/31/96 Licensee Plant Support Radweste Supervisor Tested Positive for Alcohol During "for-cause" Personnel ENS CAllC021I) FTD testing. Individual was denied unescorted site access pending Perfonnance review. Deficiency Pare 10 c/' 23 '

O PLANT ISSUES LIST 17496: Dresden I l DATE ID BY SALP . DESCRIPTION CAUSE REF 3/29/96 NRC Plant Sepport Eniergency Lighting. An inspector review of emergency light Personnel R96002/NOVand IFI suveillances perfornied since 1994 Indicated that the licensee faned to Perforinance follow promdere when performing the 8. hour discharge test. There DJAmy were 26 examples in 1994 and 21 examples in 1995. A NOV (50-237;249/96002 058) was issued for failure to follow procedure. Additional proldeins with the emergency lights were noted and wHl be tracked under IFI $0-137;249-96002-10. 3nt/96 NRC Plant Sepport PVC assee in the plant was not wen eritrolled. Specincany, no 10 Inad-p==se IR 96002/URI CFR 50.59 evolustion was done to addre:s the increased PVC leading in Procedure / Instr the Fire Hazards Analysis. Resolutio of this issue will be tracked action ander URI $0-237;249/9600249.

• 3/29/96 Liansee Engineering Numerous licenseeddentined UFSAR discrepencies remain to be PAneeringfDest R 96002/URI resolved. These Iteens were discovered through the licensee's 1993 gnDJimmy UFSAR rebasehning effort. URI $0-237;249/9600248 will tredt these issues.

3/29/96 MC Engineering UnthnelyResoultionofOperabilityEvahnstions. Noengineering

                                                                                                                                                                 -:4 Jesi    R 96002/URI proposal has been submined to duee in onier to resolve the ledt of the       gnCrawmj

• omeomstic purge snode fbr control roosn ventilation as described in the UFSAR. URI 237;249/96002 07 was issued to track this deviation.

3/29/96 NRC Enghieering UPSAR Deviada== Deviations were neced for locked closed "' * - -:4" Jest R 96002/URI namada== e a==l=da= valves, diesel Aset oil tank overflow, ACAD gn CCA ci system, toxic gas analyser, and HPCI daaresed sectan The resolution of these deviations will be tracted under URI 30-237;249/96002 11. 3/29/96 NRC Maintenance Skill of the eraA h has resehed in numerous examples of Personnet R 96002 slowed work completion and potential for personnel injury. Assessment Perfonnena of skill of the creA will be ongoing. CJAmy 3/29/96 Self-Revealed Maineenanz l - - _" . - Corrective Action on 4kVBreakers. Numerous linkage Personnet IR 96002/NOV

                                                           -                problems in 4kV breakers and poor root cause analyses have been               Perfonnance reported dating back to 1989. A NOV (30-237;249/96002 06A) was                  DJAmy issued for failure to take prompt corrective actions.

Page Iiof 25

PREDECISIONAL DRESDEN . Administrative Control Problems

                                                                                 - Poor Work Control
                                                                                 - Technical Specification implementation Problems Personnel Performance Problems Ineffective Corrective Actions O

R l

PREDECISIONAL DRESDEN 2 PI EVENTS FOR 95-3 NONE PI EVENTS FOR 95-4 SSF 10/20/95 LERs 23795019 50.728: ruas hRt R131: CONDITION EXIETED IN ALL MODES UP TO WE POWP SINCE 1983 an0UP : htACTOR TRIP INSTRtRENTAfl0N SYSTEM PLANT PROTECTION sfSTEM t' ESC  : TN! CONTROL RCD DRlW SCRAM DISCNARGE WLtRE'S RPS CONTROL LOGIC DID WOT SAflSFY SINGLE FAILURE CRITERIA. Tutt COULD RESULT IN A NALF SCRAM WNtu A FULL SCRAM ll Rt0VIRED. A Di$10N ERROR WAS INTRODUCED IN A 1983 MODIFICAfl0N. PI EVENTS FOR 95'-1 SSF 02/19/M LERs 23796003 50.728: 30001 PWR HIST: CONDITION EXISIED FOR AN l etTERMINAft PERIOD OF TIME GROUP- 3 CONTROL ROON teERGENCY WWitLAil0N SYEf tM GROUP SYSTEM CONTROL bulLDING/CONTR0t COMPLEX ElfVIRONMENTAL CONTROL SYSTEM OTN UNIT: TNIS EVthi WAS AS$1GNIO To UNITS 2 AND 3. DESC  : THE E8ERGINCY FILTRAfl0N FUNCTION OF TME CONTROL ROOM VENTILAfl0N SYSTEM WOULD MAVE BEEN ( INOPERABLE DURING A LOOP. A DESIGN OVittlGMT WITN A TOMIC GA5 ANALT2ER RELAY WOULD PREVENT s CPERAflou 0F THE CMARC04 AD50RBit FILTER TRAIN BOOSTER FANS. PI EVENTS FOR 95-2 SSF 04/26/M Lets 23796007 50.72e: 30376 PWR M131 EVENT OCCURRED DURING OPERATION AT 24% POWER GDOUP  : IMERGENCY rott COOLING STSTEM3 GROUP OfSTEM : NIGN PRil5Utt COOLANT INJECTION SYSTEM Disc  : MPCI WAS DECLARED IMOPERASLE AND TAKEN QUT OF SERVICE TO REPAIR A THROUGH WALL es0LE IN T INLET DRAIN LINE POT TO TM! CONDtustR. THE LINE CONSTITUTis PART OF TNE NPCI liSitM PREssuat BOUNDARY. TME Wott DtVILOPED FRCM FLOW ACCILERAftD Cf1mRD$10N. e

_ - - - - - - - - - - - - - - - - - - - - ~ ~ ~-'~ PREDECISIONAt. L*9*M DRESDEN 2 5""'" Refuehng

                                                                                                                                                                                                                             *" ""'"  " I                                '"*'               '

R operatJon glllllllll

                                       "                                                                                                                                                                             Industry Avg Trend                                   Shutdown m I

Ops. hot Showft using Op. Cycle RER2g Ops. ~ _ . . I n 1 I I I R E t>3 ' E I ki' be.2 Et' Es to t' Year . Quarter B3 3 kt' ks ht' E3 Et; 3 Year. Quarter 4, _ Automatic Scrams Whte Critical ,_, Safety 3yotem Acoussions 3 3-g2 , 4 2-1- 1. O b3 ht- k3 61' E7 W ' 33 3 Yeer . Quarter kt' b4 3 W1' E3 Et; ' Year . Quarter 2D 86gnlGcant Events

                                                                                                                                                                                                                         ,_                  Safety System Failures 13 .

3-W

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N sk M%, g 0.0 ' 83 3 41 M3 41 h3 41 0 h Year. Quarter 93-3 kt k3 95 1 95 3 51 Year . Quarter Forced Outage Rate (%) Equipment Forced Outagest 100

g. 1000 CommercialCrtucal Hours 7 _

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PREDECDONAL DRESDEN 2 L no s=.s. i s.., <,c.nc. wien iissiin Peer Grup Gereral Electic Pre TM1 "* '"" tow n i 93 3 to 96 2 Trends and Devutons Devutens From Plant Peer Group Seg-Trond Moden Short Term Long Term OPE *ATIONS (includino startup) l Automatic Screms While Crttical - NA 0.67 Safety System Actuations NA -

                                                                                                                                                                           -0.60 Significant Events -                     NA            -

0 l Safety System Failures - NA -

                                                                                                                                                                           -0.90 Cause Codes (All LLru)

J s Am muses co-w p eme - m -M 1J2 k uommes operamt emre - E -M .1JD0 e emer eweeman am - m -M 4.t

e. eenmannesse prememme - t4A -M 1.87

                                                                        .te =                   -
                                                                                                         ._             es   -

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v. -- - -

m - 0 SHUTDOWN Safety System Actuations - o - o Significant Events - o - o

                                                                                                                                                                        !-                 l Safety System Failures "                          ; 0.30 l                { 0.24             l l

Cause Codes (All LERs) l l l e as==ueveen c==w pree . - -

                                                                                                                                           ]020           -        0.54 e usenese coereur amre -                ] 0.23         -

C 09 [. t caer pernemme amre -

                                                                                                                                           ] 0.23         -

O e-  : Prowsme - E 0.19 - +": - 0 45 er .- _ - prue==. - 0 - 0 as 0 I 0 FORCED OUTAGES - Forced Outage Rate * - NA -

                                                                                                                                                                            -075 Equipment Forced Outages /

• 1000 Commer-'al Critical Hours ] l l  !

10 05 00 05 10 10 05 00 05 10 perfermance Inder performance tndes

• test Caeresened ter Operemonai Cytm

DRESDEN Trends & Deviations 2' -c==- l

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Shaded Ragions: Inadoquate phase time in last 2 quarters to update calculations i i l l

DRESDEN 2 PREDECISIONAL ACCIDENT SEQUENCE PRECURSOR DATA (* 1905 A801998 DATA PREUteINARY *) EW NT DATE: 12/13/E5 CDet  : 3.2E 6 MSC WORKIts DAMAst tallf 2 M 2/3 CABLE. U2 M 3 FAILS TEST (eE4alNG/9ENT EWrf DATE: 08/16/85 CDet 4.0E 5 M SC ALL RAT ON 1 PtWER SOURCE. U18 U2, St.T FAIL. U2 LOOP. IC VLV FAIL OUTAGE DATA EQUIPMENT FORCED STAaf DATE: 084/31/96 0UTAGE West 2180.0 (90.8 Days) MSC UNIT 2 WAS MANUALLY SCRAmED IN ACCORDANCE WITN TNE SPECIAL TEST PROCEDURE WNEN AN UNEEPECTED REACTOR VESSEL LEWL TRANSIENT OCCUReD DURING FEEDWATER LEVEL CONTROL SYSTEN TESTING. EQUIPMENT FORCED STAAT DATE: 05/25/96 0UTAGE Net: 100.6 (4.2 Days) MSC TAKEN OFF LIE To REPLACE AN ELECTalCAL FED TO TNE FEEDWATER REOULATING VALVES AND UPGRADE TNE FEEDWATER Couttot SYSTEM LOGIC. SCHEDULED STAAT DATE: 06/04/95 s CUTAGE M45: 7831.0 (326.3 Days) D DESC REFUELIhG CUTAGE. EVENTS AEOD CONSIDERS IMPORTANT EVENT DATE: 10/ ' "$ DESC 4 LER 95 019 01: DN 951020, scaAN DISCNAaGE VOL MCLAaED shoptRAstE. CAUSED BT INADEQUATE MSIGN REVIEW PROCESS. SENIOR STAfl0N MGT NOTIFID OF INC00AECT LOGIC. EVENT DATE: 10/20/95 DESC LER 95 019 00: ON 951020. CONTa0L RCD Mlvt ScaAN DisCNAaGE VOL aPS CONTROL LOGit FAl'.ED TO MEET SINGtt FAILURE CalTEtlA DUE TO MSIGN MFICithCY. N0f tflO SEN10e STAfl0N NGT OF INCORRECT LOGlc. W/951116 Lit.

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DRESDEN 2 PREDECISIONAL PREDECISIONAL PI EVENTS NOT INCLUDED IN THE 96-2 REPORT SEF 10/0s/96 Leks 50.72e: 31109 ' M tl5T : Ctuelflou DitTD FOR M leDETE85tlaATE PEllOD OF TIM GRCLP 00NTA0L totW EsERGEuCT VEWTILATion STITEM 90UP STITEM 00rTROL gulLDluG/ttwitol toePLEI EWyltoisEWTAL CIlWTROL SYSTEM 8PTN UNIT Tul8 EVENT m3 ASSIGNED TO WITS 2 AND 3. MSC TEE C0KTacL totes COULD 301 M Petssual2D TO THE REeults PREtsunt WITN RESPECT TO ALL . MJCET AREAS. TME LICENSEE 15 INVE5flGAfluG POTENTIAL LEAKAGE PATNS. SSF 0F/N/96 tEtt 50.728: 31061 M NIST : EVENT DISCDVERD DLRlhG OPERAflou AT 1001 POWR MCRJP DERGENCY Coke C00LluG SYSTEMS att1P 8YSTEM  : NIGN PRESSURE C00LMT luJECTION SYSTEM MSC  : NPCI ms McLAAED luoPERAsLE WEs TIE NPCI Ptar DiscuARGE TEsrERATURE EX2EDCD 150 f. Tut LICENSEE IS IWWESTIGAfluG Tut CAUSE OF TNIS IWCREASE. SSF 07/z3/96 Leas 23795021 50.728: 307s0 M N!si Coelflou EXISTD IN ALL MCDES UP TO 1001 PWER tlNCE 1974 ERCUP  : CouTAllSENT AND CouTAlleENT 190LAflou stoup SYSTEM REACTOR BUILDibG OTN UNIT : TNil EVENT W S AstlGutD 10 UulTS 2 AND 3. MBC  : A POTEuTI AL SEconDART CouTAIIstui STPA$$ PATuwt RdSULTING FRGt NCDIFICAfl0NS PERFORMED lu 1974 COULD NAVE CAUSED TME COWit0L Recu 00sE RATE TO EXCEFD GDC+19 LIMITS. M IEADEGuATE SAFETT EVALUAflou FOR THE 1974 PLANT MODIFICAf tow CAUSED TNIS EVENT. MANUAL SCRAMS SCRAM 05/31/96 LEus 23796009 50.72s: 30569 M NIST P wet QPERAflows A1 451 MsC Tut am ms mmuiLT sCtaastED wEu A FEEDw!ER REGutAT!ws VALVE SNuf DURIuG MAluTEhANCE ON THE RX FEEDWATER LEVEL CONTROL SYSTEN. TN15 WAS Titt RESULT OF A LOGIC EXECUTION SEQUENCE EtROR, WICm WS A DESIGu CMARACTEt!5 TIC OF THE 51$1EM. ACCIDENT SEQUENCE PRECURSOR DATA (* 1995 AND itse DATA PRELledlMAMY *) EVENT DATE: 06/04/94 CDPR 3.1E 6 MSC LONG TERM UNAVAILAstLITY OF NIGN PRESSURE COOLANT ImJECTion EVENT DATE: 06/06/94 CDPR 6.1E 6 MSE, a te0 TOR coutt0L CEuTER TRIPS DUE 70 luptopf t BREACER $ETTihG$ EVEuf DATE: 06/02/90 CDPR  : 2.6E 4 DESC StuCE OPEu SAFETv RELitt waLvt fosLowto av sCtau EVENT DATE: 01/16/90 CDPR  : 3.1E 6 DESC REACTOR SCRAM FOLLCWED 8, LDS5 07 of f 51TE POWEt

DRESDEN'2 PREDECISIONAL DEVIATION ANALYSIS REPORT USTED BELOW ARE EXPLANATIONS FOR THE NEGATWE BLACK DEYLATION BARS IN THE 96't Pi REPdRT: BSFS TE SSF NVIAflon POR OpteAflen4L PttlWS RESWLTB F90M 13 EvtuTS DISTtiguTW Pe0M 10/93 19 4/96. ALL EUT GE twaf OCamagD e a stPant 1/7/95. Tuts PLAlff us GEmuTLY sitJTDche FOR 10 MouTuS (6/95*4/96). AAGUT SALF M TE EVENTS Wat ACTUAL FAILURES. W Tut 13 EvtuTS, IIGuf luv0LVED THE ultu PetBSURE COOLANT luJECTION SYSTEst. TW IVtuTS atEULTD Fates ELECTelCAL PEGBLtus leCLWluG CitWIT SatAEER TalP ETituts 100 Libi AND 9tERADO VOLTAE ELATS. PERR EVtuTS W at ALs0 38F8 FOR Det3 DEN 3. OF TE OTWA 22 PLANTS la TE Pett etnJP, peEsDEN 3 ms TE mLY PLAuf TO EMPEtituCE As Ithiff SSFS AS Sttelu 2. FOR Tut FOR etVIAfim aEsutt:D reise FIV OuTAaES TOTAllut 1e9 sATS o!$TaleUTED Pacu 4/96 70 4/96. TuE LouGEST GUTAE (119 SATS) EGAN In 8/94 AIID luv0LvtD PecBLE45 WITu A ulGu PRESSURE mu auf luJECT10m CNER VALVE. Tilt TWO 408T AEttui OUTAGES luv0LVED IPORADES T0 fut FEEDWTER CIluft0L SYSTEM. Tuls PLAuf EMPitituCED IIORE FOR2D ELITAE TIE TuAN Auf 0F fut OTuta 22 PLANTS la Tut PIER tuouP. CAUSE CODES ADMIN Tut AnalutSTRAfivt CAust Cet stVIAf tsur POR tyttATIONAL Pfaltos etsutTED Felsi 24 EvuuTS DISTR 10UTED FNtul 9/93 TO 5/95. Outf FIVE OF fut EvtuTS IP N teed lu 1995. Tutt PLAuf WS RECENTLY SuuTDthas FOR 10 uouTuS (6/95 4/96). Tut 24 34mTS luCLWED ulut TEcleulCAL SPECIFICATION VIOLAT!ous EIGui EuGlalEERED SAFETT FEATnst ACTUAficus, Ptna CoelTlous GUTSIM DESIGu Basis, Ase TieREE FAILlatt OF SAFETT EeulpeEuf. THE EVENTS WRE DIVERSE lu MATURE, WITu TIE EXMPfim THAT THREE luv0LVED IMERGEuCT DitSEL EutRATOR AUTD STARTS. Tutt PLAuf EuPERIEuCED NORE Apollu1STRAflWE CAUSE CtDE tytufs fuAN Auf M Tilt Ofuta 22 PLANTS la fut PEER SatnJP. UCOP fut LICEuSED GPERATOR ERACR CAUSE CDDE DEVIAflou FOR OPERATIONAL PERIODS RESULTED FRm FIVE EVENTS D!$ftt00TD Fem 9/93 TO 2/95, onLT TWD OF wicu OCCunatD lu 1995. Tull PLAuf MS RECEuTLY SuuTDOW FOR 10 IsouTuS (6/95 4/96). TuttE tWtuts W RE TECseulCAL SPECIFICATI0m VIOLATIONS. TWO EVENTS INVOLVED ENERGEuCT DItstL flutRATOR$1 Out luCPERASILITY Asc cett AUTO START. Tu!S PLAuf tuPERIEuCED Iu3RE LICENSED OpttATOR Ett0R CAUSE CEDE EvtuTS Tuas Auf 0F fut OTieER 22 F'LANTS la Teet PEER GROUP. OTHPER Tut OTutt PER$ouett Ene0R CAUSE CODE DEVI Aflou FOR f.MRAflouAL Pit 1005 RESULTED teou EIGuf EVtuTS DISTRituTED FRom 9/93 TO 5/95. Out? TWO OF Test EVEuTS OCCuRaED la 1995. Tuts PLauf WAS RfCENTLT SuuTDow FOR 10 uouTuS (6/95 4/96). TutEt EVENTS WEtt TECuulCAL SPECIFICATION V10LAfl0sts. TeenEE WRE ENCIIstttED SAFETT FEAftat ACTuAflous Aac TWO Wrat FAILystES OF SAFETT Eeulpestui. Tull PLAuf EuPttituttD NORE LittustD OPit4 TOR tee 0R CAUSE CCDE EVENTS TuAu Auf 0F Tut Ofuta 22 PLANTS la fut PEER Gacup. MAINTEN fut etAluTEuANG CAUSE CODE HVIAflou FOR OPitAfl0 MAL Pitl0DS Rt9ULit0 Fem 35 EvtuTS DISTRitUTED FRID 10/93 10 5/95. TEu 0F TIE EVENTS OCCURRED lu 1995. Tutt PLAuf WAS RECENTLY SuuTDOW FOR 10 secuff ul (6/95 4/96). Tut EvtuTS WRE APPe0KlenAf tLT EVtuLf DISTRIBUTED ETEEN FAILURES OF SAFETT EeUIPeEuf, TECloulCAL SPECIFICATI0m VIOLAflous, fuClutERED SAFETT PEATUR8 ACTUAflout, Ade teelTICuS GUTSIM IKSteu 84515. TEN OF f ut tvtuTS Iuv0Lvt0 fat ulGu Petssunt COOLANT luJECTicu SYSTEst Amo Fivt luv0LVED SERGENCY DIESEL liENERATORS. Tuls PLAuf EXPERIEuMD Nott IIAluTENANCE CAUSE CEDE EVtuTS TNAN Auf 0F fut Ofufa 22 PLAalTS IN Tut PEER attRJP. DESIGN fut DellGu CauSE Copt etvlAf tm FOR Opstafloual PER100$ assutTED Fem 19 EvtuTS DISTRIBUTED FRou S/9310 3/93. Tull PLAuf WAS RECENTLT SuuTDom FOR 10 se0NTuS (6/95 A/96). Tut EVENTS W8E AuPaculuATELT Evtulf DISTRituTED SETWEEu FAILURet OF SAFETT EeUIPMENT, Coselfl0NS OUTSIM MSIGu SASl5. TECaulCAL SPECIFICAf ton VIOLATIOut, AND ENGlutERED SAFETT FEAfunt ACiuATlout. Tut twENTS WERE DIVERSE AND UuttLATED. Tull PLAuf EXPERituCED NORE MSIGN CAust C1lDE EVENTS TNAu Auf 0F fut of tett 22 PLANTS In Tuf Pitt GROUP.

PREDECISIONAL PLANT: DRESDEN, Units 2 and 3, August 1996 AEOd CONCLUbONS: A review of information relating to plant operation since January 1996 revealed that the licensee is expe ioncing problems similar to those that have occurred over the last several years. These problems include control of plant activities, personnel enors, and implementation of the Technical Specifications (TS) requirements. The licensee response to most events was usually

• thorough, although a small number of events still received narrowty focused corrective actions; sdditionally, ineffective corrective actions from previous events caused some of the recent -

events. NRC inspechon reports for the current review period state that the licensee continues to hue problems with control of work practices and timely implementation of effective corrective actions. The improving performance trend noted in the last review report has not continued. PROBLEMS: Administrative Control Problems - The licensee still experienced problems caused by poor control of work activities, although the number of reported events decreased during recent months. Examples are: Unit 2 personnelinitiated a manual scram following a loss of feedwater control during testing. The system engineer testing the feedwater regulating valves (FRVs) made several logic changes to the controller, with concurrence from the instrumentation engineer and a licensed senior reactor operator. The engineer failed to document the changes as required by station procedure, and failed to obta,in approval prior to deviating from the test procedure. (LER 237/96-09) The Unit 3 EDG automatically started while electrical department personnel were restoring a bus to service, The electrician was directed to continue with the procedure even though the first line supervisor (FLS) notiSed the general supervisor that the procedure did not include a data sheet for Cubicle 1. The FLS a.ssumed that the contact arrangement for Cubicle 1 was the same as other cubicles, and directed the electrician to continue the work. When he performed continuity readings on the wrong terminals, the EDG automatically started. (LER 249/96-05) Numerous TS violations occurred due to weaknesses in implementing the TS surveillance requirements. This was most notable in the tracking and timely completion of nordroutine surveillance requirements. Examples are: The licensee failed to perform required TS surveillances during a plant shutdown. The licensed operator failed to clearly direct the instrumentation manager to perform two surveillances required while the plant was decreasing power. There was no operational procedure step to verify completion of the requirement. (LER 249/96-07) The licensee failed to correc*ly perform the required tritium analysis from June 1995 through 1996. The licensee collected the samples, but failed to perform the analysis within the required time period. No programmatic requirement existed to verify that the TS requirement had,been met. (LER 237/96-10)

PREDECISIONAL

• The licensee failed to obtain and process a grab sample of the Unit 3 service water effluent while the service water effluent gross activity radiation monitor was inoperable.

The normr! umple point was unavailable due to maintenance, preventing obtaining a representative sample from being taken. Less than a month later at Unit 2, the licensee fand to meet the same TS requirement; the technician forgot to otdain the sample within the required time, and there was no program verification of analysis completion. (LERs 249/96-03 and 237/9608) Personnel Performance Problems Personnel errors, both by licensed and non-licensed personnel, caused several events. - Examples are:

• A licensed operator inadvertently started the swing emergency diesel generator following a test. He tumed the control switch to "run* rather than " auto." (EN 30801)
• The EDG automaticalty started while electrical department personnel were restoring a bus to service. The electrician and the first line supervisor continued work after they recognized that the procedure did not cover the specific equipment they were testing.

(LER 249/96-05)

• A licensed operator inadvertently inserted a manual scram during scram instrumentation testing. He should have depressed the panel acknowledge pushbutton, but depressed the manual scram pushbutton. (LER 237/96-06)

Ineffective Corrective Actions ineffective or incomplete corrective actions from past events contributed to several recent events. Examples are:

• Unit 3 declared the high pressure coolant injection system inoperable due to a through-wallleak caused by flow-accelerated corrosion. Both units experienced severalleaks on this portion of piping in the past (20-30 for e.sch unit), but the licensee only recently considered modifying the system to upgrade the piping material. A similar event occurred at Unit 2 six weeks later. (LERs 249/96-02 and 237/96-07)
• A reactor scram and engineered safety features (E!'F) actuation occurred due to a reactor vessellevel transient caused by FRV stem separation. The licensee attributed the cause in part to ineffective corrective actions following a FRV stem separation in 1987. Additionally, the licensee placed the FRV in an abnormal operating condition without considering the ability of the valve to function. The NRC sent an Augmented inspection Team to the site to review the circumstances surrounding this event.

(LER 249/96-04, IR 249/96-008)

                               . A reactor protection system actuation occurred during shutdown when a power supply to the 3B RPS MG drive motor tripped. Corrective actions from a previous event failed to prevent this event. (LER 249/96-06) 2

DRESDEN 3 P1 EVENTS FOR 95-3 SSF 09/11/95 Leks 24995c16 50.72e: 29316 PWR HIST: EVENT OCCUttED DUtlNG STARTUP A161 P348 GROUP  : EMERGENCY COPE C00 LING ST5 flus GROUP ST5 FEM : NIGN PRESSURE COOLANT INJECTION SYSTEP NSC TWE sect STsTEM ms DECLARED INOPERARLt DURING BURVEILLANCf TElllNG WutN AN ExNAusf DRAIN PCT NIGN LEVEL ALARM WAS RECEIWD As ta3ULD NOT CLEAR. A ptALFUNCT104 07 TNE ALARM RELAf AND LEVEL SWITCM FOR TME TURIINE EINAUlf DRAIN PCT CAUSED fuls EVENT. SCRAM 09/28/95 LERf 24995h17 50.728: 29390 Put KIST: Posta OPERAflows AT 771 MSC A REACTot ScaAM OCCLR6D ON 4 GENERAfot TtlP FOLLOWING A LOS$ OF GENERAfot FIELD C1NtRENT. A RE5l$ TOR In TME VOLTAGE REalLAfot CIRCulf FAILED. PI EYFJrTS FOR 95-4 SSF 10/12/95 Leas 24995 cia 50.728: 29451 PWR HIST: EVENT CCCURRED DutlNG CPERAflok AT 20E POWER at0VP  : EMERGENCY Coal COOLING STITEMS StoVP SYSTEM : NIGN PRE $$Utt CX30LANT INJECTION SYSTEM DESC  : WPCI WAS DECLARED INOPERABLE DURING A MONThlf TEST WHEN # NPCI EENAUST DRAIN PCT MIGN LEVEL ALARM WAS RECEIVED A m WarLD NOT CLEAR. THE PROCEDUIt! SHOULD NAVE REOultED DRAINING THE EXMAUST DRAIN PCT Pal 0R TO TME TEST. PI EVENTS FOR 96-1 SSF 02/19/96 LEts 23796003 50.72*: 30001 PO NIST: CONDIT10N EXISTED FOR AN INDETERMINATE PEtl0D OF TIME GR3JP  : CONTt0L ROOM EMERGENCY VENTILATION SYSTEM GROUP SYSTEM : CONTROL SulLDING/ CONTROL CopFLEX ENYlRONoENTAL CONTROL SYSTEM OTW UNIT: TMil EVENT WAS Al$1GNED 10 UNITS 2 AND 3. DESC THE EMERGENCY FILTRAtl0N FUNCTION 08 TME CONTROL ROOM VENT 1LAfl0N SYSTEM WOULD MAVE BEEN RENDERED INOPERABLE DUtlNG A LOOP. A DE51GN OVEts!GNT WITN A T0XIC GAS ANALTZEt RELAT WOULD PREVENT OPERAflok 0F THE CNARCOAL AD50R8ER FILTED TRAIN 8005fEt FANS. SSF c3/05/96 Leks 24996002 So.72s: 30068 PWR MIST: EVENT OCCUttED DutlNG CPERATION AT 100% POWER GROUP  : EMERGENCY COPE COOLING 575fEMS GROUP SYSTEM t MICM PRESSUt! COOLANT INJECTION SYSTEM DESC TME MPCI TutBIN'. STEAM SUPPLT WA5 ISOLATED TO REPAIR A LEAtlNG DRAIN LlhE. A THROUCM WALL MOLE IN TNE INLET DRAIN POT LINE TO THE CONDEN$te WAS CAUSED If FLOW ACCELERATED Cott0510N. PI EVENTS FOR 96-2 SCRAM c5/15/96 Leas 24996004 50.72s: 30469 PWR nist: POWet DettAfl0Ns AT 83x DESC  : A ex SCRAM OCCuttED ON A LOW RX WATER LEVEL 80LLLhilhu A Lots of FEEDWATER. A FEEDWATER RICULATIM, VAL (E STEM SEPAAATED FROM ITS Disc DUE TO FAflGUE FAILutt. SSA c5/15/96 Leas 24996004 So.72sr 30469 PWe Hist Not sMsTDOWN FOLLOWINC A SCRAM DESC  : MPCI STARTED Am INJECTED ON A LOW RI MATER LEVEL CONDITION FOLLOWING A ECRAM. e

PREDEC lONAL Leperus 5^""'**"***"""g' DRESDEN 3 Re+veling R

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PREDECISIONAL DRESDEN 3 t 9.aa s====c.'s e aen == Poet Gw Generst Elecine Pre TMI M*dlum EC 933b962 Trends and Demons l'* ' Deviations From P6ent Peer Group SelfTrend Median Short Term Long Term onee,we ti,reves wwe esent OPERATIONS Automatic Scrame While Crftscal - o - 0.63 Safety System Actuations - 1.12 0.30 Significant Events - o - 0 Safety System Failures - 0.48 -

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DRESDEN 3 rREDECISIONAL ACCIDENT SEQUENCE PRECURSOR DATA (** 1De6 AND 19e6 CuTA Mll.kehAMV *") EVEtt Daft: 03/25/M

• CDM 1.M .$

MSC LatW Wiin WAVAll LPCI, Mt.AAMD up1:1 Am Cts.4 tytti DAf t 06/27/96 CD*P 2.7f.5 Mtc  : la its1, WCI, LPCt I, LPCI mig. Flew VALyt 414 2/3 FAIL. OUTAGE DATA EQUIPMENT FORCED statt Daft: 06/21/M CUTAM MS: IF25.0 (F1.9 Den ) Hlt 1AKKu Off SflitM 10 Rifuttism Att SAf tTT MLATED 6tY MEArtkl. . EQUIPMENT FORCED stat! DAtt 05/15/M MAGl MS: 665.0 (27.7 Den) MSC wit SCsweerD wiu Int site Of 34 fttoWitt MapLAtlN VALyt ExPttitmC#D A f ATndut FAILutt WICR Q11 Off ittDWAftt TO TM D'. ACTOR. FORCED STAtf Daft: 10/29/95 EA11 AGE M S: 214 3 (8.9 Den) DESC L8hli SNUfDOWW NCAust of klCN Dif f tatuflAL Patssutt Acaoss Cl4CULAf tkG Witt ig((1 Scattu Dut 10 LARGE ACCLMAATION OF DEMll ou Statie. EQUIPMENT FORCED START DATI: 09/28/95 M AGE Net: 393.0 (16.4 Den) Dist U411 SCR A'etCD DVt 10 G(httAf 0R LOAD ttJECT. EQUIPMENT FORCED sfAtt Datt: 05/2s/95 001 AGE MS: 2796.0 (116.5 Den) DESC UN11 $CRAfstfD Wtu IUtilut DAMAGE CA05tD WIGN vlMA,f trui f tip AssD STCP VALVI CLOSUtt. EVENTS AE00 CONSIDERS IMPORTANT eCMe l

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antasp

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SSF 07/z3/w LEte 23795021 H.72e

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DISC

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lu 1974 COULD HAW CAustD fut CONTROL GOOM Dost RAf t TO EECit0 #C+19 LIMitt. AN l lueDteUATE SAFtif IVALUAfl0N FOR TIE 1974 PLANT testflCAflou CAustD full (WNT. i SE 06/20/w Lite H.72e: I Pwe alst : ConDillou trisitD rom An uurwown Pet 00 Of flMt DISC A LOW Pittsunt Cn0LAuf INJECTION PubeP SUPPLY patarte f AILED 10 OPit DW DEMAWD. Trt ' LIClustt MitaMittD flat CAust TO Bt Gt(A$t MAAD(kthG Ik E islP LATCH etECmANISM. 70J9 OTMit letArtt$ Wttt FOUW W11N $1MILAR GatAlt hatDtulWG. l

   .                                                                                      MANUAL SCRAMS i

i SC3 TAM 10/29/95 Late 24995019 M.72e: 29520 l Pwe alst : Pwth OPERAflous At 601 i MSC tnt atACTOR ml IUu) ALLY SCRAfeEED lt ANTICIPAflou Of A LOSS Of CitCULAtlWG Witt DUt 10 SLOCKAGE 15 THE f tAWLlalG Scattas Amo luf Art STRUCTutt. Tiet SLOCEAct WS rAlstD ST MMll, 51LT, Ae Am WuusuALLY LARGE AM0Laff 0F fl$M. 1 as

                                                                                                                \

DRESDEN 3 PREDECISIONAL DEVIATION ANALYSIS REPORT USTED BELOW ARE EXPLANAT)ONS FOR THE NEGATNE BLACK DEVIATidN BARS IN THE 96 2 Pi REPORT: , OOM TIE staM MYlAf t.lu NSULTED Pton flW BCaMB DltitlMS Pam 8/M 10 S/M. TWD OF fut StaMB tttuLip Palut Lal REActet WsetL LtytLt. 1918 PLANT 83rtaltuGD Nott Stams fuAu MT OF TE OTIES 22 PLAuf 8 la fut Ptit mouP. BSFS fiE est sev!Aflom ret CPERAflanAL PEttes atSAfD feet 13 EVEIrf 5 918TtlEUTED PRON 1/M 19 3/M. Amoul m4LF OF fut IVtufB War ACTUAL PAILL5ttl. EleNT EVENTS IWWLVED TE WlGN PettSLat 000uuri luJECTim STrftM As TW Evtsf 8 IINOLVED TIE ItoLAflu CBWEtatt. TuREE tvtu18 W tt AL90 SSFS Pat Det Stu 2. OF THE 0158 22 PLANTS lu TIE PEtt 50uP, MtBlu 2 WLS flE WLT PLANT TRAI EXPGtitWCW AS MANT $$FS A8 Delets 3. FOR fut eat MylAflow tratit0 resi FIVe aufAus TOTAtluG ice oafs. Tu mifacts Wtt DlBitituTED feet 1/9510 6/M. TE Lasust DufAat (117 Mfs) etGAm lu 5/95 wuts futelut HMAGE RESULTED lu A MACTOR SCRAft. fut WEKT LONGilf 1111Att (N Mf8) MGAN IN 5/M Wuts feet 38 FitDwaffe tigJLAflus VALVE trPetitNCED A FAfimE FAILLRt. OF fut Oftett 22 PLAuf 8 la TM Ptte enouP, MisMu 2 mt fut Duti PLANT TNAT EXPEtllectD Nott fotCfD OUTAGE 114 fWAN MtIMu 3. CAUSE CODES ADMIN f ut AouluistLAfivt CAust CxDe Myl Aflom past CP LAfl0NAL n tl e s Resutt a Penn is tvtuts DltitiguTED Facue 12/9310 2/M. fut rytuf t Wat APP 90rlanAf tLT tVtuLT DISTRl0VfD AM0mG f ttuulCAL StitlFICAfim VIOLAflout, FAILutt$ OF SAf tff 80UlpeEuf, tu'lluf tete SAf ttf FEATWat ACfuA11tur$. Ae Ctuelfloul GuillM Mllem RAll$. AT LEA $f FlW rWuf t luv0LYtD PeoCtautAL MFltituCits. OF TW Otuta 22 PLAuf t lu TW Mit autWP, DetIDeu 2 El felt Outf PLAuf fuAT EXMalthCED Matt ADelful518AflVE CAUSE CED EWuf t fuAt DettDtu 3. LICOP fu LICEusto OPatAfet Ete08 CAUS Cet MylAtleu Fat CPetAtionAL Petles ResutitD recut FIME EVtufl Ol31tlBUTED Feet 8/M 10 9/95. TWD OF EWufs wat tuGluttetD SAf ttf FEAfutt ACTUAfl0ml, out ut A TECuulCAL SPECIFICAtl0m V10LAfl0s, AND Out as A FAILutt 07 SAFETT EGUIPutui. OF feet 01ste 22 PLAuf t la feet Mit anGJP, DettDtu 2 WAS ist tutLT PLAuf f uAT EXPitituCED seott LICENSED OPitATOR Ete0R CAUSE CODE EVtuTS TuAN dst 3Deu 3. DESIGN fut Desica CAust Cmt DevlAflou Fce cateA110 mat neloos etsutfro Fami f6 tvtuts DIstaltutt0 FacM 12/9310 3/M. Attolf ML OF Test EVENTS Wat toelflows tW151De DESIGu SA515 OR f tCNulCAL SPtCIFICAlltu vl0LAflous, funf t (Ytuf t luv0LvtP fut ulGu Pettsvet SAFEff luJECflom STsitu. OF f ut Ofutt 22 PLAuf $ la fut Mit GaGuP. Det3Dtu 2 El f ut Outf PLAuf f uAT ERPitituCED nott M5tGu CAult CEDE EVtuTS f uAu Det3Deu 3. 2

4 4 QUAD CITIES l i

PRE DECISIONAL SEMIANNUAL PLANT PERFORMANCE ASSESSMENT QUAD CITIES NUCLEAR POWER STATION . Assessment Period: March 1996 to September 1996 SALP Period: July 23,1995 through October 26,1996 Previous SALP Rating: Ops 1 " Maint 1 Eng 1 PS 1

1. Performance Overview .

Operations performance during the recent period was similar to the previous period. Operator performance during the May 10 tornado ALERT was good; however. ( severalinappropriate interpretations of the Technical Specifications (TS) pointed to a continuing weainess in operator understanding of TS and licensing basis requirements. Major plant evolutions such as core reload and plant startups were conducted in a careful manner without algnificant operator performance problems. However, operator errors continued to occur during less focused activttles mainly due to lack of attention to detail and week communications. A few examples of operator knowledge deficiency and procedural problems were noted and occasionally contributed to human errors. Material condition problems still existed, but were better understood and managed by operations at the end of the period. Self assessment and root cause activities have generally improved. Performance in maintenance was adequate. Several complex maintenance activities were performed well, and appropriate reviews were conducted in response to breaker problems identified at another facility. However, significant weaknesses were identified in human performance, work quality, and job oversight. Additionally, lack of training, weak skill of the craft, and a poor questioning attitude resulted in increased equipment outage time, industrial safety incidents, and unnecessary rework. Several violations were issued for failure to follow procedures. The licensee has devoted resources to address these deficiencies.

       ,    Overall, engineering performance was adequate. Poor equipment material condition remains a key problem and continues to hinder plant performance. The licensee's identification of material condition problems has improved overall, partly due to a

'( lowered threshold for generating a problem identification form. However, due to a weak root cause analysis and corrective action process, addressing material condition issues has been slow and ineffective. Engineering evaluations and calculations continued to be weak. h

t Quad Cities PPR 3/96 9/96 Pre Decisional Radiation protection and chemistry performance was good, with continued ' improvement in ALARA planning, good plant water chemistry, and increased hydrogen injection availability. However, emergent engineering issues, a poor station work control and planning process, inconsistent contractor redworker performance, and catinued problems with maintenance of chemistry equipment impacted the improvement rate. Security performance was good, but declining, an the phychological testing and vehicle and package control programs were not well

• implemented. Emergency prepareoness was good, but some concerns were identified in the 1996 annual exercise and the May 10,1996, Alert activation.

However, these concems did not significantly impact licensee response, ll.- Functional Area Am==saments A. Operatioris

1. Current Performance

( Operations performance has remained constant with similar themes as the previous report period. No significant adverse trends developed.

2. Annaamment/le=Een Operator errors continued to occur as a result of inattention to detail, inadeq9 ate self check, and weak communications.

e During a retum to service of the Urdt 2 'D' condensate domineralizer, two operators were required to position 2 5599-4 valve to the closed position. Both operators believed they had retumed the valve to the required position during the retum to service, but the easily observed rising stem valve was left in the open position. The consequence during startup was minimal but could have been more serious due to starving condensate flow. (8/96) Three consecutwo shifts of operators failed to detect during operator rounds that the Standby Diesel Generator (58D0) output breaker to bus 131 was discharged, and therefore inoperable. (7/96) e A control room operator attempted to start a Residual Heat Removal (RHR) pump with the suction volve closed due to inadequate self check. The supervisor also did not verify the flow path. (6/96) Non-Licensed Operators (NL0s) removed the wrong Reactor Building closed 4 Cooling Water Heat Exchanger from service due to a lack of self check and weak communication. (4/96)

           ;      e Weak supervisory reviews of equipment operator logs resulted in a safety system (Control Room Emergency Ventilation) being inoperable for three shifts without the shift engineer's knowledge. The NLOs had idwified

___m___.-.---_------ - - - - -

i Quad Cities PPR 3/96 9/96 Pre Decisional during founds-that the CPJV retoperation condensing unit had low freon

• pressere The supnvisos,1 Serdor Reactor Operator, reviewed the rounds i

i sheet w} treat detecting the def.cient condition. (2/96) t i j Coordination of Out-of Servkas (005) continued to be a problem area but resulted in fewer sigrificant proWomt dunne the most recent outa9e (01R14) as compared i to the previous outage (Q2R13): - 1 J j *

• The station replaced the Unit 2 ottomate 125V battery with the Unit 1 alternate 125V battery as a result of damage to the battery while it was OOS for repair of the trickle charger. Operators did not know that falling to open i

the breaker between the battery trickle charger and the battery would result i in the battery losing ha charge. The Urdt 1 alternate 125V battery remained ODS through the end of the period. (8/96) l

• Poor preparation at d review of a change to an OOS rendered the shared SBDG inoperable for Unit 2. Condition existed for 3 days before being identified by operations. (4/96) i (

e Operators hung an OOS that unexpectedly caused a Group ll Primary j Containment isolation on Unit 1 (during Q1R14 Refuel Outage), inadequate self check and poor scheduling were identified as the causes. (3/96) i i Some recent examples of operator knowledge deficiencies showed a weakness in understanding some characteristics of complex system interactions: I i

• Operator response durlag Unit 1 Reactor Core isolation Cooling (RCIC)

! System Overspeed Trip testing was conservative but revealed that operators did not understand the imorlock between the steam inlet valve and barometric condenser drain valves. (9/96) ' Operators took appropriate action and manually scrammed the Unit 1 reactor in response to increasing reactor water level after the turbine bypass valves unexpectedly opened. However, an operator knowledge deficiency with

'                                                                      respect to the Electro-Hydraulic Control (EHC) System pressure set at low pressures contributed to the event in the first place. (8/96)

Inadequate and/or inaccurate procedures challenged operators and hindered work progress: !

• The operating crew identified that the interim procedure used for fail safe testing of the 1D MSlV was inadequate. (9/96)

( );

• Operators found the annunciator response procedure for RCIC Gland Seal Steam Condenser Hi Level was inadequate. (g/96) 4 3

Quad Cities PPR 3/96 9/96 Pre Decisional Operators incorrectly used a procedure field change'(PFC) to ' perform the - Control Rod Drive Scram Air Header Test. The original procedure called for the test to be performed with no fuelin the vessel. A PFC was issued to allow the tett to be performed with fuelin the vessel. The NRC identified that this changed the intent of the procedure without appropriate review, and was a violation of TS (4/96) Operations management displayed conservative decision making during startup activities whh the exception of orw example when the shift engineer inappropriately used Generic Letter (GL) 87 09 to interpret a TS requirement with concurrence from operations management and regulatory affairs staff. Operations control of risk significant work during on line maintenance was improved during 1/2 SRDG work. However, better efforts to I.arform the work during dual unit outages would have preventea the need for the dual unit 7 day LCO in the first place. (10/96) The licensee inappropriately invoked GL 87 09 to allow a 24 hour grace ( period to perform a missed reactor protection system surveillance rather than following the TS action statement. (9/96) The operating shift demonstrated conservative decision making by electing not to take the Safe Shutdown Makeup Pump out of service during Unit 1 startup since it increased both unit's risk factor. (9/96) e Operations management discontirwed the Unit 2 startup pending the evaluation of a breaker calibration test device. Electricians had identified a disparity between digital and analog readings on the device and were concemed that safety < elated breakers trip setpoints had been set non-conservatively. (8/96) Operations self assessment and root cause programs have improd. Some corrective action deficiencies were noted. e Monitoring and trending of Performance improvement Forms (PlFs), LERs and supervisor observations led to improved root cause evaluations. (10/96) e An uncontrolled, posted operator aid was identified in the control room after previously being identified by site SOV and NRC inspectors. (9/96)

3. Actions /rsc-.Ter.ar.dations

( Continue core inspections enhanced by operator licensing and project engineer support. Areas of focus should match theme areas highlighted in this report

         -                                       'encluding operator errors, OOS errors, operator knowledge, and procedure weaknesses.
                                                                                             -4                                                 '

i i i l t f f Quad Citler PPR 3196 919(. Pre Decisional i B. Maintenance ' l 1. LungDJ..P.edsannnt.t i Performanes ln mainterance was adequate. Several complex maintenance activities i were performed well, and appropriate reviews were conducted in response to breaker problems identified at another facility. However, significant weaknesses were identified in human. performance, work quality,.and job oversight, i j 2. Assessment /lanues Quality of Maintenance ActMties l Several complex maintenance activities were performed well. ' During the feedwater regulating isolation valve spring pack repair work the valve engineer was knowledgeable and provided assistance and oversight for l the troubleshooting and repair work. The workers demonstrated a high 1 ( degree of skill and efficiency in performing the repair. The job site was l orderly and workers demonstrated proper use of procedures. The valve engineer noted all safety telated motor operated valves were equipped with

grease reliefs. (9/96)

,

• The inspectors interviewed contract workers and reviewed contractor work packages to assess adherence to Comed work procedures. Work was performed by experienced workers and job preparations and work execution appeare.', good. Werkers overhauling hydraulic control units (HCUs) were well tra! ~ d for the tasks. The inspectors noted the contract workers identifiou deficiencies created by Comed electricians during the installation of scram solenoid pilot valves. (4/96)

The licensee conducted appropriete reviews in response to breaker problems identified at Comed's Dresden Nuclear Generating Station. 4 l

• Comed determined that one of the primary causes for the Dresden failure was hardened grease in the trip latch roller bearing. The inspectors reviewed i

procedure OCErM 020001,4 Kv breaker Sala and the vendor manual, and i determined that the licensee had incorporated applicable vendor information into the maintenance procedure. The inspectors concluded that the licensee 1 was addressing 4 Ky breaker concerns in an acceptab;e menner. (8/96) 1 e A review of the preventive maintenance (PM) list identified that all of the safety-related breakers (480V) were within their maintenance frequency. l The inspectors concluded that the licensee addressed 480 volt breaker

    ,         y                              maintenance in an acceptable manner. (8/96) s 5

Quad Cities PPR 3/96 9/96 Pre Decisional Quad Cities personnel reviewe'd their practices for maintaining the 4160 volt breakers and concluded tht their maintenance procedures were in accordance with vendor recommendations and there was no operability issue. However, some breakers had exceeded their 3 year PM inspection period.16/96) Problems were still evident in the qualhy of maintenance work, and a number of human performance problems occurred throughout the report period. During the Urdt 1 outage, workers installed new flow elements in the off gas system. However, there were no post maintenance tests of the signal from the flow element to the transmhter. During startup of Urdt 1 operators identified that " sparge' air flow to the off gas system did not indicate as expected. The licensee determined that workers had improperty wired the flow elements. The inspectors noted that no PlF was generated to document this event. (9/96) e ( Maintenance personnel, installing a cathodic protection line, contacted a buried 13.8 kV electrical power line during excavation with a backhoe. The personnel involved were not injured and no safety related equipment was effected. Personnel involved failed to follow work control processes. After unearthing a woming flag buried to mark the presence of power cable, workers continued to dig with the backhoe. (9/96)

• e instrument maintenance (IM) technicians removed the wrong source range mordtor shorting links due to a procedure error. An independent review of the procedure by the IM shop had not detected the error. Maintenance determined that the electrical drawings were read incorrectly during the procedure preparation. (5/96) e

! A lack of questioning atthude by maintenance workers coupled with an unclear work package led to workers reassemblity a standby diesel generator room oooler in h degraded condition. The licensee trained work ' analysts to ensure specific artteria for rotests was included in future work packages. (3/96) Four violations of TS 6.2.A.1 were Hentified for failure to follow procedures.

                      *                                                                                             ~

Workers had to rewire the low pressure' coolant injection outboard isolation i valve power supply breaker in accordance with instructions from

.i        .

Engineering, Quality Control inspectors were required to verify the wiring. i However, a worker miswired the power supply breaker and the Quality Control inspectors failed to identify the error. (8/96)

        -

• During post maintenance testing of the residual heat removal service water

                             -(R54RSW) pump, mechanical maintenance personnel noted problems with the inboard beenng seal. Maintenance determined that the seal centering clips
                                                                  -6

4 i Quad Cities PPR 3/96 9r96 Pre Decisional were not removed and the er.4i set ne'ews were not tightened. However, . the work step was signed ty the fontman as having been completed. (6/96)

• A maintenstet mechanic Started te disassemble a lubricating oiler for the Unit 2 SBDG cooling water pump by mistake. The work package required workers to replace a lubricating oiler on the 1/2 SBDG cooling water pump.

(S/96)

• The maintenance crew incorrectly aligned the reactor head nameplate to the bulkhead nsmoplate by one bolt hole. An additional radiation dose of about 2.76 person-tem was received by workers during the rework activity to correctly set the reactor vessel head. The inspectors found that several experienced maintenance mechanics familiar with reactor head installation were involved in this work. Lack of knowledge and questioning attitude coupled with imprecise procedural steps resulted in reactor head misalignment. (5/96)

Training deficiencies and weak

• skill of the craft" resulted in a number of

( maintenance problems and unnecessary rework.

• A recent meeting of RCIC users had determined that a conservative non-trending criteria would increase the confidence of the overspeed trip function. The RCIC turbine required many attempts before three consecutive non trending results were achieved. Several f actors contributed to the difficulty of passing the criteria. These included: The use of a hand held tachometer. First time evolution of overhauling the turbine since commercial operation of Unit 1. Change in practices of using contract or vendor personnel. The vendor manual instructions were not clear. (9/96)
• The inspectors found that the licensee considered the assembly of compression fittings to be a ' skill of the craft" issue. As a result, the licensee relied upon the training program, rathat than technical work instructions, to provide the necessary guidance to maintenance personnel to ensure the proper assembly of compression fittings. The inspectors found, however, that maintenance personnel did not receive training on all vender recommended installation practices. (6/96) e Operator actions when a stuck valve was discovered was to apply external force to free the valve'. If this action was unsuccessful, the licensee normally took the valve out of service for disassembly, inspection, and repair. From 1991 through 1995 operators tolerated the valve problems, which were essentially operator work arounds, and did not actively communicate with licensee management or other work groups for long term resolution. (5/96) e Lack of training for electricians mechanically installing scram solenoid pilot valves resulted in rework to repser HCU air header fittings Comed 7

I Quad Cities PPR 3/96 9/96 Pre Decisional electricians installed the fittings using ' skill of the craf t* practices and were ' not aware of the unacceptable practice of mixing pressure fittings. (4/96) A failure of the Unit 1 *A* standby liquid control (S8LC) squib valve to operate during surveillance testing was indicative of a degraded system conditinn and poor soldering techniques by maintenance personnel. Further investigation by Comed revealed that soldering techniques were not routinely

• taught to electricians, and were considered skill of the craft capability. The inspectors concluded that initial root cause and corrective actions did not identify problems with craft capability and work environment. (4/96)

Work Control Weaknesses in the licensee's work control and problem identification processes were identified. - The inspector found that lessons learned from the previous Unit 2 RCIC ( turbine overhaul in 1990 were not applied during the Unit 1 turbine testing. A PlF on the 1990 testing problems had not been written. A PlF documenting the problems ard lessons loomed from the Unit 1 testing was also not written until prompted by the inspector's questions. (9/96) e During operation of the 1D RHRSW pump, the licensee determined that the outboard radial bearing seal generated excessive host and declared the pump inoperable. The licensee attributed the cause of this problem to workers making adjustments to conter the impeller in the pump housing which reduced clearance between the seal and sleeve nut. The work package lacked acceptance criteria for the gap setting. The failure to establish appropriate quantitative or qualitative acceptance criteria for this gap in the maintenance procedure was a violation. (9/96) e The viton seating surface of a solen 86d for a MSIV was not machined during the manufacturing process Neither the vendor nor the licensee consider this a critical dimension worth measuring prior to assembly into the solenoid valve. The failure to establish appropriate quantitative or qualitative acceptance criteria in the maintenance procedure was a Violation. (9/96) The inspectors reviewed.the licensee's rolling 13 week non outage work control process. The inspectors concluded that the licensee's work control process was adequate. However, numerous weaknesses were noted, particularty in performance monitoring, self assessment, and backlog classification. (7/96)

       -                        The inspectors determined that oversight of the testing and temporary
       "                        modification of the source range monitoring system was poor. A written safety evaluation was not preparnd. The activity was not reviewed by station management. The inspectors determined this was a violation of TS 8

e i k i Quad Cities PPR 3/96 9/96 i Pre Decisional 6.2.C. The inspectors also noted that the PiF review of the incident f ailed to * ! recognize the need for proper oversight and review of testing procedures j involving the reactor protection system.16/96) j

• j The calibration and maintenance program for the in line instrurteents was pood and modifications of the reactor water sempling panels were i

successfully completed. However, maintenance of other chemistry sampling i equipment continued to be a problem. The chemistry staff identified and ' documented many of these giwoblems in corrective action requests, yet progress in resolving issues remained slow. (4/96) Material Condition ! Tt.e inspectors noted a significant improvement in material condition during the Unit 1 refuel outage primarily duc to the licensee's efforts to correct deficiencies. However, equipment f ailure caused several forced shutdowns, reduced safety system availability, and continued to challenge plant operators.  ! ! i i The licensee rebuilt the Unit 2A control rod drive (CRD) pump. Operations tested the pump and retumed it to service. However, the operators had to l i remove the CRD pump from service due to high vibrations after only 40 hours of service. During reassembly of the 2A CRD pump, workers i determined that the rotor contained an incorrect metal. The second rotor, i

'                                       delivered from a vendor, was dimensionally incorrect. At the end of the inspection period, workers were having problems with aligning and

{ reassembling the pump. (8/96) j

• The discovery of growth of zebra mussels m the suction strainers to both fire i

diesel pumps, resulted in the licensee declaring the fire protection system i

inoperable. The blocide ir(ection point did not preclude biological growth in the firs water systems. The licensee considered both diesel fire pumps to be i inoperable from May 6 until the suction strainers were cleaned on August 9

(8/96) i

• During Unit 2 startup with the main steam system at normal operatir's pressure, en operator, performing system walkdowns, identified a 14 gpm leek from the bonnet of the high pressure coolant injection (HPCI) 2 23017 l check valve. Operators shut down Unit 2 to allow disassembly and repair of the valve bonnet. The valve was previously disassembled to check rahoe of l movement during the otetage. The licensee believed the leak was caused by i

i improper reassembly by the valve vendor.18/96) i

)                           Supervisory Oversight l

; Weak supervisory oversight contributed to poor work practices.

9

( Quad Cities PPR 3/96 9/96 Pre Decisional The inspectors concluded that during Air Compressor maintenance, supervisory and technical oversight did not focus on ensuring that poor work practices did not negatively affect equipment availability and reliability. Additionally, the licensee's work control process was weakened by reliance on vender supplied verbal work instructions. (5/96) The inspectors reviewed individual industrial sofoty incidents, and determined

              '                   that most could have been avoided with better worker sensitivity to accepted safety practices, or improved' supervisory involvement and oversight. Two electrical shocking issues were of particular concem because the lasues involved were close repetitions of previous problems. Also of concem was the use of the air motor without a safety feature intended to prevent injury from rotating parts. (5/96)

C. Engineering and Material Condition

1. Cunent Performance

    -(

Overall, engineering performance was adequate. Poor equipment material condition remained a key problem and continued to hinder plant performance. Additionally, a weak root cause analysis program resulted in slow and ineffective corrective actions. Engineering evaluations and calculations continued to be weak.

2. Anneanment/lanues  ;

Material Condition The licr.nsee devoted sierdficant resources to correcting material condition deficiencies, and noticeable improvement has been made. However, equipment material condition remains a key problem and continues to hinder plant performance: e Weaknesses identified in system walkdowns, equipment performance ' trending, and review of surveillance testing indicated that system engineers were not consistently using all available tools to evaluate the material condition of their systems. (9/96) e Material condition problems affected severalimportant safety systems. These included an stypical number of intergranular stress corrosion cracking (lGSCC) indications in recirculation piping. (4/96) I Numerous material condition problems continued to challenge operators. The following are examples of equipment problems for the period:

 ,                y

• A Unit 1 SBLC squib valve failed to actuate during testing. (4/96) 10 1

                                                                                                            \

Quad Cities PPR 3/96 9/96 Pre Decisional A faulty Unit 2 generator syn'chronizing relay prevented closure of the + generator output breaker several times before a successful closure was accomplished. (4/96) Unit 2 HPCI motor overload annunciator indicated a problem with the auxiliary oil pump. Troubleshooting revealed a failed annunciator circuit component. (4/96) Root Cause and Corrective Action Programs Due to a weak root cause analysis and corrective action process, addressing material condition issues remains slow and ineffective. The inspectors identified several examples in which implementation of the root cause analysis program was not consistent with written procedures. * (9/96) I Numerous failures of SBDG fuel oil pressure gauges w}thout a timely root cause analysis or timely implementation of corrective actions once the root cause was identified indicated weaknesses in the licensee's root cause analysis and corrective action programs. (9/96) A review of licensee SOV audits ident}fied continuing problems with the corrective action process. In addition, the inspectors identified weaknesses with SOV follow up efforts to resolve those problems. Overall, the corrective action program remained poor. (9/96) Nine examples of Icng standing technical issues were identified and addressed by the licensee. Five of these issues had been previously identified, but had not been corrected in a timely manner. (7/96) Due to poor licensee corrective actions, the inspectors identified pipe < compression fittings from different manuf.neturers being used together in safety related applications although an NRC Infomistion Notice had been issued on this subject. (7/96) Croctive action weaknesses for a LPCI comer room structural steel design margin issue reflected an inadequate safety focus toward prompt analysis and correction of design deficiencies. This inadequate safety focus caused the licenses to consider these issues to be of low safety significance, adversely affecting the thoroughness of the technical approach and licensee management decisions. (4/96) (SL lli Violation) Engineering Evaluations and Calculations Engineering evaluations and calculations continued to be weak. I1

t Quad Cities PPR 3/96 9/96 Pre Decisional

• During a review of a memorandum containing battery temperature operability

limits, the inspectors identified that supporting calculations assumed non.

conservative battery load profiles due to weak understanding of system design. (9/96)

• The inspectors identified a lack of engineering rigor (non conservatism) in the irdtlal decision that unit startup could commence prior to repair of the reactor  !

building exterior panels damaged on May 10,1996. (7/96) (Apparent l

                                                                , , Violation]                       '

e Three examples of poor engineering operability and design basis review , concerning an air leak on a standby diesel generator, the impact of a HPCI tegout on operability, and an erratic reactor recirculation pump speed controller, pointed to the need for more rigorous engineering support and , overview. (4/96)

3. Actions / Recommendations t Continue reviewing the licensee's 1996 Management Plan improvement efforts. A

, System Operational Performance Inspection (SOPI) is scheduled for May 1997. I D. Plant Support  ; i

1. Cunent Performance Radiation protection and chemistry performance was good, but inconsistent contractor radworker performance and problems with chemistry maintenance and work planning lessened the improvement. Security performance was good, but declining. Emergency properedness was good, but some minor problems were identified which did not siprdficantly impact licensee response.

9 2. Assessment / Issues Radiation Protection Emergent engineering issues and poor station work control and planning continued to impact station dose: e Collective exporure through mid October 1996, totaled 976 rom, compared i to a total exposure of 737 rem in 1995. (10/96) e Over 200 rem resulted from emergent engineering issues. Specifically: the installation of structural steel supports to the unit 1 and 2 residual heat removal (RHR) systems; increase in Inservice Inspection (ISil scope owing to signs of IGSCC in reactor recirculation (RR) system piping; addition of weld overlays, on RR piping, based on indications of cracking; and additional valve work identified during local leak rate testing (LLRTl (4/96) 12

s < i l Quad Cities PPR 3/96 9/96 Pre Decisional l A s'tetion task force reviewing the outage identif,vd several weaknesses in the work control and planning process, which were similar to past NRC  ; observations. Specifically, previous station and industry experience was not l effectively used tn identify emergent work, and some known work was not appropriately identified (Late 1995 through early 1996) Efforts to improve ALARA planning and radiological source term continued: o

 '                                                                   The MP group formed an e@sure reduction task force to reviety 1996 dose performance and to develop recommendations to the ALARA planning                         '

process. To date, the group has identified esveral weaknesses in the work control and planning process, where RP notification was not timely, which prevented better ALARA planning. Most of these weaknesses involved support activities (scaffolding, shielding, out of service clearing and crew size management) (8/96).

• e The licensee assigned specific ALARA managers to those significant outage activities discussed above and effectively implemented contingency plans to

( handle emergent work (4/96), o Good ALARA controls (cameras, shielding, etc) were used to control outage /non outage dose and improved RP technician job coverage and ownership was noted (4/96). i e Dose rates in the unit 1 drywell general area remained unchanged since the last outage, owing to past source term reduction efforts. Efforts to date, included chemical decontamination of the reactor water cleanup (RWCU) and RR systems, removal and rerouting of the control rod drive repair room sink drain lines, and increased use of lead shielding and hydrolazing. The + inspectors noted good involvement by the source term reduction coordinator in the ALARA planning process (4/96) Overall, redworker performance improved, but incoisistent contractor performance remained a problem: i e A licensee redworker performance task force attributed the mejority of the events to poor redworker skills, a complicated work process, and ineffective past root cause evaluations. - Long term corrective actions were being developed, but shunt term actions (increased training, tailgate sessions, etc) l have resulted in an improving trend. (10/96) L e Radiological actions, in response to and recovery from, a spill of resin in the i truck bay, were good. The spill, which was being investigated by the licensee, was attributed to contractor error and poor oversight of contractor activities by the licensee. (9/96) s

                                                                                                  '13

Quad Cities PPR 3/96 9/96 Pre Decisional Numerous minor radworker performance problems (loitering in radiation ' areas, material crossing contaminated boundaries, etc) continue to be observed by the licensee and NRC. However, the majority of these events involved contractors who were unfamiliar with the facility or had ingrained poor redworker skills. (5/96)

           .                  e Weaknesses wrth maintenance " skill of the craft" resulted in additional time in plant and rework. Of particular note, was the misalignment of the unit 1 reactor vessel head, causing rework resulting in about 3 rem of unnecessary exposure to workers (5/96).

e The licensee took strong disciplinary action against a contract employee who willfully attempted to bypass a whole body frisker. An RPT had earlier observed this individual exhibiting unacceptable redworker practices (i.e.

                                       -

• horseplay *) during control rod drive work. (4/96)

Plant water chemistry was good, but past, poor control of hydrogen water chemistry (HWC) had adverse affects on radiological conditions: e Key chemistry parameters were ma'rnained below the current EPRI water chemistry guidelines. The overall water quality helped reduce rtxficactivity in effluent releases.15/96) e The trending and analysis of plant water chemistry parameters was well managed. Overall, water quality improved as evidenced by increased service life of lon exchange resin and several licensee actions including: plugging existing condenser tube leaks and increasing preventive testing; maintaining strict controls over floor drain input; and discharging floor drain water to the river vs. recycling in the radwaste system. (4/96) e Frequent past cycling of HWC increased dose rates in the turbine and condensate systems. Increased management attention has improved HWC avallsbility from 30 50% to about 90%, to date. (4/96) e To improve corrosion protection, the licensee may have to increase the HWC injection rate. The current rate is already significantly higher than the industry everage and was based on a plant specific analysis of vesse!intomal corrosion. The licensee was reviewing the possible effects the increase may have on radiological source term and plant dose levels. (4/96) Previous problems associated with completion of system modifications were k 8 resolved, but maintenance of chemistry sampling equipment continued to be a concern:

         -      e 4                             Poor communication of system priorities between the chemistry and system engineering departments delayed the repair of a balancing damper associated with a chemistry sample hood. The failed damper resulted in backflow from s

14

f Quad Cities PPR 3/96 9/96 Pre Decisional the hood, increasing the possibility of contamma' ion spread, and contrary to the description of system operation as described in the UFSAR. (5/96) e The calibration and maintenance program for tne 6nline instruments was good and modifications of the reactor vessel sampling penets were completed. However, maintenance of other chemistry sampling equipment continued to be a problem. The chemistry staff documented man'y of these

                    ,   problems in corrective action* requests, yet progress in resolving issues remained slow. (4/96)

Several minor problems with compliance with the Updated Final Safety Analysis Report (UFSAR) were noted; e Several discrepancies were identified between the effluent and solid redweste systemdiagrams contained in the Offsite Dose Calculational Manual (ODCM) and the UFSAR. Specifically, the gaseous effluent flow path listed incorrect air flow rates, and the liquid and solid radwaste processing diagrams did not indicate the current operating condition of the system. * ( (5/96) Emergency Preparedness Effective management oversight of the Emergency Preparedness (EP) program was noted with strong support from the new EP coordinator and the quality of the EP program audits: e A new EP Coordinator was hired and was providing good support to the program. Emergency Response Organization personnel appeared knowledgeable about their responsibilities, procedures, and emergency actions. (9/96)

• The overall quality of the station and corporate self assessments, audits and surveillance of the Emergency Preparedness program were excellent in scope and depth. (6/96)

              - The overall operational status of the emergency preparedness program was good with well maintainej response facilities and equipment and several recent enhancements to improve performance.

Although some minor problems were identified during the 1996 annual exercise and y the May 10,1996, Alert declaration, the overall EP performance was good. L i e The 1996 EP exercise overall performance was good. The control room staff was professional and maintained effective communications with the TSC and

   +

OSC, Both the TSC and OSC performed affectively with good technical 4 discussions and coordination / control of emergency response teams. 15

i Ouad Cities PPR 3196 9/96 Pre Decisional Command / Control transfer to and from the corporate emergency operations facility (CEOF) were orderly and timels.19/96) The licensee successfully performed the 1996 biennial excercisa, with only minor problems related to (1) classification of the Unusual Event, (2) slow initial NRC notifications, and (3) simulator fidelity and exercise controller problems. (9/96) The overall actual emergency plant activation was good, for the Alert declared on May 10, 1996.(5/96) The licensee's staffing of the interim CEOF for the May 10,1996, Alert, was not timely. Minimum staffing was achieved about 98 minutes after the Alert declaration, compared to the Generating Stations Emergency Plan goal of 60 minutes. (5/96) Security * ( Effective management support activities was evident in equipment upgrades (hand geometry, new security computer), maintaining sufficient resources (experienced and professional personnel), arx' continuing tactical training and drill activities. (9/96) s However, there was a decline in security personnel performance and the psychological testing. Vehicle and package control programs were not well implemented: Some material deliveries into protected area were not adequately controlled while unattended. (9/96) e The licensee failed to adequately implement vehicle access control requirements in accordance with procedural guidance. (9/96) A weak questioning attitude by contrut security management resulted in an unqualified official returning to armed response duty. (9/96) The licensee failed to adequately proctor some psychological evaluation testing activities in accordance with procedural guidance. (7/96) _ Fire Protection __ ._ i While no focused program inspections were pierformed during this assessment period, the resident inspectors assessed the fire protection program during routine tours of the plant and follow up of issues. The fire protection program was affected by similar work control and material condition problems as descr.ied in the Maintenance section above. 16

4 Quad Cities PPR 3/96 9/96 Pre Decisional The 1 A fire pump LCO took several days longer than planned due to poor - review and oversight. The 18 pump LCO was planned peorly and never needed 'o be taken out of service for the work parformed. Fire protection LCOs are " administrative" and treated less aggressively than TS LCOs. (9/96) Both fire pump suction stralners were blocked by zebra mussels. The cause was the blocide injection point does not preclude biological growth in the fire water system. Mthi> ugh problems with blocide control had been identified earlier by NRC and the licensee, corrective actions for zebra mussel growth had been delayed. (8/96)

3. Actionsmecommendations Continue performing the routine inspection program, but increase emphasis on the control of station dose and the resolution of those problems identified in the security program. Perform a fire protection inspedtion during the next assessment period.

( lli. Future insoection Activities Operations Routine core inspection program supplemented with ROAR Plan on TSUP post implementation inspection in November Maintenance Maintenance Process and Work Control inspection -late 1996 Engineering ( MOV Closeout - November 1996 System Operational Performance Inspection (SOPI) - May 1997. Mant Support Routine program c IV. Attachments 6(

1. Plant issues Ust

 *

• 2. AEOD Performance Indicators

3. Power History Charts e

17

  -               ~                    **
                                                                                                                                      .\

i

                                                                                                                                      .l PLANT ISSUES LIST QUAD CITIES l      DATE       l     ID BY   l       SALP  l DESCRIPTION l    CAUSE l        REF 10/28/96          Licensee      Ops ENS call. The licensee determined that       Design     ENS call control room emergency zones do not all maintain 1/8" positive pressure. Sa fety-
               .                                   related "B' train of control room HVAC declared inoperable (7 day LCO for both units).            -

10/27/96 Licensee Ops "B" train of Control Room HVAC Design OPEN refrigeration unit declared operable. New - - heaters installed and safety-related power supply provided. 10/27/96 Licensee . Ops Unit 2 turbine offline. reactor at 20% Equipment OPEli power. Repairs to level control valves Problem for moisture separator drain tanks in

                                          -       progress. Disassembly of valves reveals                        .

foreign material (bolts, nuts, washers). 10/26/96 ****** ****** SALP 13 period ends. ****** ****" 10/26/96 Licensee Ops Mechanic identifies problems with bolts on ' Equipment OPEtt ' spare RHRSW pump. Licensee identifies two Problem affected in-service RHRSW pumas (IC and 2C) and declares them inoperayle. 10/26/96 Self Ops Unit 2 atteg ts to increase load, but Equipment cpi t: can't increase above apporox. 100 MWe due Problem to failed moisture separator drain tank valves. I

l OATE l ID BY l SALP l DESCRIPTION l CAI1SE l REF l 10/25/9s Licensee Ops , Troubleshooting of NWe output swings . Equipment OPEN during fl CIV testing inconclusive. Problem Turbine on-line for further testing.

• Licensee subsequently identifies EHC pressure problems during repeated testing of the #1 CIV as the cause of the power swings.

10/24/96 Licensee Ops Unit 2 fl CIV problem attributed to failed Equipment OPEN SADI board. Board replaced but during Problem testing operators respond to FW heater level alarms. Operators fati to notice swings in generator NWe output. All reactor parameters remain normal. Turbine later taken off line for further troubleshooting. - 10/23/96 Licensee Ops Control room operators identify Unit 2 #1 Equipment OPEH Combined Intennediate Valve (CIV) erratic Problem operation. 10/11/96 Licensee Eng. ENS call. The licensee determined that Engineerin EN5 Q 11 the train 'B' Control Room HVAC g/ Design (311dD refrigecation unit crankcase heater is fed Deficiency from a non-safety related (non-0) power supply. In this condition. it is not assured that the cogressor will be able to perform its design function under all conditions. 10/09/96 Licensee Maint. ENS call. Unit 2 HPCI dechief Equipment Et6 Call inoperable. The licensee could not Malfunctio (31122) determine if the system was filled and n vented. Per TS 3.5.a.3. Unit 2 entered a 14 day LCO. 2

                                ^
                                                                                             ^

l DATE l ID BY l SALP l DESCRIPTION l

                                                  '                                                                      CA'JSE  l       REF Exit of           NRC              Eng.           Inspectors identify that licensee LLRT 9/23/96                                                                                         Human         IR 96012 program does not include temperature           Perform. NCV -07 compensation as required by appitcable code to which licensee is comitted.

Exit of Lic/NRC Eng. A FW isolation valve ex)ertenced spring 9/23/96 Equip. IR 96012 pack hydraulic Tork. T1e inspectors and Design the licensee iridepadtitly identify other Igortant to safety valves with similar spring pack features. . Exit of Licensee ~ Eng. A pressure switch associated with an SRV Poor 9/23/96 IR 960!2 failed due to heat buildup. Switch lagged Procedure because vender manual warning was not  ! communicated to laggers. . Exit of NRC Maint. Ins)ectors note that several equipment Poor PMT 9/23/96 IR 96012 3ro)lems which affected startup would have-

                                                                      )een identified earlier if more thorough post maintenance testing had been performed.

Exit of Licensee Ops. Unit 1 operators were noted to have 9/23/96 Human IR 96012 knowledge deficiencies re RCIC condenser Perform. drain valve operation during Unit I startup Exit of NRC . Ops. Inspectors identify lack of sensitivity to Human 9/23/96 IR 96012 potential seismic concerns. NCV issued Perform. NCY -01 9/14/96 ~ Self Plant Resin spill on HIC. Good H.P. response. Human Revealing .Suppo.-t IR 96012 Perform. IFl 08 9/09/96 Licensee Maint. Workers failed to implement 3rocedural Human IR 96012 controls and excavated 13.8 tV line Perform. e 3

f DATE l ID BY l SALP l l DESCRIPTION CAUSE l REF l 9/10/96 Self Maint. Foreign material plugged a moisture Poor Work Revealing RI Obsv separator drain level control valve. Unit Practices 1 taken off line to clean out the valve. 9/8/96 - Self 'Maint. IC RHR5WP experienced 2 gpm se 'eakage. Poor Revealing IR 96012 10 RHR5WP declared inoperable (,. to hot Maint. VIO -04a bearing. VIO issued for RHRSW ptanp worked w/o quantitative acceptance criteria for

               ~

seal dimensions. 9/6/96 Self Ops. ? High dose rate alarms were received on Human RI Obsv Revealing refueling floor. Crane operator snagged Perform. an LPRM in fuel pool due to inattention to detail. LPRM was drawn near fuel pool , l surface by trane hook. l 9/7/96 Self  ? ENS call. Booster fans for the ~B" train Equip. IR 96012 Revealing of control room ventilation failed to Malfunctio URI -02 start. n LER 96020 9/7/96 Self Maint. Newly installed U-2 FWRV controller Poor RI Obsv Revealing experienced instability / slow response at lesson low power. Vender modifled software. Learnad Repeat of problem with U-1 modt fication. 9/6/96 ******** ****** Unit I synchronized to the grid following ********** ******* OIR14 and extended maintenance period. 9/4/96 Licensee Ops. ENS call. Licensee interred and exited an Poor IR 96012 NUE based on determination that a TS Procedure. LEP 96016 action statement for RPS surveillances had Poor

                                   ~         not been met. Licensee subsequently          Approach determined that action statement did not     to Reg.

apply. Licensee mis-applied G.L. 87-09 Compliance upon initial identification of apparently missed surveillances. 4 i

t m, f DATE I ID BY l SALP l DESCRIPTION l CAUSE [ _REF

   ' 9/2/96         Self       .

Maint. New HSIV solenoids operate erratically. Revealing Vendor IR 96012 A5CO representative identifies mis- Supplied VIO -4!b machining of plunger assemb1;. Mode Equip. (.hange required for valve re) air. Part 21? VIO issued for lacc of I ' quantitative acceptance criteria for MSIV solenoid stem travel. 8/27/96 Self Paint. PTant remained at about 140 psig (TS grey lack of Revealing IR 9all2 area) for several days due to inability to Experience successfully complete RCIC and HPCI w/ setting overspeed trip tests. Several minor Ov5pd Trip prcb! cms with turning gear auto-disengage and barometric condensers complicated evolution. 8/27/96 Sel'f Eng. Exhaust form swing EDG caused ventilation Design Revealing RI Obsv for SB0 DG battery and day tank ruces to secure. NRC observed that control room operators responded in passive manner. Issue turned over to DRS for follow-up.

               ~

8/26/96 Self Ops. Unit 2 alteinate 125 VOC battery trained Knowledge IR 96012 Revealing due to operators leaving failed trickle Defic. charCtr attached. 8/25/96 - Self , Ops. Operators trip plant during startup due to Op. IR 96012 Revealing rise in indicated water level. Transient Knowledge LEP.96017 caused by BPVs ccaing open because of Defic. nonlinear calibration of EHC at low press. 8/23/96 Licensee Eng. ENS call. Licensee retroactively declares Inadeqt. IR 9f012 secondary containment inoperable due to Design URI -05 broken boits on blow-out panels. Control LER 96016

                                 .            Engineering slow to report problem.

5

                                     ,                                                    w . .w ~

l DATE l ID BY l SALP l DESCRIPTION 'l-CAllSE l 'REF l 8/23/96 Licensee Eng. Licensee's initial screening of degraded. Human & IR 96012 secondary containment blow-out panel bolts Program URI -95 failed to identify all applicable UFSAR Perfonn. accident analysis requirements. Exit Date NRC Eng. Licensee is using an area radiation 8/22/96 Technical IR 96011 monitor in lieu of 10 CFR 70.24 required Expertise URI -0! criticality monitor. Licensee attcg ting Issue to provide technical justification. Exit Date Licensee Eng. 8/22/96 While reviewino the failure of the Unit 2 Orig. IR 96011 HPCI discharge check valve to open during Equipment NCV -07 testing, licensee determined that Defic. Installed test mechanisms did not cycle valve flapper through its full movement (30 deg. Instead of 75 deg.). Exit Date Licensee Plaat Supt. Licensee Task Force concluded that ALARA 8/22/96 Work IR 96011

                                                                   ~              dose goals were exceeded (950 vs. 700            Planning rem.) due to poor outage 91anning and work       issue
                                                                  ,               scopegrowth(notreasonablyforeseen).
                                                                  '                                                                                                j Exit Date          Licensee              Eng.

A high energy line break or s' RWCU piping Orig. 8/22/96 IR 96011 (Monticello identified scenario) was found Design URI -05 to be outside the bounding conditions of Issue the UFSAR. Licensee responding to NRR request for information and description of planned actions. Exit Date Licensee Ops. l Tto operators failed to position a Human IR 96011 8/22/96 condensate demineralizer drain valve in ] Perform. the required position. Feedwater flow to l reactor not significantly effected. 0 6 i j

v,

 -          L ,,                     3, f      DATE      l     ID BY     ~l     SALP l                  ' DESCRIPTION             l    CAUSE  l       REF l Exit Date               -

Plant Overa'l performance of 1996 EP exercise l 8/2?/96 ' Support IR 960? i considered very good. 8/16/96' Licensee Eng. ENS call. Unit 2 HPCI pipe whip restraint Original IR 96011 determined to have been incapable of Construc- URI -06 resisting applied design lo3 ding due to tion LER 96015 incorrectly-installed anchor bolts. Temporary Alteration installed. 8/15/96 ******** ****** Unit 2 synchronized to grid. ****** ******** 8/11/96 Self Maint. ENS call. Poor reassembly of HPCI Human IR 96011 Revecling discharge check valve led to excessive Perform. leakage (14 gpm) from mechanical joint. HPCI declared inoperable. 8/09/96 Licensee ~En9 Both diesel driven fire water pum)s were Poor IR 96011 declared inoperable because of zeara Design URI'-03 mussel foulinn of the inlet strainers. Mod. for LER 96013 Blocide injection point was downstream of Blocide fire water pump suction point in water Injection bay. 8/09/96 Seli Maint. ID RHR Service Water Pump experiences Poor IR 96011 Revealing, bearing failure (seal last worked in 9/93) Maint. due to mud in seal. Shaft also found to Practice be incorrectly sized. 8/xx/96 Licensee Maint. Severe plugging of vessel bottom head lack of IR 96011 drain line re.sults in inaccurate !.ottom Maint. bead temperature indication. 7

N . l DATE' l 10 BY l SALP !_ l DESCRIPTION CAUSE l REF  ! 8/xx/96 Licensee Eng. Licensee identified that the rupture disk Original 5 IR 96011 downstream of the 40 code safety valve had Construc-ruptured. No indication or relief valve tion j lifting or leak-by was found. Condition '

                               ~                                attributed to DWEDS piping arrangement.

7/29/96 Licensee Maint. Workers miswired power supply br-2aker for Human IR 96011 1A LPCI outboard isolation valve. 0A Perform. VIO -04b ' inspectors signed that wiring was correct. Breaker smoked during post maintenance testing. 7/29/96 Licensee Maint. Licensee identifled and resolved problems Design / RI Obsv with safety related battery mounting Install. & fixtures. Batteries being grounded by Ins)ect. buildup of salt in styrofoam paddine. Pro)lem i I 7/10/96 Licensee Hafnt. Worker removed oiler from wrong EDG Human IR 96011 l coeling water pump (no DOS required). Perform. VIO -Orla i 7/08/96 Licensee Eng. ENS call. 107 valves required for Design IR 96008 l Appendix R Safe Shutdown are susceptible URI -11 to " hot shorts." An earlier opportunity LER 96011 to identify this issue was missed during licensee assessment of IN 92-18. 7/05/96 Licensee Ops. Operator works radiological (non-safety Human IR 96011 related) ventilation fan with out an 005 Perfonn. 7/03/96 Licensee Ops. 0)erators failed to identify a ccndition Human 19 96008 witch rendered the shared emergency diesel Perform. NCV -02 generator output breaker inoperable to Unit I for a period of three shifts. 6/11/96 Licensee Eng. ENS call. Licensee determined that U-l Design LER 96012 EDG fuel oil transfer pump was inoperable due to degraded voltage issue. 8 6

                                                                           ~

e l DATE l 'ID BY l SALP l DESCRIPTION l C/USE l REF 6/xx/96 NRC Maint. NRC inspectors identify that plant Procedure IR 96006 procedures and training applicable to use & Training URI -16 of compression type pipe fittings do not Weakness

                                                             'incorprate all vender recomended instailation instrections.

6/xx/96 IDNS Maint. Inspector observed that maintenance Human IR 96008 activity on Unit 2 instrument air Perform. compressor involved poor work practices and was poorly controlled. 6/xx/96 Licensee Ops. An operator failed to open one of the 2D Human IR 96008 RHR pump suction va~.ves while establishing Perform. NCV -01 shutdown cooling ~ flow path. 6/xx/96 Licensee Maint. 2C RHR Service Water Purp bearing Human IR %011 incorrectly assenbled during installation. Perform. VIG -04c Supervisor signed-off work step which had not been completed. Vibration problems experienced during post-installation testing. Superviso.' terminated. 5/24/96 NRC Eng: ENS call. U2 was operated in an Human IR 96008 unanalyzed condition with HPCI 40 and 41 Perform. ' valves closed. 5/23/96 Licensee' Eng. ENS call. U1andU2LFCIinjectionvalves Design IR 96008 inoperable under degraded voltage URI -09 scenarios. Cable length information in LER 96009 data base used for original voltage calculations was non-conservative. 5/17/96 - Sel f- Maint. 2A CR0 pung exhibits high vibration after Poor IR 96008 disclosing _ only 40 hours of service following Maint. IFI -06 corpletc rebuild. Rotor found to contain Practice IR 96011 incorrect materials and incorrxt shims. 9

     ,              t,. . . ,                  ,.

l DATE l ID BY l- SALP l l DESCRIPTION CAUSE l REF l 5/17/96 Licensee Maint. ENS call. B Control Room HVAC inoperable. Equip. IR 96006 Controlling at 82 degrees F vs. required Problems band 70 to 80 degrees F. 5/16/96 , Illinois Eng. RVLIS test director inattentive during Nuclear Human IR 96006 test in control room. Perform. IFI -04 Safety ' Inspector 5/xx/96 Licensee En9 Licensee review grou) identifled that a Human IR 96008 portion of the HPCI teep fill line was not Perform. URI -12 designated as being safety related. Licensee initially dispositioned this conditions as being satisfactory. NRC inspectors questioned this conclusion. ' 6/11/96 Licensee Eng. ENS call. " Gallery" platforms associated Program IR 96008 with safety related equipment were found Failure URI -13 l to be inadequately braced to withstand LER 960f0 l

                      '                                  seismic design basis loading. Licensee originally identified this condition in
                  '                                      1978 but never implemented necessary
                                            ,            modtffcation.

5/xx/96 - Licensee Eng. Supports for non-safety related portions Program IR 96008 of the reactor ballding ventilation supply Failure URI -13 ductwork were not installed. This condition placed safety related portions of the RBSV outside of its UFSAR basis. Condition identified in 1991. madiffcations made in 1996. 6 l l 10

l DATE l ID BY l SALP l l DESCRIPTION CAUSE l REF 5/yx/96 Licensee Eng. t In 1994. the licensee' identified that HPCI Program IR 9600E pump inlet nozzles would exceed the Failure URI -13 manufacturer's recommended loading limits during a desip basis seismic event. Unit 2 was modified. but the Unit I modificatton was cancelled. Unit I was modified after NRC enforcement action for

                                                             -RHR corner room steel.

5/xx/96 Licensee Eng. LER 96012. Licensee upgraded the EDG fuel Program IR 96008 011 system to safety related in 1991. The Failure URI -13 licensee recognized that the safety LER 96012 related fuel oil-system required physical isolation from connected non-safety related fuel oil systems, but failed to take action on this until 1996. 5/xx/96 Licensee Eng. Licensee sb.veillance and training Program IR 96008 procedures identifled incorrect ratings Failure URI -13 for the EDGs. UFSAR was also incorrect in one section, but correct in another. Licensee failed to identify this problem for decades then failed to correct it when first identified by plant staff. I 5/xx/96 Licensee Eng. Licensee identified that LtRT for Hydrogen Poor Test IR 96008 Analyzers were inadequate because Line-up NCY -15

                                          .                  deenergized solenoid valves allowed the                   LER 96006 development of back pressures on the boundary check valves.

11

t b DATE l ID BY' l SALP l DESCRIPTION l ' CAUSE l REF 5/xx/96 NRC & Eng. Thermal overloading "ampacity* problems Licensee Design IR 96006 existed in some cable routirr points. The URI -10 NRC first identified some amp)acity problems in 1991. Complete resolution still not accomplished in 1996. 5/xx/96 NRC Eng. Plant indicated readiness to startup with Human IR 96008

                                                                  ;                degraded Reactor Building exterior           Perform.

Janeling. NRC intervention required

                                                                                   )efore licensee recognized full design bases for R8 exterior siding.

5/12/96 Licensee Maint. 3 of 6 ARI vent valves failed to open Equipment IR 96006 during testing on Unit 2. Problems 5/10/96 Sel f- Plant Sup. ENS call. Alert declared due to secondary disclosing Weather IR 96006 & containment damage as a result of high 96008 winds. 27 emergency strens without power. l . Unit 2 :;nutdown. Activation of Corporate Emergency Operations Facility was not considered to be timely. 4 5/10/96 - Sel f- Eng. Wihd evet causes damage to Reactor disclosing Design IR 96006 & Building exterior siding panels. Falling 96008

                                          '                                     panels damaged 500 diesel generator power                 LER 96007         '

supply cables to Unit 2. 5/9/96 Self- Maint. 1/2 1A instrument air compressor manually Equipment disclosing IR 96006 tripped. Abnormal indications - not Problems properly executing starting sequence. 5/8/96 Licensee Plant Sup. ENS call. Contractor maintained Contractor IR 96006 background records may contain errors. personnel 12

           -              c. r-                   ,-                                                                             .,

l DATE l 10 BY l SALP l OESCR!PTION l CAUSE l REF 5/6/96 Self- Maint Contractor electrician shocked due to Human IR 96006 l disclosing failure to verify dead leads and operator Perform. Ifl -03 not taking breaker out of service properly. 5/6/96

• Licensee Maint. Unit 1 CRD 25 valve leaks by during hydro. Equipment IR 96006 Valve replaced.

Problems 5/1/96 NRC Engr Predecisional Enforcement Conference Mngmt. IR 96005 regarding apparent failure to provide Error Apparent adequate design controls to maintain LPCI Violation corner rooms' structural steel design margins. The licensee initially IR 96007 identified the failure to meet design Pre & cis. requirements in early 1994. but did not Enforcemnt plan on doing work until NRC questioned Conference timeliness of corrective actions. 5/96 Sel f- Maint. Numerous RBCCW TCVs stuck. At one point 3 Equipaent IR 96006 disclosing of 5 out-of-service. Problems i 5/xx/96 Self- Engr Leaking SSPVs from Shoreham caused tquipment IR 96006 disclosing inability to reset Unit I scram signal. Preblems 4/30/96 Sel f- Maint Fire in IB RHR room due to inadequate H' san IF %106 , disclosing protection for flamable material while Per form. torch cutting. 4/29/96 Self- Maint Mechanic was injured while installing head Human IR 9t*006 disclosing bolts due to safety device on air " wrench" Perform. being disabled. 4/29/96 Licensee Maint Reactor head set one bolt hole out of Human IR 96006 alignment. Perform. NCV -01 13

l DATE l ID 8Y l SALP l DESCRIPTION l CAUSE l REF l 5 4/29/96 Self- Hafnt 28 gland seal exhauster breaker failed. Equipment IR 96006 disclosing -2A gland seal exhauster started and Problem

                                                     .                                tripped.

4/25/96 NRC Ops Operators incorrectly used a procedure Human IR 96006 field change (PFC) to perform the Control Perform. Rod Drive Scram Air Header Test. The original procedure called for the test to be Mrformed with no fuel in the vessel. A P C was issued to allow the test to be

                                                           -                        performed with fuel in the vessel.               NRC identifled that this changed the intent of the procedure without appropriate review.

and was a violation of Technical Speci fications. 4/18/96 Sel f- Ops Unit 2 rod moved in wrong direction due to Equipment IR 96006 disclosing problem with notch override switch Problem  ; 4/9C Licensee Engr Numerous IGSCC indications found in Unit 1 Equipment IR 96004 i recirculation piping during ISI. Problem IFI -04 l 4/17/96 Licensee Plant Unauthorized access into facility by Human IR 96006 Support individual by ta11 gating through access Perform. IFI-11 4/17/96 Licensee Maint. U-1 Instrument Technicians removed wrong Hunan IR 96006 SRM shortirig links. Perforn;. NOV -02 l 4/17/96 Licensee Ops. Operators remove U-2 "B" RBCCW Hx from Human service in lieu of "A" RBCCW. Perform. 4/14/96 Licensee .0ps 2B Recirculation Pump MG set run- down IR 96004 from 68% to 46% w/o operator der a id. 4/10/96 Contractor Plant Horseplay - RP issue Human IR 96004

                                                          . Support                                                                      Perform.

14 5 0

                                                                                         . ,i-.-......... .

         ,                ,~.,                  ,.                                                                                 .

t k DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF l 4/10/96- Licensee Maint SBLC squib valve did not fire

                                                             ~                                           Loose Wire IR 96004 in CR Cabinet 3/24/96              Licensee     Ops          Equipment operator removed back up N          Poor.        IR 96004 EDG dampers in lieu of U1 back up N,, to Commnicat ion 3/20/96',           Contractor    Hafnt       ems assenble "Swagelock" fittings into   .

Human IR 96004 Hoke fittings on HCUs. Perform. 3/19/96 Licensee Maint ENS call. U2 HPCI Overload annunciator in Equipment

                        -                                                                                            IR %004 CR alarms when operating Aux Oil Pump.         Problem HPCI declared inoperable 3/18/96             Licensee     Maint       During surveillance test. the alternate        Equipment IR 96004 feed from breaker Bus 19 to Bus 18/19-5        Problem
                                                        .(safety related) caught fire.                                               )

3/15/96 Licensee Ops During 00S. Operator removed wrong fuses Human IR 96000 in RPS bus-resulted in ESF actuation R8 Perform.

    ,                                                    ventilation stopped. SBGT auto started 3/7/96              Licensee      Ops.       ENS call. Fuel movement with both shared       Human       RI ObsV           !

and U-1 EDG inoperable. Perform. 3/7/96 Licensee Engr. 10 kHRSW vault seals failed leak test. Inadequate IR 96003 i The diesel coeling xmps are located in Corrective the RHRSW vaults. J-l SBOG inoperable. Actions The vault seals had failed the leak test in 2/24/% and no corrective actions. 3/5/96 Licensee ' Plant Scott Co. emergency sirens inoperable. Equipment IR 9600i Support ENS Call Problem

                                                                                                                ^

15

   ,                 t,..,                  ,.

l DATE- l 10 BY l .SALP l DESCRIPTION l CAUSE l REF l 3/4/96 Sel f- Maint. disclosing U-2 main turbine #2 TCV oscillating. Equipment IR 96002 Problem with servo-mutor. Power rapidly Problem IR 96004 reduced to < 45%. Turbine offline next day for repairs. 3/4/96 Self- Maint. ENS call. "B" control room HVAC train disclosing Equipment IR 96002 declared inoperable due to su Problem exhaust dampers failed open. pply and 3/4/96 Self- Tiaint. disclosing U-2 condensate demineralizer master flow Equipment IR 96002 controller oscillations. Resulting Problem Open

                                         ~

pressure changes almost reached low suction pressure trip of condensate booster pump. 3/3/96 1.icensee Ops. During planned maintenance on U-1/2 $80G Human IR 96002 circuits associated with U-1. the Perform. Open overcurrent protection relay fuses for the U-1/2 SBDG were removed per the 005 instructions. The 005 stated that

 -                                                       removing the fuses would disable the U-1/2 overcurrent protection during an auto startup from U-2 circuits. (The U-l/2 i

SB0G would have auto started and loaded.) Holt Self- Eng & 1995 disclosing Loss of control room annunciator audible Equipment IR 95010 Maint. alarms due to a computer failure (a Problem RI Obsv condition repeated several times in 1995) 2/28/96 Self- Maint. U-1/2 SB0G inoperable due to failed disclosing , Equipment IR 96002 breaker for oil circulating pump and Problem Open . failed lobe oil heater. 16 _ . _ i

y , . . . l l' ID BY l l DATE SALP DESCRIPTION l CAUSE -l REF l 2/25/96 , Sel f- .Eng. 28 Service water pump tripped due to disclosing Design IR 96002 electrical ground. Other loads on MCC Open

                                              ,               tri ved too. Another example of problems

• witi breaker trip coordination problems.

(Note: returned to service 3/6/96.) 2/25/96 Licensee Maint. ENS call. B-train of control room Equipment IR 96002 ventilation system inoperable due to low Problem Open refrigerant pressure. Identified during ENS Call operator rounds. LER 95001 2/24/96 Licensee Eng. Crack (6 - 8 inch) near thermal sleeve on Equipment RI Obsv U-1A core sp ay. piping between tie core Problem shroud and t reactor vessel. 2/23/96 Licen:ee Eng. Small crack on elbow of U-IA core spray Equipment RI Obsv piping inside core shroud. Problem 2/22/96- Self- Maint. Uilstandbydieselgenerator(SB0G) Inadec disclosing . IR 96002 inadvertent startup during overspeed Procecure ENS call-testina. After test overs med signal Own reset. Local startup switci was in LiR 96003

                                                           " start" position per procedures.

2/21/96 Licensee Eng. ENS call. Toxic gas analyzer had a non- Design IR 96002 safety related power supply. If LOOP /LOCA Own occurred. no control room emergency LER 96002_ ventilation system booster fan to maintain msitive pressure in ccntrol room.

                                                           )rocedures modifled.

I O

                    ,                                                     17

? ev s - _ e l DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF ! 2/14/96 ~ Sel f- Ops. disclosing U-1 refuel floor dose rates higher than Ngmt. IR 96002 expected. RWCU secured 2 days after shut Decision Open down vice normal 5 days. (Note that the RWCU system is going to be chemically decontaminated and portions of the piping will be removed during OlR14.) Using fuel pool cleanup system to reduce radiation. 2/10/96 Licensee Ops. Multiple. Intentional violations of Mgmt. IR 96002 containment integrity and voluntary Decision URI/NOV entries into TS 3.0.A for leak rate LER 96006 testing. Open 2/10/96 ******* ******* U-1 begins refueling outage 14 (0lR14). ******* ******* Scheduled 77-day outaoz. 2/7/96 Sel f- Maint. disclosing U-1 load reduced due to 3/4 inch relief Equipment IR 96002 valve lifting in low pressure feedwater Problem Open heater string. Valve gagged shut. Heater string bypassed.  ; 2/6/96 Sel f- Maint. i disclosing U-1 high pressure coolant injection (HPCI) E@ IR 90002

              '                                 gland seal condenser exhauster tripped      Proo,ipment lem    Open during surveillance. Defective circuit brecker.

2/3/96 . Licensee Ops. ENS call. Control room emergency Design in %U07

             '                                 ventilation system inoperable due to                     0 en extreme cold temperature (-28 deg F). 14             L >L %000 day LCO.

1/30/96 Sel f- Maint. disclosing U-l HPCI inoperable due to aux. oil pump Equipment IR 96002 cycling on & off daring surveillance. Problem ENS call Open LER 96004 18

. e PREDECId,0NAL QUAD CITIES 1 PI EVENTS FOR 95-3 NONE PI EVENTS FOR 95-4 SEF 10/21/95 Leas 25495007 50.728: 29492 < PWR MIST CONCITION EXISTED IN ALL MCDE5 UP TO 100% POWER $1NCE 1964 GRCUP REACTOR f tlP INSTRtMENTAll0N ST3 FEM : PLANT PROTECTION ST5 FEM OTN UNIT: Thil EVENT 6R$ AS$10NED TO UNITS 1 AND 2. DESC TNE CONTeot etc DRIVE SCRAM DISCMARGE YOLLME'S RPS CONTROL LOClC DID NOT SAflSFT SINGLE FA CRITEtim. TNIS CEULD REsuti IN A NALF SctAM WHEN A FULL SCRAM l$ REOUIRED. A DEslGN Ettot WAs INTRODUCED lu A 1964 selFICATICW. PI EVENTS FOR 95-1 SSF 02/05/96 LEts 25496004 50.728: 29911 PWR NIST: EVENT DISCOVERED DURING CPERATION AT 921 POWER GROUP  : EMERGENCY CORE COX1NG STsTEN$ GROUP SYSTEM : NIGN PRESSURE COOLANT INJECTION ST5 TEM DESC MPCI WAS DECLARED IN0PERA8LE WNEN TNE GLAND EENAusi SAEAKER TRIPPED DutlWG TESTING. THE INSTANTANEOUS itlP SETPolut NAD DRIFTED AND CAU$ED THE BREAKER TO TRIP AT A LOWER INtU$ SSF C2/20/96 LEts 25496002 50.728: 30006 PWR GROUP HIST: CouDifl0N EXISTED IN ALL MODES UP TO 1001 PcWER SINCE INITIAL OPERATION

CONTROL ROOM EMERGENCY YENTILATION ST5 FEM GtouP SYSTEM :

CONTROL SUILDING/ CONTROL COMPLEX ENVIRONMENTAL CONTROL SYSTEM OTH UNIT: TNf$ EVTNT WA$ ASSIGNFD TO UNITS 1 AND 2. DESC  : THE EMERGENCT FILTRAfl0N FUNCTION OF TME CONTROL 800M YENTILATION ST$ TEM WOULD NAV INOPERABLE DURING A LOOP. A DEllGN OVERSIGHT WITf : TorlC GAL ANALTZEt RELAT WOLAD PREVENT OPERAfl0N OF TNE ChARCCAL AD$04tER FILTER TRAIN t,x$TER FANS. PI EVENTS FOR 96-2 SSF 05/23/96 Leks 25496009 50.72s: 30532 PWR GROUP HISTr CONDITION ExlSTED IN ALL MODES UP TO 1003 POWER SINCE 1972 MJLTIPLE ST5fEMS GEDUP SYSTEM MULTIPLE ST5fEMS OTh UNIT: TNis EVENT WA5 ASSIGNED 10 UNITS 1 AkD 2. DESC SEVERAL SAFETT ST5 FEM 5 Wtti P01ENTI ALLY IMOPERABLE BECAUSE OF INSUFFICIEuf v0LTAtt DuRING Lo votTAGE C0kDITIONS. laaeopte CABLE LENGTN1 VEtt USED Ik Th! DIT,tADED VOLiatt :s;t ~,s*tm. O

PREDECISIONAL to.ena QUAD CITIES 1 "*""""'"""l ""*' ' Refuehng T Operation am 93-3 to 962 Quarter 1r Data

                                                                                                                                                                      ~~

hot Shown Mmg Op. Cycle ggggg ops -, _ ops. - , - ~_ - R R R R N ~ b7 be.1' k, 51 Year . Quarter 53' hti 3 E likt 1- k3 '61' Year . Quarter 95 1 ' Et' I~

                                       ,           Automaec Screms Whee C#tuca!                                           ,                                    Safety 8ystem ActuaGons 3                                                                                  3-                                                                  *
                                'g 2-                                                                                     2-

1. 1.

0 = 93 3 kt c beJ W1 b3 96-t i 3 t>3 k1; k3 ' E3 ki' ' Year . Quarter Year. untier 2D Signl6 cant Events Safety System Fauvres

                                $ 15.                                                                             I 3                                            1.

W t 11D-5b - u.g

                                                                                       ,                        g4       2-03 .

l 1- '

• 1_ A ,,,, _ g $

0.0 D53 kt; k., bt' b, I o

                                                                                              $1                                   3                      ki        k,        35 1     95 3       gi-Year . Quarter Year Quarter I                                                                                                                                    Equipment Forced Outagest 100                  Forced Outage Rate (%)

6 1000 Commetdel Celtical Hours 80 s h  ! e so . 8 73 a ', k , 3 '* $! 2 .; l' a ,i M k ,;a, til i h j! , >i g . .u ., -, ,,, ,s, ., . ,,,

                                                                                                                                                         . . ,     ..,        ,,.,     ,,.3         .,--

Year . Quarter Year . Quarter Cause Codes Conective Raciatxm Esposure ,-

                                                                                                                         ***

• L" OP" t othe P*'

200 , _,_

                                                                                                                                                             ,y                    .,

k *' '

                                                                                                                                                                                   ! .. l.

o ptsos

                                                      .       1 I*l 100-g

• E E . - . . .. l E mth is , . .

                            ;5           .                :;-                   -              ..

e 50 y n I i 'i - - - - - - . . . . w , l

                                                                !k                                  NA                                                                             .                           j
                                           .3      _.. ... _.                     _, ..                         .r                                        .                              .                      ,

a  !.**27' ."Di E 2, ;.Am ,,  : t ___m__. ... _ . _ . _ -

{ PREDECISIONAL QUAD CITIES 1 to.ona Sinos e.i S.o~f c.ac. w>en ===== Peer Group General Electnc Pre-TMI "* W3 to 962 Trenes and Decatons Demtens From Plant Peer Group Self Trond Median Short Term Long Term ames,seg me ,,, sed weree tener OPERATIONS Automatic Scrams While Critical - 0 - 0.22 Safety System Actuh - 0 - 0 Significaevt Events - o -

                                                                                                                                                      ,i;8lg           0.89 Safety System Failures .                                              .o,77            -

0.50 , jI'd Cause Codes (All LERs)

e. assessee cwww p.ema . - 0.90 -

l 4.07 [ s s us==es cener smes - 0 - O e cow oweeansa aners - 0 - 4.33 I e unassisaeaseersenses -

                                                                                                                               ) 0.05            -

0 07 [ e 5: .- - - enasseea pree e -

                                                                                                                               ] 0.22            -

0.24 [ e en a - 0 - 0 SHUTDOWN Safety System Actuations - 0 - 0 Significant Events - o - o J Safety System Failures - .o 13 , . i j .o 07 ', , i  ! Cause Codes (All LERs) e asanwevem c==w Poemas.s - 0 j. 0.32 ,, e t= eases comin severs - 0 0.30 _l c oow *wisanes emes - 0- - 0.90 M 5] e r . r - --- - e snessimaeace Pessweis - __ eenseenaoveen s - 0 0 61 E 0 0 90 N@! e ==== - 0 - 0 FORCED OUTAGES P Forced Outage Rate * - L .o 03 i .o 47 " Q Equipment Forced Outagest * - 1000 Commercial Celtica; etours 0 0 60

          ,                                                                                               10     -0.5       00        05      to  10     05       00       0.5     10 Performance Indes                       Performance Index

• sin cewuamse sen ceemeaes creae e

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1

QUAD CITIES 1 AEOD DID NOT PERFORM A DETAILED PLANT ANALYSIS OPERATIONAL PERFORMANCE DATA FOLLOWS 1 G I

QUAD CITIES 1 PRFDECISIO!4At PREDECISIONAL PI EVENTS NOT INCLUDED IN THE 96-2 REPORT 55F 07/0s/M Lees 254 M011 50.728: 30722 PWR HIST Comottlow Exisito le nLL sulpf t UP TO 1001 PCwt slutt Bulfl AL CPit?.floh GRCUP  : 8tATIPLE SYSTEns atmJP ST8 TEM IRATIPLE SYSTEMS OTN lastf TNIS titut ms AstlestD 70 Uulfs 1 He 2. MSC A POSTULAf tD Flkt CouLD MMAGE 107 VALVts tteulatn FOR SAFE $NUTDOWN. uCT saiORTs COULD RFSULT 15 DAMAGE TO THE VALVES. PtfMNTING FutT*2R OPERAfl0W. Tull EVtui m3 CrJSED ST A COGulflVE MSIGN AhALTS15 REVIEW tatot. MANUAL SCRAMS SCRAM 08/25/M LEtf 254 M017 50.728: 30920 PWR sist sTARTUP pe0DE AT 41 DESC  : Tet ex WAs MAmuALLY SCRApeED WNEW RX LEVEL SWELLED FOLLOWING TME UMPLANNED OPfutuG OF ALL mlut MAlu STEAM STPASS VALVES. TNis EVENT WAS CAust0 BY AN InADEcuATE TESTING PtoCEDutt. ACCIDENT SEQUENCE PRECURSOR DATA (*" 1996 AND 1996 DATA PREUMINARY ***) (VENT DATE: 02/06/92 CDPt 6.9t 6 DESC RX f tlP & FW ISOL. MPCI AMD Cut stV UNAVAILASLE EVtWT Daft: 02/13/90 CDPt  : 3.7E e DESC TW3 (MitClkCT DIESEL CthttAfots CUT OF StevlCE (Viuf DATE: 08/08/84 CDPR  : 6.7E 4 Otst  : UNDEf tCilD Atsich (RROR. LPCI thJECT VALVE 5 Fall CLO$ED. m. OUTAGE DATA

                      *CHEDULED                                                                                            -
                      **?ti DATE: 02/10/96 0UTAGE uts: 4892.0                                                              (203.8 Days)

OfSC EfFUELluG OUTAGE. D L FORCED g' START DATE: 10/22/95 QuTAGE mal: $37.7 (22.4 Devs)

                    . Dist                                                        :

MANUAL SCRAM DOE TO DESIGN 115UE ON TMt scaAM DIStuAaGE VOLLMt LEVEL SWITCn. L a

QUAD CITIES 1 PREDECISIONAL EVENTS AE00 CONSIDERS IMPORTANT tVtsi Daft: 01/30/96 - - MSC Ltt % 004 00: Du M0130. WPCI STS MCLARED laOPitASLE DUE TO GLA2 EXMAU5ff t HEAK!t TRIP. WPCI GLt2 EXMAUlitt MEMIR ttPLACED & Tf 5f tb FOR P90 Pit OPERAfl0W & AOP TIE MLAT BfPA55 SWITCuts tu STAttluG CitQJIT ttPLActo, W/960227 LTR. Evtul DAlt 10/20/M M SC LEt 95 00? 00: Du 951020, Cao SCRAM OISCmAP0f WL CONTROL LOGIC FAILED TO Eff SINGLE FAILutt CRiff tl A. CAU".ED BT MSIGm MFICifuCT. Plf 95 2485 WRITTfu TO luvtsTIGATE CAUSE Of MSIGN MFIClfNCY. W/951114 LTR. s Y

1 PREDECISIONAL QUAD CITIES 2 PI EVENTS FOR 95-3 SCRAM 06/25/95 LEts 26595005 50.728 29238 PWR NisT: PWER OPf aAll0Ns At 60% MSC A SCRAM OCCURRED ON NIGN FLUI/MIGN POWER DURING A MAIN TuttlNE ENC PRES $URE REGULA10e IEST. P ENC STtTEM ENWLEDGE AND INNERENT INSTRWIENT CAtlBRAfl0N INACCURACIES CGelNED TO CAUS PI EVENTS FOR 95-4 SSF 10/M/95 Lake 24595007 50.72#: 2 Mil M hl8T EVENT OCCURRED DURING OPERAfl0N AT $7I POWER moup  : seRGEWct CORE COOLING STsIEMs eRoup SYSTEst NIGN PRE 88URE COOLANT INJECTieu SYSTEM MbC  : NPCI WS NCLARED IN0PERA8LE WEN TNE-fnmNING EAR NOTOR NOULD WOT AUTOETART Ale ENGAGE FOLLO SURVEILLANCE TURNING SEAR HDTOR TEET. THE LOG *C, ISET P90BABLE CausE WS A FAILURE OF A CONTACT TO CNANGE STATE IN TME SSF 10/1s/95 Leks 2659500s so.72e: 2M73 PWR NIST: EVENT DISCOVERED DutING OPERAfl0N AT 871 POWER GROUP : EMERGENCT CORE COOLING SYSTEMS GROUP SYSTEM : NIGN PRESSURE COOLANT INJECTION SYSTEM MSC THE NPCI SYSTEM WAS McLARED INOPERABLE DUE 70 FLOW AND DISCNARGE PRESSURE OSCILLAfl0NS SUR"EILLANCE TEST. THE FLOW CONTROLLER NAD NOT BEEN ADJUSTED FOR A NEW TEST OPERATING SSF 10/21/95 Leas 25495007 50.72s: 29492 PWI NIST: CONDITION EXISTED IN ALL N00ES UP TO 1001 POWER SINCE 1985 SROUP : REACTom TRIP INSTRLalENTAfl0N SYSTEM : PLANT PROTECTION SYSTEM

            '        OTN UNIT: TNil EVENT WAS AS$1GNED TO UNITS 1 Am 2.

MSC  : TNE CONTROL ROD DRIVE SCRAM DISCMARGE WOLunt's RPS CONTROL LOGIC DID NOT SAflSFT SING CRITEtlA. TNil COULD RESULT IN A HALF SCRAM WNEN A FULL SCAAM 15 REQUIRED. A DESIGN Ett0a WA INTRODUCED IN A 1985 MODIFICATION. PI EVENTS FOR 95-1 SSF c2/20/96 LEaC 25496002 50.72s: 30006 4 PWR ERWP N15ft CONDITION Et!5 FED IN ALL MODES UP 10 1001 POWER SINCE INiflAL OPERAfl0N CONTROL RDOM EMERGENCT WENTILATION SYSTEM GROUP STITEM : CVW140L BUILDING /CONTt0L COMPLEX EINIRONMENTAL CONTROL SYSTEM OTN UNIT: TMit EVENT WAS As51GNED TO UNII$ 1 AND 2. MSC  : THE EMERGENCY FILTRAfl0N FUNCTION OF TNE CONTROL ROOM VENTILATION ST5 FEM WUU IN0* ERA 8LE DUalNG A LOOP. A M51GW OVERSIGNT WitM A Toxic Gas ANALTZER RELAT Wout0 PREVI 0*Etatlow 0F TME CNAtC0AL A050RSER FILTEa TaAIN 3305fte FANS, PI EVENTS FOR 96-2 SSF 04/17/96 LEpe 26596001 50.72s 3053a

   ,                put MIST: EVENT OCCuatED DURING OPERAfl0N At 99E POWER
    '               EROUP          EMERGENCY CORE COOLING SYSTEMS OROUP SYSTEM : NIGN PRE 55URE COOLANT INJECTION SYSTEM MSC       :

NPCI WAS INOPERASLE MTWEEN 4/17/96 Am 4/23/96 SECAWE tNE NPCt TURsINE Eumausi LINE Vacuum 3REACER$ TO BE ISOLATED WERE FOLLWING ISOLATED. A MODIFICATION. MFICIENT OPERATING AND SURVIILLANCE PROCEDURES ALLOWED TME GSF 05/23/96 Leks 25496009 50.72s: 30548 PWR NisT: CoelfloN EXISTED IN ALL N00Es UP TO 1001 PWER SINCE 1972 GROUP  : sRJLTIPLE STSTEns GROUP ST11Em a sRJLTIPLE ST5fEMS . OTN UNIT: TN15 EVENT WA5 ASSIGNED TO UNITS 1 Am 2.

   }                DESC
          ,                        SEVERAL SAFETT SYSTEMS WERE POTENTIALLT IN0PERA8LE SECAUSE Of INSUFFICIEN! VOLTAGE DURINC LO
   .Q WOL1 AGE CONo!TIONS. IMPROPER CA4LE LENGIN$ WER( USED IN TPE DEGRADED WOL T AGE CALCULATIows Y

4

PREDECISIONAL QUAD CITIES 2 PI EVENTS FOR 96-2 (CONT.) SSF 06/03/96 LEts 50.72s: 30577 PWR Mist: CouDIT10N EulETED in ALL sitets WP to 1001 POWER SINCE 5/92 . . saoup  : EMERGENCY AC/DC PWER SYSTEMS GRmJP SYSTEM Es(RGENCY cullTE POWER SUPPLY SYSTEM DESC ONE EDG ms SEEW lucPEtaaLE simCE mt 1992. A CA8LE LENGIN AND UNDEnv0LTAGE ISSUE MV CAUSE THE EDG TRANSFER Ptsr IID10R 70 FAIL. f4 SvluG EDG WAS OUT OF SERVICE ON vat lDUS OCCA$10NS Dut!NG TNil fille. 9 t I

PQEDECIS10NAL lLeeena QUAD CITIES 2 5"" Refuehng

                                                                                                           *" * ** * ' "2 " I                               5"" CD R                Operation m gg g g                                                                                 MOu5try Avg Trend Shutdown m ops               --

Not $hown using Op. Cyc4 EEElsa q , 0 95. R  ! I R E I 93 2 kti 42 51- tu ht F E lis.3 Year. Quarter kt' ks Wi i E7 Et' F Year . Quarter

              ,                    Automanc Scrorns Whae Cettical                                     ,                      Safety System Actusoons 3-3 g     2-2-

t 1 $ 0 _ _ _ D3-3 k1' k3 ' o 1 BM E t' 53 7 k1' k2 Et; $3 Year. uarter $1 i Year . Quarter 2.0 Significant E vents

                                                                                                     ,_                      ' Safety System FaHures 1.5 -

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PQEDECISIONAL QUAD CITIES 2 t no s==.- s e cene. n mn=== Peer Group General Electne Pre TMt " ' " '"* C 93 3 to 96 2 Trenos and Dewatons Devotions From . Plant Peer Group f Self. Trend Medan Short Term Long Term OPERATIONS (irscluding startup) Automatic Scrams While Crttical - 0.56

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e QUAD CITIES 2 AE00 DID NOT PERFORM A DETAILED PLANT ANALYSIS OPERATIONAL PERFORMANCE DATA FOLLOWS (

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I.

QUAD CITIES 2 PREDECISIONAL OUTAGE DATA EQUIPMENT FORCED START DATE: 03/05/96

           -A     .: ..$

M SC TalPPED Tuttlet TO HPLACE Tut #2 Tuttlet tcWTeot WA1W Str@. EQUiF*aLENT FORCED STaaf DATE: 11/29/95 00iAGE uts: 18.7 MBC T8tPPED TUR$1NE 10 PLUG Euc LEAK ON #1 TuttlWE CONTROL YALVE. EQUIPMENT FORCED staaf Daft: 10/21/95 cuTAGE WRE: 799.1 (32.9 Deys) MSc TRIPPED funtlet Dut TO LEAK Ou #1 Tuts 1NE CouTROL VALyt. FORCED START DATE: 08/25/95 cuTAGE was: 198.6 (8.3 Days) MSC AutrmATIC SCRAM DURluG ENC ftSTibG. EQUIPMENT FORCED ITART Daft: 08/12/95 M Ast was: 125.8 (5.2 Days) MSC MANUAL SCRAM Dut To tuC LEAK ON CIV $6. SCHEDULED START DATE: 03/05/95 cuTAGE uns: 3660.0 (152.5 Days) DESC Coot!WCIO *tFUEL OUTAGE C2t13. EVENTS AEOD CONSIDERS IMPORTANT EV!WT Daft: 10/04e<5 MSC Lia 95 006 00: on 951004. ftto satAtta tom MoTom Cowinot Cia af SV!TCMGEAa TRIPPED from CURRENT WitLA:D. CAUSED ST TRIP SETTiuG 100 LOW F0n Clvtk PLAhT. M010e COW 1ROL CTA at$TORID & EXIT LCD. 9

QUAD CITIES 2 h

, PREDECISIONAL DEVIATION ANALYSIS REPORT i r ) USTED BELOW ARE EXPLANATIONS FOR THE NEGATTVE BLACK DEVidTidN BARS Ik THE 96 1

FOR Tat FOR uvlATI0m assuLie FR<> Tru GUTAots TOTalluG 178 Dafs. Tw Louctsf GetAat (75 l

' DAYS) NGAm 10/96 As IWWOLVED reUIPMut P900LEMS Aae PitsaustL PitFonMANCE 183Uts. TNE ' utXT LouMST GUTAM (51 DAYS) NGAN 5/96 As nsLS Ou00lWG AT Tut END OF tnt MYl Afl0W M t100 (6/96). TNil GUTAGE INAVED ToenADO DAMAGr. Pout DUTAM5 INVOLVED TutelWE CaffROL VALVE LEAKS. Tull PLANT REPttitecto Matt EeulPMWT roactD OUTAats TRAN ALL BUT l Cut OF TM OT ER 22 PLANT 5 IN T M Pitt 800VP. EFO TM 70s uvl Artom tenutta rROM tlGwT CuTAars TOTALING 139 DAYS. Tut LONGEST st/TAGE (75

DAYS) NGAN 10/94 Am Irv0LVED EOUIPMENT PdQBLEMS AND MRStBoutt MRFORMANCE 189ut$. INE

' NET LONGr$f OUTAGE (33 DAYS) MGAN 10/95 WITN A Talpero Tutslut DUE TO A LEAK Ou A Tuttlut CONTROL VALVt. A FtW DAYS AFTER tnt RESTART. ANOTNtt DUTAGE (out DAT) WAS i At0Ulkt0 70 atPalt A LEAC tdt TNr SAME Turglut CONTROL VALYt. IN ALL. FOUR OUTAGES luv0LVED TUS$1bt CONTROL VALVE LEAK $. TNIS PLANT EEPitltNCED Matt reUIPMENT FotCEO , GUTAGE$ TNAN ANY OF TNE OTNtt 22 PLANTS IN INE Met GROUP. 1 I l I i i 4 ) I t i

QUAD CITIES 2 PREDECISIONAL PREDECISIONAL PI EVENTS NOT INCLUDED IN THE 96-2 REPORT SSF 10/09/M LEte 50.72e: 31122 pta ulti : EVENT DISCOsts guttuG OPfRAfl0m AT 1005 MWER StEIP  : agggGENCT C0t! C00LluG SYSTEst$ OROUP ST8 TEM ulGu PREssutt "DOLAuf luJECTION SYSTEM M BC uPCI mt MCLARED luoPERABLE WEu WTER FLOW CouLD NOT M ESTAttitutD futCUGN A RIGN P0luf VEuf FOLLOWIIIG A IONTulf SURVEILLamm TEST. Tut LIMuSEE il luvESTIGAfluG WutTutt IDV LLAK BT l$ PREVENTING FILL Of Tut PIPluG As OsttavtD AT Tiet ulcu Poluf Vtui. SSF ea/11/w LER8 Sc.72s: 3cou PWR utsf : EVEuf DISCOWtB DuttuG OPERAT10m AT 105 Podt an0UP EMERGENCY Cott C00LluG ST81Det GPCUP ETSTEM ulGu PREttutt C00LAuf luJECTiou STETEM MSC  : Tut IIPCI SYSTEM ES MCLARED IMDPERA4LE Wutu fut PWP DISCNARGE C18EM VALVE MvELOPED A SEAL tiuG LEAK OF APPtoulmATELT 14 EALLous PER MluuTE. SSF 07/08/96 Ltte 254 M011 50.72fs 30722 PWR ulST : CalDiflom EulsTED lu ALL NODES UP TO 1005 POWER $ lum lulflAL OPERAfl0N .u EROUP MULTIPLE SYSTEMS GROUP SYSTEN  : 8tATIPLE ET$f tu3 OTu Uulf a Tula EVENT WAs AssicutD To Unifs 1 Amo 2, DESC A POSTULATED Flat COULD DAMAGE 107 VALVES REeultED FOR SAFE SuuTDOWu. NOT Ste0RTS COULD RESULT Im DAMAGE To fut YALVER. PREVENTluG FURTMER OPERAfl0W. Tuls EVENT WAS CAUSED BT A COGulflVE DESIGu ANALYS15 REYlEW ERROR. MANUAL SCRt.MS NONE ACCIDENT SEQUENCE PRECURSOR DATA (*" 1995 AND 1996 DATA P9ELIMINARY m) EVENT DATE: 04/22/9) CDPR  : 6.0E*5 MSC DEGRADaflow of 90Tu EMERGENCY DIESEL GEutaAT0ts EVEuf DATE: 10/25/84 CDPR  : 8.9E 6 DESC RCIC TalP. CRDS valve FOLulD CLOSEC(1 RG) TAILS TO FULLY luSERT). OUTAGE DATA FORCED START DATE: 05/10/96

    - OUTAGE uts: 2326.0           (96.9 Days)

DESC Uu!T 2 WAS un0UGuf Off*Llut DOE TO ToeuADO DAMACE A

           ..a 4 4

LASALLE A s d s

                                                                                                         )

1 l PRE DECISIONAL-

                               ' SEMIANNUAL PLANT PERFORMANCE AME.5MiV1 LASALLE STATION Assessment Period:           March 1996 through.Septembe 19F SALP Period:                 11/27/94 througn 08/03196 Previous SALP Rating:        OPS-    3 MAINT 3-ENG     3 PS      2

1. Performance Overview While several actions were taken to improve performance, two persistent weaknesses limited the effectiveness of those actions. First, a large amount of emergent work and difficulties in )lanning and executing work hindered progress in the im condition improvement plan.plementation Thus, materiel condition of t1e station problems materiel continued to challenge plant operators and led to reactor scrams and other forced outages. Second,-human performance errors continued to result in unplanned plant shutdowns. inoperable-safety equipment and loss of configuration control. These continuing weaknesses in materiel-condition and human performance resulted in a risk-significant service water tunnel fouling event that occurred in June 1996. This event provided the NRC a number of insights into the LaSalle County Station perfomance. That event showed thSt work controls had broken down, revealed previously unidentified materiel condition problems, and disclosed significant engineering weaknesses in support to plant operations.

II. Functional Area Assessments A. OPERATIONS

1. Current Performance-An overall decline in operations-performance was observed. Increased operator errors and non-conservative decisions contributed to the decline. Although the licensee has taken action to address longstanding materiel condition >roblems: results of the efforts have been slow and plant equipment pro)lems continue to impact the operators. Corrective actions to identified problems were slow or inadequate. Procedure weaknesses also have led to poor operator performance. Poor procedures-resulted in operators becoming desensitized to procedure weaknesses and

  -             working around them instead of initiating appropriate corrections.

l l-

l. . ._ . . . -_ .. _ -- . _

2. Assessment / Issues Degraded materiel condition continued to impact plant operations.

e A chemistry excursion resulted when a sticking check valve allowed a resin intrusion into the reactor coolant system. (96005) . e Operators created a workaround to automate generating the weekly list of switchyard deficiencies to counter the slow resolution of the deficiencies. (%004) $ e A temporary alteration (TA) of the 28 diesel generator caused a local alarm which operators identified and ignored. The TA defeated the motor driven fuel pump function of a backup to the engine driven pump for approximately five years and no action was taken by operators to correct the annunciator response procedures. (96005) e Problems with the Unit 2 containment air particulate and noble gas monitors resulted in a Technical Specification 3.0.3 entry due to insufficient instruments when one monitor tripped while the other was being calibrated. (96007) Operations procedures continue to be a weakness. Improvement continues to be limited, e Inadequate temporary procedure changes of controlled LaSalle Operating Procedures (LOP) located in the relay house were used twice without proper review or approval. The procedures were for testing relays in the switchyard and improper performance of the procedure could result in tripping one of four 345 kV offsite power circuits. (96004) e Operations failed to conduct TS surveillances on eight manual primary containment isolation valves due to inadequate procedures. The valves had not been checked monthly as required, but rather were controlled administrative 1y and checked every 18 months. (96007)

 ,         o    Inadecuate non-essential service water strainer backwash
 .             procecures hampered operators when responding to the strainer clogging events. Additionally, no instructions for manuel backwash of the essential service water strainers were included in other operating procedures. (96009)

Operations has demonstrated both conservative and non-conservative decision making. However, operators have primarily exhibited a poor safety focus.

 $        e    Operators took the "0" diesel generator (DG) out of service during testing on Unit I to prevent an automatic DG start. However, should the DG be required to operate during a potential accident 2

on Unit 2. the DG would have neeaed to De man.a ' y started by operators. The operators., although not ir. violation of Technical S>ecifications. " worked around" a degret eo i cont 11 tion to complete tie testing. (96004) e A degraded RCIC pipe support identified by y operator was not promptly corrected due to a poorly writte! N(, no PIF and the failure of the operator to infom his %g: visor. (96005) e Operators demonstrated an inaopropriate safety focus when making operational decisions regarding CSCS operability following the plant transients related to the foam sealant injection into the service water tunnel. (96009) Operator performance in the control room was improving. e Unit I was manua'1f scramed due to high vibrations on the main turbine generator bearings. Operators observed the higher vibrations and developed a plan for the subsequent load reduction and eventual scram as vibrations increased. (96005)

• Heightened level of awareness briefings were generally thorough.

Operators maintained good control of control room activities. (96004)

• Control room operator response during the service water clogging events was good. (96009)

Operator errors are still occurring, e An auxiliary operator incorrectly opened a valve while exiting a procedure involving a condensate polisher. The turbine building sump overflowed as a result. (96004) e A Nuclear Station Operator (NS0) incorrectly removed the Mode Switch key for no apparent reason, placing the Unit 1 in an unplanned LCO. (96005) e Two out of service errors occurred on BOP equipment where non-licensed operators manipulated the wrong equipment. Tne operators failed to perform an adequate self-check. (96005) e Four channels of the Intermediate Range Monitoring (IRM) trip function were inadvertently removed from service. (96016) e Irradiated fuel movement was conducted while Containment Purge and Ventilation system valves were in a condition outside of technical specification requirements. (96016) e L 3 l3

3, Actions / Recommendations Continue with the core inspections for the operations area, with-increased emphasis if field observations of control and auxiliary plant operator performance. Continue to monitor outage activities as they impact the operations area. Specific inspection focus areas will be - developed by the resident staff. B, PRINTENANCE

1. Current Performance In June, a major breakdown in work control culminated in work on a safety related structure being conducted 4s minor maintenance. The work was performed without sufficient reviews, procedures, or oversight, As a result, foreign material was injected into the safety related service water tunnel, rendering all service water inoperable for both units.

During the period, continuing problems with plant equipment were l indicati n of weaknesses in initial design, work control, personnel performance, procedures, and preventive maintenance. While some-i improvements were observed in the areas of plant materiel condition and work control, these areas require continued management attention, The work control process was not an effective mechanism for improving the materiel condition. Work was not being effectively planned and scheduled, Progress was slow on improving overall materiel condition of the station, Improvements were implemented for several-long-standing equif 't deficiencies and operator work-arounds. A large amount of emer" mrk, rework, and difficulties in planning and executing work, hinos , . gress in implementation of the station s materiel condition improvement plan, 2, Assessment / Issues Procedural guidance continued to be problematic. Weaknesses in some craft skills contributed to rework on several components. In addition, personnel performance errors, including inattention to detail and failure to follow 3rocedures by maintenance personnel, led to several

 ,          plant events. Wort package quality was satisfactory for most jobs:

however, some faulty work packages led to plant events and delays in work execution, e Procedures used to maintain the service water strainers were weak and the workers did not identify in the package all required information with regard to as found conditions. (%009) e Weak procedures led to the inadvertent de-energizing of the p ' security uninteruptible power supply during performance of L preventive maintenance. (96004) 4 s

e Unit I restart following the refueling outage was delayed due to problems with the electo hydraulic control (EHC) calibo t m procedures. (96005) e Examples of human perfomance errors included a fire in the Unit I heater bay, inadvertent engineered safety features actuations . during surveillance testing (96004), missed TS surveillance on manual scram push buttons (%005), and out-of-service problems. , (96007, % 016) . Corrective actions continue to be weak. The Ouality Verification i organization has had an outstanding Corrective Action Request (CAR) on  ; the weak corrective action program for two years and the station has not I demonstrated the ability to fix the problem. e Corrective actions taken as a result of the service water event  ; did not prevent unauthorized work on equipment such as the strainer flow measurement and excavation of the cooling lake dike. (96009) e A maintenance work practice deficiency and a procedural weakness  ! resulted in a main steamline isolation and reactor scram during a surveillance. Corrective actions for a previous event and a Problem Identification Form (PIF) were inadequate to prevent J recurrence. (96007) e Poor materiel condition of the EHC syrtem continued to challenge operations. Problems with turbine control and bypass valves forced a shutdown of unit 2 in May and a shutdown of unit 1 in September. The problems identified with shutoff valves and servo-valves had been seen in the past but were corrected on a case by-case basis. (96005) o Materiel condition of the reactor water cleanup system led to a resin intrusion into the reactor water system and delayed unit startup by two weeks. (96005)

3. Actions /Reconnendations Continue to perform routine core and regional initihtive inspection with

.. emphasis on work planning and control. Place increased emphasis on direct observation of maintenance and surveillance activities. There were no deviations from the previously planned inspection activities. 9 I 5 l

C. ENGINEERING

    -1.-Current Performance An overall decline in engineering performance became evident in=

responding to the service water event near the middle of the period. . Incomplete and inaccurate cause investigations, which resulted in errors and non conservative decisions contributed to the decline. Although the licensee had taken some actions to address longstanding material

.ondition problems.-results of the efforts have been slow and plant equipment problems continue to be accepted. Corrective actions to correct identified problems were slow or inadequate and design change procedures were not always used for design changes.

, 2. Assessment / Issues Eng'ineering problem identification and documentation wre poor, i e Inadequate problem documentation by systems engineers contributed  ! f to the misclassification of lake screen house crack sealant work. . I which jeo>ardized essential service water and the ultimate heat- ) sink for Joth Units. (96009. Section El.2.1) ' e In September 1996, the licensee's preliminary determination based upon conservative calculations, was that some WKH 70-13 ADVs would

not close under their design basis dynamic loads. Although the i recent licensee actions to address this issue were proactive and

! thorough, the inspectors determined that the problem had not been

formally documented by a PIF and had not received a formal i

operability assessment in March or April 1996 (when the issue was

first identified) as required by plant procedures. (%016) i

e ' Engineering failed to identify a possible water hamer problem

- with the RHR heat exchangers. When questions were raised by the NRC, subsequent engineering investigation indicated that a water

hamer problem existed. Units 1 and 2 remained shutdown until a

               " keep fill" type modification to prevent water hamer could be installed. (960011)

, Weak and inadequate root cause analysis and inadequate and untimely

. corrective action continued to be a problem.

! e Engineering determination of the cause of the first service water !- clegging event on 06/19/% was incorrect. lacked a thorough Questioning attitude and had weak technical support. This-l resulted in a continuing challenge to the ultimate: heat sink of L both units and a-second service water clogging event on 06/24/96. (%009. Section E1.2.1)' e Failure to initiate prompt actions to remove the sealant material from the service water tunnel and system after the service water L 6 l l l'

cioggin,q events resultec in exten#c rist of ngnificant reactor cooling problems. (96008) e Action tc resolve e licensee 1.%ntified pit @em of weak root cause analysu and troubh; shooting ter.hvime! wu wery slw and appeared to ham 14t'le effect even thoagn 'It waF;0entified in a licensee . corrective act W n recoro ICAR1 more than two years ago. This issue had ten addressed 1r. . sever 6 NRC insoection reports.

                                           -(95005) e       Root cause team ret.omendations on the RCIC rupture disc failure were weak and included preconditioning of the RCIC system.

(96010) e Root cause analysis of the *0" DG failure was narrowly focused and non conservative actions were recommended. (%010) Engineering operability evaluations'were poor, and contained-inaccuracies, o An operability evaluation, performed after the first service water clogging event was based on the wrong cause and was invalid. (96009) e An operability evaluation.. performed after the second service water clogging event, addressed the correct cause but was based on erroneous vendor information and was also invalid. (%009. i Section El.2.3) , e The inspectors identified a potential weakness in' the licensee's implementation of NRC guidance (GL 91-18) on TS required equipment operability. The licensee's program was overly reliant on TS surviellence test results for operability determinations. (96016) The design control process was not always used to control design changes. j _e. The size of the pump impeller for the "A" RHR Service Water Pums was increased using a maintenance work request and by-passing t"le ! change control process. This resulted in increased pump pressure i and flow. The increased pressure and flow exceeded the capacity-of the installed flow meter and resulted in igroper testing of the pump and damage to the manual isolation valve on the pump outlet. Results were the improper in-service testing of the RHR service water pumps and the in operability of the "A" service < water system. (%011) e The pump casing material- on the service water spent fuel pool (;- makeup pug s was changed from carbon steel to stainless steel using a maintenance work request without using or involving the design control process. (%011) 7

    --      - - - - -  ,  y_,                       ..                              - _ .

e A temporary alteration (TA) on the 28 diesel generator, which had been in place for approximately five years, caused a local alarm each time the diesel was run. The operators, who were aware of this TA. identified and ignored this alarm. The TA defeated the motor driven fuel pump function as a backup to the engine driven fuel pump. The design modification to correct the problem had not - beon installed even though the TA had been installed for approximately five years. (96005) Design calculations were sometimes incorrect or used questionable assumptions. e Calculations VY-004. ATD 0375 and 3C7-089-001 did not include heat piping heat loads even though a modification had changed the system to take suction from only the suppression pool which is a hot water source. (96011) Multiple differences between plant equipment and the system descriptions in the updated final safety analysis report (UFSAR) were not identified and corrected. s For years the EDG service water strainer backwash flow was set considerably below the minimum of 250 gun as tequired by Section 9.2.1.2 of the UFSAR. Under these conditions, there was no assurance that the strainer backwash would have functioned as designed. (Section E4.2 of 96009) . e The size of the non-essential service water strainer screens were larger than the size specified in Section 9.2.2.2 ef the UFSAR, (Section E4.3 of 96009) e The pump casing material on the service water spent fuel pool makeup pumps was changed from the carbon steel s Section 9.2.2.2 of the UFSAR to stainless steel.pecified (96011) in

3. Actions /Recomendations Continue to perform routine core and regional inspections of engineering.

[...... . . . . , . . . . . . . . . . _ . , . . . , , . . . . . . .....,.. ..

                                                                                                       .~..]  --

Postponed. Perform an Engineering and Technical Support inspection during early 1997.

                    ~ The previously planned inspe'ction activities were performed as scheduled. Several additional inspections. including an augmented team inspection, were conducted as a result of the service water sealant injection problems. In addition. a safety system functional inspection (SSFI) of the essential service water system was completed during September of 1996.

8

i-D. PLANT SUPPORT

1. Current Performance i i'

Overall perfomance in the area of plant support was good. Radiation - protection, chemistry ana emergency preparedness perfomance improved during the period, but challenges remain, Weaknesses-in t;#e station's ability to effectively schedule, control and perfom work causeo unnecessary dose expenditures: two resin intrusion events, which were caused by material condition problems, impacted plant chemistry. controls. Performance and overall status of the Emergency Preparedness (EP) program was good. The new EP Coordinator is functioning well, and the program appears to be on an improving trend, The meteorological tower issue is still pending resolution. Challenges also remain in security and fire protection. Personnel errors contributed to a decline in security performance: poor work practices during welding caused a significant fire; and, several firewatches and required fire protection surveillances were not performed,

2. Assessment / Issues Radiation Protection Continued igrovement was noted in ALARA planning and source term reduction, e 1995 dose (520 rem) was the lowest in recent history, and both non outage station oose and indiviuual worker exposures continued to decline (96004),

o Good ALARA planning sndused initiatives etc used. The licensee effectively Limerick(cameras Station l shielding,esson)swe learned" in radwaste modification work (%004), e Unit 1 drywell dose rates (20100 mrem /hr) remainci constant owing to zine injection (general). Weaknesses were noted with work planning and coordination. e- Continued problems with schedule adherence, work scope-control and rework contributed to additional dose during the unit -1 refueling outage. In particular, about 11 rem was accrued from rework

                     . activities alone. (%004) e    Weaknesses in comunication and clearing of out-of-services (005) by operations delayed work and ispacted RP coverage of inservice inspection (ISI), refuel floor and source tem reduction 3ctivities. (irs 96002, 96004) e Poor interde artmental comunication (shieldin installation and tool availab lity/ ownership) delayed severa' j!bs in (and prior 9

1

to) L1R07. The delays impacted RP coverage-of plaat activities. _These problems also occurred during L2R06. (96002, 16006) Radworker practices and radiologicM housekeeping continued'to be a problem.

                                                                                      ~

e- Contrary to RP requirements, high pressure water hoses running from inside the reactor building, under the trackway doors, to an outside high pressure spray system, were left unattended. The hoses were used during source term reduction activities and were a potential unmonitored release pathway. (%005) e A laundry bag having localized radiation levels of 700 mrem /hr (contact) and 150 mrem /hr (at six inches) was transported to the laundry area without RP having been contacted and, therefore, an adequate survey being l)erformed. General radiation levels on the -- bag ranged between 60 30 mrem /hr at six inches. (96006) Material condition concerns continued to impact radiological performance o The licensee experienced two resin intrusion events (Unit 2 condensate polisher and unit 1 RWCU filter demineralizer) resulting in elevated sulfate and decreased pH levels. Material condition problems contributed to these events. (95011. 96006) e Station efforts to improve material condition continue to impact station dose. For example. -in addition to the 75 rem during the Unit I refueling outage, and estimated 180 rem was expected from planned material condition improvement efforts in 1996. However. improved ALARA planning and source term reduction efforts have resulted in declining non outage station dose and individual worker exposures. (%004: General) The chemistry program was good, but some minor weaknesses were , identified in the Radiological Environmental Monitoring Program (REMP). t e The ins)ectors found numerous deficiencies in the implementation

               -of the REMP program, compared to the requirements of the ODCM; Additionally, the licensee did not describe corrective actions for deviations from the REMP sampling requirements in the 1995 annual

( report. as required by the 00CM;-(%006) e The chemistry and REMP programs were good, with excellent-analytical ability (radiochemical and chemical) demonstrated by-the staff.'(96006) e Plant water chemistry was good, with improvements noted in reactor-water sulfate levels.-but feedwater iron levels remained above average and material condition problems continued to-impact chemistry. (%006) 10 o

e Maintenance of the Post Accident Sampling System (PASS) and line orgar.12ation self-assessments of the chemistry and REMP programs imprnved. (96006) Security , Several personnel error events contributed to a decline in security program performance: e A deliberate violation by a first line security supervisor (alann station operator) who caused an alarm record to be falsified. (0! Case No. 3 96 019) Enforcement A: tion Pending e Deliberate violation of the security plan involved the removal of a security badge from the protected area and an effort to surreptitiously return the badge to inside the protected area. (96004) e 31x individuals were granted pre,;ected area unescorted access authorization without the full background investigation being conducted within 180 days in violation of 10 CFR 73.56. (96005) e A violation of 10 CFR 73.56 involved the failure to two security officers to make a timelt report to supervision concerning observed indications of aberrant behavior by a third officer. (9600.5) i e A violation involving the improper implementation of compensatory measures for a failed intrusion alarm zone. (96005) Security and station self-assessment activities continued to be good, e 50V identified that the contract security contraband drill program was ineffective. (96005) e Excellent self assessment using root cause analysis by Security of events involving security human performance deficiencies identified organizational weakn3sses. (%005) Maintenance support activities for the security system were professional, complete, and timely. (96005) 1 Emergency Preparedness The overall status of the emergency preparedness program was good and improving, but a long standing discrepancy regarding the UFSAR was not resolved. o Response facilities were in an excellent state of operational readiness. Material conditions had improved significantly. Emergency equipment inventories and maintenance were very good. 11

with timely corrective actions taken where deficiencies were identified. (96004) e The material condition of the Operations Support Center was . significantly improved, and was a dedicated facility maintained in a setup state. (96004) ~ o Emergency cocinunications capability was very good. (96004) e was named in AnewEmergb.PreparednessCoordinator(EPC)Part of this September, change inc responsibility for the Radiological Environmental Monitoring Program (REMP) from the EPC, allowing for greater oversight of the EP program. (%004) e Station EP staff workload was high, dealir.g Hth program maintenance, past issues and needed procedure revisions. (96004) e A violation of 10 CFR 50.59 was identified concerning the failure to evaluate the emergency response effect of new site structures on the accuracy of the meteorological monitoring system. This represents a long standing discrepancy in the Updated Final Safety Analysis Report. (96004) Although EP self-assessments were good, a portion of the 1995 station audit was weak. , o A Peer Review had been performed during January 30 - February 1, 1996. This review identified several items, including needed procedure revisions and procedure disposition. Peer reviews have proved very valuable (96004). e The 1995 audit was weak in the area of assessment of the interface with offsite authorities in thac interviews, either in person or , via telephone, were not cunducted. The audit report did not contain a clear conclusion as to the adequacy of the interface. (96004). Event response and performance during the 1996 annual exercis? were a good: e The October 31. 1995 Alert classification (Traversing Incore Probe , (TIP) malfunction) and notifications were made properly and in a timely manner. A debrief meeting and event critique was conducted. An outstanding, highly detailed review of the activation was performed according to procedure (96004).

• Performance during the . lune 19. 1995 exercise was good. Emergency r classification and notifications were aopropriate and timely.

I Activities to mitigate the postulated accident scenario were effective. The decision to evacuate non-essential personnel was untimely. Some OSC responders failed to demonstrate adequate 12

i concern for inplant redtologiti' :onditions. The licensees' self. assessment cf the exercist was gvad, (96006)

        ' Fire Protection The licensN co'.Tinued oesoping 9b Fire Protection Improvement Plan, identifying mosi of the!? fire praten ton weaknesses, but occasional problems cont tnue1 f.960N.)  .

e A signif1 tant not wk hre curred prior to the inspection as a result of poor work practices. Although there were good initial corrective actions for this fire, the inspector identified additional hot work controls that were not followed. A violation was cited for " hot work" performed without combustibles removed or covered within 35 feet of work for two jobs. (%004) e Other fire protection activities, including control of combustibles (with the exception of hot work), fire protection equipment and fire protection staff knowledge and performnce were considered good. (96004) e Backlog of approximately 100 open fire protection work reauests (WRs) which dated from the 1994 to 1996 time period. Some WRs were significant items. (96004) l e There was a low number of fire protection impairinents requiring a l-fire watch. (96004) i

3. Actions /Recomendations Continue to perform routine core and regional inspection with emphasis on radiological dose, work planning and control, and security personnel -

performance. There were no deviations from the previously planned inspection activities. 111. Future Insoection Activities ( Special Nuclear Fuel Services inspection (Salehi)' Maintenance Rule inspection 11/4 - 11/15/96 kVM postponed Routine Security inspection 1/27 - 1/31/97 Engineering and Technical Support inspection 7/14 - 8/3/97

          'Although this is on the current inspection plan, it is not clear whether or not the inspection will take place since K. Salehi, who was originally assigned to perform the inspection, is currently on a 3

rt,tation in HQs. I, 13

IV. Attachcents

1. Plant Issues Matrix

2. AE0D Performance Indicators

3. Power History Charts '

4. Plant IPE Data Tables i

) 14

LISalla PPR 3/%-9/% PLANT ISSUES HATRIX LASAILE l DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF l 10/08/ % NRC ENGR Potential weakness in the licensee's Inadecuate IR96016 implementation of NRC guidance (GL 91-18) Procecure/ on TS-required equipment operability. i Instruction Licensee's program overly reliant on TS surveillance test results for operability determinations. 09/29/ % licensee OPS Four channels of the IRN trip function human IR96016 were inadvertent']y removed from service perfornance under an 00S for the APRH trip function (trip functions shared a common RPS contact sich was jumpered out of service). Compliance with the RPS technical specification was achieved fortuitously (scram inserted for unrelated work). 09/28/ % licensee OPS Irradiated fuel movement was conducted human IR%016 outside the applicable TS requirements performance (while Containment Purge and Ventilation . system valves were in a condition where one valve functional but inop.. the other valve closed but energized). When the condition was identified. the on-duty operators misinterpreted the TS tine clock, and thought that they were in an 8-hour LCO rather than non-compliance. 09/28/ % licensee ENGR

Some WM 70-13 ADVs would not close under human IR96016 their design basis dynamic loads. The performance inspectors determined that the problem had not been formally documented by a PIF and had not received a formal operability assessment in March or April 1996 as required by plant procedures.

W 4

                ~

i LaSalle PPR 3/%-9/% PLANT ISSUES MATRIX ' LASALLE l DATE l ID BY l SALP l DESCP.IPTION l CAUSE l REF l 09/28/ % licensee ENGR A proactive and thorough preventive Self- IR%016 maintenance initiative led to Critical identification of a potentially generic concern with the effective diaphragm area and spring preload (spring to close) of WKM Hodel 70-13 ADV actuators. These ADV actuators were used in the RCIC (steam drains) and PCIS systems at LaSalle. Problem initially identified in March / April 1996. 09/24/90 NEC ENGR The size of the pump impeller for the "A" design IR%Dil RHR Service Water Pump was increased using control a maintenance work request and by-passing the change control process. This resulted in increased pump pressure and flow which involved work-arounds and finally improper in service testing of the PJ1R service water pumps. 09/24/96 NRC ENGR The pump casing material on the service design IR960ll water spent fuel pool makeup pumps was control changed from carbon steel to stainless steel using a maintenance work request without using or involving the design control process. 09/24/96 NRC ENGR Calculations VY-004. ATD-0375 and 3C7-089- design TR960ll 001 did not include heat pi)ing heat loads control even though a modification .iad changed the system to take suction from only the suppressica pool which is a hot water source. 09/24/ % NRC ENGR The pump casing material on the service design IRS 60ll water spent fuel pool makeup pumps was control changed from the carbon steel specified in Section 9.2.2.2 of the UFSAR to stainless steel. pn m0/96 ------- Unit 2 shutdr for Refueling Outage ---------- IR96r

LaSalle PPR 3/%-9/% Pl>NT ISSUES MATRIX LASALLE ' l DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF l 08/19/ % self- ENGR Weak root cause analysis of the RCIC weaknesses'in IR96010 disclosing / supture disc failure. Root cause team root cause NRC recommendations to PORC were weak and analysis included preconditioning of the RCIC system. BEING TRACKED AS UR1 PENDING FURTHER REVIEW 08/14/ % sel f- ENGR Weak root cause analysis of 0 DG failure. weaknesses in IR%010 disclosing / Root cause team was narrowly focused on root cause NRC one component as causing the failure and analysis i reconnended non-conservative actions to PORC. ' 08/14/ % NRC MAINT Inadequate documentation of safety related personnel IR96009 work performed on the essential service performance  ! water strainers during the service water event. 08/02/ % licensee OPS Failure to conduct TS surveillance on procedure IR%007 eight manual primary containment isolation deficiency valves. They had not been checked tronthly. but were controlled  ! administratiyeiy and checked every 18  ; months. ' 07/31/ % licensee PS Missea Firewatch due to poor 00S: the human IR96007 initiator and reviewer of the fire performance impairment did not properly identify the fire protection equipment that was to ; taken 005. 07/22/96 self- OPS Unplanned eritry into TS 3.0.3 due to loss materiel disclosing IR%007 of containment air particulate and noble condition / gas monitors due to materiel condition work control problems and work control weaknesses. 07/22/ % licensee OPS /MAINT Several 00S errors occurred in a short human IR%007 period of time and the operations manaaer performance initiated an 005 standdown. Individually. the 00S errors were insignificant. but together repra' ant a negative trend.

                                      . .( .,.

LaSalla PPR 3/%-9/% PLANT ISSUES MATRIX LASALLE l DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF l 07/14/ % NRC MAINT Inadequate Maintenance procedure for procedural IR96009  ! reassembly of the Unit 2 RHR service water deficiency strainer 07/--/% NRC/ ENGR For years, the EDG service water strainer design IR96009 licensee backwash flow was set considerably below control > the minimum of 250 gpa as required by Section 9.2.1.2 of the UFSAR. Under these ' conditions there was no assurance that , the strainer backwash would have ' functioned as designed. , 7/--/% NRC OPS STRENGTH: Control room operator response Teamork/ IR%009 during the service water clogging events Skill Level was good.  ; 06/--/% NRC MAINT Inadequate control or work allowed a foam work control IR90009 l sealant to be injected in the service  : water tunnel ' 06/29/ % ------ OPS Both Units were shutdown due to foam -------- IR%007 i sealant in service water tunnel 06/26/ % self- OPS / MAINT Unit 1 Reactor scram and MSIV isolation IM work disclosing IR96007 ' during IM surveillance of MSIV hi flow dp practice switches (SOR switch). Violation issued deficiency for failure to take corrective actions. and procedure one previous event and PIF without weakness corrective action. ) 06/24/ % NRC ENGR Operability evaluation for second service personnel IR96008 water event was weak. Testing of the foam performance sealant did not simulate water tunnel weakness in condition. Licensee did not challenge root cause

                                                                                                                                          ~

vendor information. No thorough tunnel inspection. 06/24/% self- all Second power decrease due to service water work control disclosing IR%007 problem due to low service water header weakness IR96008 pressure. Power reduced to 773. IR96009 L e

LaSalle PPR 3/96-9/% PLANT ISSUES NATRIX LASALLE l DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF l 06/--/% NRC OPS Procedures for service water strainer procedural IR96009 , operations were inadequate in that they weakness i did not provide adequate instructions to the operators during the 06/19 event. Other procedures for essential service water strainer were found to be inadequate. 06/20/ % NRC ENGR Operability Evaluation for essential personnel IR%C98 service water was weak: problems with perfonnance service water pressure were initially in conducting thought to be due to " corn cob" root cause sandblasting material. Op Eval was narrowly focused and not thorotsh. 06/19/96 5.el f- all First power decrease due to service water work control IR96007 disclosing problem due to foam sealant injection in weakness IR%008 the lake screen house. Service water IR96009 header pressure dropped requiring power reduction on both units to 771. 06/15/9c soif- OPS /PS Failure of the radwaste evaporator causes materiel IR%006 disclosing spill of highly contaminated water and condition sludge and creates a high radiation area. 06/13/ % NRC OPS / ENGR The drywell post-accident H,/0, management IR%006 (hydrogen / oxygen) monitors were not being deficiency o mrated consistent with the UfSAR. and tle 50.59 had not been performed. The operators were given directions per " night orders" to operation the monitors in this configuration. 05/28/96 licensee OPS Control Rod Mispositioned by an operator personnel IR%0% due to the failure to self-check. ONE performance inxdiately identified and corrected the deficiency error. 05/28/96 self- MAINT unit 2 EHC Instrument Line Leak caused by equipment IR96006 revealing fatigue failure initiated a fire alarm and malfunction required swapning EHC train.

LaSalle PPR 3/%-9/% PLANT ISSUES MATRIX LASALLE l DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF l 5/24/% licensee PS Missed Firewatch: an auxiliary buildirty personnel IR%005 firewatch was missed for 7 hours. The performance watchperson thought that the watch was no deficiency longer required when a fire impairment was removed. He was unaware that there was another fire impairment which required the watch. 05/20/ % self- OPS Unit 2 Forced Outage Due to #3 Turbine equipment IR96005 revealing Control Valve (TCV) and #1 Bypass Valve malfunction (BPV): On 04/24 during routine cycling of TCVs. the #3 TCV stuck shut due to mechanical binding in the shutoff valve. The unit was run at reduced power due to this condition. A maintenance outage was

                                                                     )lanned, however. the spurious opening of FV #1 caused the unit to be shut down on 5/21. The cause of the il BPV problems were a failed card (max combined flow limiter). the pre-amp, and the servo-valve.

05/16/ % self- OPS Operator out-of-service error almost personnel IR%005 revealing necessitated Unit 2 scram: when tagging performance out a condensate transfer pump, the deficiency operator mistakenly closed the conmion suction valve to the CRD pumps. 05/13/ % licensee OPS Operating Department Individual Entered personnel IR%005 Radwaste Truckbay without Dosimetry: the performance individual did not perform a self-check. deficiency Dose received was minimal. 05/12/ % sel f- OPS Unit 1 a,anual scram due to high vibration equipment revealing IR96005 on the turbine bearing #11 and 12: the malfunction cause of the high vibration was impraper clearances on the stationary oil deflectors on both bearings. These were supplied by GE as part of the Turbine Supervisory Inctrumentation Modif1 cation. Unit I was r 'ted on 5/16 and synched , to tie grid t ./17.

 ,               c.,                .-                                                                                                                   _

LaSalle PPR 3/%-9/% PLANT ISSUES MATRIX LASALLE l DATE l ID BY l _SALP l DESCRIPTION l CAllsr l MF 05/06/96 self- OPS Unit 1 Synch to the Grid following L1R07: ***** IR%005 revealing problems with EHC calibration and reactor chemistry slowed startup significantly. 04/27/96 NRC PS Personnel Failure to Report Aberrant personnel IR96005 Behavior: the inspectors etennined that a performance security individual had exhibited aberrant deficiency . behavior (chiseling a hole in a cinder block wall with a )ocket knife. and making statements to anot1er watchmen abxit being destructive when he is bored) and it was not problem report to management as a potential FFD concern. 04/22/96 NRC OPS Degraded RCIC Su port Not Evaluated in a personnel IR96005 Timely Manner: tie inspectors identified performance , that a degraded RCIC support was not deficiency evaluated properly. An operator  : identified the condition on 4/6: however. ' engineering was not informed until 4/22 when they performed an evaluation which cor.cluded RCIC was operable. 04/21/ % licensee MAlHT Failure to Perform a Tech Spec parsnnnel IR96005 t Surveillance: operations failed to perform perforrance i weekly surveillance of the manual scram deficiency pushbuttons (LOS-RP-Wl). 04/21/96 licensee OPS Improper Hanging of an Out-Of Service: the persoralel IR96005 2A condensate transfer pus) was performance inadvertently isolated ratler than the 2A deficiency condensate makeu) pump. Before the error I was recognized tle reactor operator  ! attes)ted to start the condensate transfer pump )ut quickly identified the pump was  ! not performing correctly and shut it down. No damage to the pump was sustained.

LaSalla PPR 3/%-9/96 PLMT ISSUES MATklX LASALLE l DATE l 10 BY l SALP l DESCRIPTION l CAUSE l REF l 04/21/ % self- MINT Unit 1 Chemistry Excursion durira ~ tartup: skill of the IR96005 revealiry the unit was started up on 4/21 4+1 later craft and that day a chemistry excesion occuired past due to a resin intrusion. The internals maintenance of a check valve in the RWJ1 system was test replaced during the outage. A machining defect on the valve casing caused the valve disk is stick open during startup. This problem should have been identified tile working on the velve. 04/17/ % licensee MAINT High vibration on 2A CRD Pump following personnel IR96005 maintenance Delayed Maintenance on 28 CRD performance pump: while disassembling the 2A CRD pump. deficiency the mechanics did not question that a coupling bolt was missing and subsequently reassembled the pump and coupling as they found it. 04/17/ % self- MAINT Unit 1 Shutdown after attemptina startup revealing inadecuate IR96005 following LIR07: Unit I was started u) on procecures - 4/13. however. due to calibration pro)lems rework with the EHC turbine speed control system the turbine could not achieve 1800 rpm. The unit was shut down on 4/17 04/16/ % licensee OPS Reactor O mrator Removed Key from Mode personnel IR96004 Switch: tils p'. aced the unit into a Tech performance Sper action statement. Operator was not deficiency

                                         " thinking" and did not understand the consequences of his actions. He was terminated based on past performance problems.

NRC OPS A temporary alteration (TA) of the 28 Personnel IR96005 diesel generator caused a local alarm Performance whicu sperators identified and ignored. Deficiency The TA defeated the motor driven fuel pump function of a backup to the engine driven ping for approximately five years ar.d no action was t by operators to correct

 .                                      the annuncia,                         response procedures.

LaSallh PPR 3/%-9/% PUWT ISSLES HATRIX LASALLE l DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF l 04/16/ % licensee OPS Operators created a workaround to automate materiel IR96004 generating the weekly list of switchyard condition / deficiencies to counter the slow Persennel resolution of the deficiencies. Performance Deficiency l 04/16/96 NRC OPS Inadequate temporary procedure changes of Inade uate IR96004 controlled LaSalle Operating Procedures Procecure/ (LOP) located in the relay house were used Instruction  : twice without proper review or approval. The procedures were for testing relays in the switcnyard and imprope performance of the procedure could result in tripping one of four 345 kV offsite power 04/16/ % NRC OPS O mrators took the *0* diesel generator Personnel IR96004 (Xi) out of service during testing on Unit Performance 1 to prevent an automatic DG start. Deficiency However. should the DG be required to , operate during a potential accident on Unit 2. the DG would have needed to be manually started by operators. The operators. although not in violation of Technical Specifications.

• worked around*

a degraded condition to complete the testing. 04/16/96 NRC OPS STRENGTH: Heightened level of awareness Teamork/ IR96004 briefings were generally thorough. Skill Level Operators maintained good control of control room activities. 04/16/ % Self- MAINT Weak procedures led to the inadvertent de- Inadecuate Revealed IR96004 energizing of the security uninteruptible Procecure/ power supply during performance of anstruction preventive maintenance. , 04/15/ % licensee PS Six Managers and Three IW O Personnel human IR 96004 Violate RWP: these people accessed the perform. refuel floor, a posted high radiation area. The R' 'my were on did not allow access to hi, Jdiation areas. i

w ,, LaSalle PPR 3/%-9/% PUNT ISSES ETRIX LASAllF l DATE l ID BY l SALP l l DESCRIPTION CAUSE l REF l 04/12/ % licensee OPS Amertap Pmps Found Deadeaded: during a human IR 96005 walkdown by the system engineer. he perform. and identified that the operators had not materiel i properly restored the equipment following condition a weekly surveillance. As a result. the 1 pumps were dea @eaded for 24 hours and a seal leak on the A pump bad degraded. , 04/12/96 self- MINT Painter Inadvertently Tripped an RPS Bus:  : disclosing the )ainter accidently bumped the EPM human IR 96004 . perform. breater. This caused the trip of the RPS bus, containment isolation. and a half scram. Een the painter recognized what he did. he inappropriately reset the i breaker. 04/09/ % Sel f- MINT ESF Actuation While Valving in RVLIS:

                 . 11sclosing                                                               unknown.                        IR 96004 a Division III actuation occurred due to a licensee has                                        l pressure spike while IMs were valving in     not                                               !

RVt15. The IB DG started and HPCS pump deterstmd started and injected into the vessel for ' 14 seconds. Reactor level went from 44 to 58 inches. Violation for failure to take adequate corrective actions to prevent  ! t recurrence. A previous identical event occurred on Unit 2 on May 3. 1995. (Not reportable because the test considered the possibility of the actuation and pre- i planned for it.) [ 04/04/ % NRC MINT /PS i Violation for Failure to Comaly with human IR 96004 ' Procedures: the inspectors o) served hot perfona. work (cutting. grinding. welding) not being conducted per procedure. There were t combustibles in the area and not properly i covered. l i

m LaSallb PPR 3/%-9/% PLANT ISSES MATRIX LASALLE l DATE l ID BY l SALP l DESCRIPTION l CMKE l REF l 04/03/ % sel f- MAINT ESF Actuation during Excess Flow Check procedures. IR 96004 disclosing Valve Testing: a instrument rack spike possibly caused a Unit Division II initiation (IA other root DG. and B and C RHR pumps started). causes Initial cause appears to be procedure problem. (Not reportable because the test considered the possibility of the actuation and pre-planned for it.) l

      ' 04/02/%     self-        MAINT         FE P'ug in Stator Water Cooling System:                                         human             IR 96004 disclosing                after returning the system to service                                            perform.

I following work during the outage. it did not operate properly. The cause was a FME plug left in the system piping. 04/01/ % licensee MAINT Failure to Complete Tech Spec Surveillance human IR 96004 within Required Time: all aspects of the perform. and Tech Spec required response time test work control surveillance for Unit 1 Division 2 could not be completed during the originally scheduled time (03/13) due to safety concerns. Poor communications led to the failure to complete all aspects of this

                                                                                                    ~

test before it was past 1.25 date (04/03). 03/27/ % sel f- OPS Unit 1 Reactor Scram During Refueling: a materiel disclosing IR 96004 full scram was caused by a spurious spike condition of "H' IRM. One rod was withdrawn at the time and properly inserted. (The shorting link were removed per Tech Specs which allowed the non-Coincident scram.) The root cause was determined to be a bad connector. 03/27/ % self- OPS Sump Overflow Due to Improper Valve human IR 96004 disclosing Manipulation: while responding to an perform. actual fire. an opera?or made an error in securing the D condensate polisher (CP) after performing a rouline operation. The G CP vent va' was inadvertently opened. causing the . . to overflow. .

xe tcSalla PPR 3/%-9/% PLANT ISSUES MATRIX uSaue I me I 1o n I sue I ascai m on I cause I atr 1 03/24/ % licensee PS Missed Tech Specs Hourly Firewatch: an human IR %004 hourly firewatch was not performed on an perform. and LER impaired fire door. communication 03/27/ % self- MAINT Fire in Unit 1 Heater Bay Due to Poor Work huran iR 96004 disclosing Practices: workers went on break with the perform. welding stinger energized and an acetylene bottle valve open to a cutting torch. The welder stinger created heat in a chain-fall dich melted the acetylene hose and caused an acetylene fire. Combustibles in the area also contributed to the fire. I i

p . 8 PREDECISIONAL I.ACALLE 3 i PI EVENTS 70H tb? SCRAM os/ tem ues snnoi. M.ne, reti . e4 er.s14 ews wtasilows at toot MEC

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PI EVE RD FOR 9F-1 MONE PI XVENTS POW 96-I 30'NE PI EVENTS FOR 95-2 SCRAM eva6/96 Lier 50.na: H644 MSC rw alst P0wt cettatl0Ns At 1001 ' \ A km BCRAM OCCuttt0 Wtu tnt MllVI CLOSED UuttMt!EDLT DusthG A CAllDRA110W OF 3 FLOW l&OLAfl0W RLA&0N5. IWlftuMENTAfl0N. tut LICEN$tt il INYt511GAflNG int CAunt. ONE CmAmatL WAS Ik 1851 Wit f >t 01htt thANWil f s I

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PREDICISIONAL LASALLE1 tend Se am s e c ~ aen - Poet Group Gereral Ekctnc Post.Th41 "'#"" E 913 to M-2 feends and Devwbons Deutsons From Plant Peer Group Self Trend Median short Team Long Term OPERATIONS (includino startup) Automsuc serarne Whlie Crtlical - -0.23 - 0.09 Safety Syttom Actuations - - o o Significant Events - o - o Safety System Failures - g -

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LASALLE Trends & Deviations 1 rw Decnown-

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4 LASALLE 1 PREDECISIONAL OUTAGE DATA FORCED  ! SIMt DAlta N/)6/M * * ' ' ' M AGE h85: 431.9 (18.0 Dors) , MK 1 McMilt DCam M 10 eMur 1 Mle STEAM lt0LAtlaw (Ltti 373tente). Lasit M Minto ) Wf

• LIM Dut 10 ICS As CSCS fallPutet (20LleG BTritus le0PtAABLE $UE 10 70RileN i MittlAL la IW DitVitt natilt tviita tunutt (Lite 3T396006). '

EQUIPMF.NT FORCED SIMT DAfti M/12/M Maar uts: 123.3 fl.3 Days) MBC 3 Lallt satischer M 70 hitM VitAAf f te LtytLS ON TW MIN TUR81W btAAl#C fit. SCHEDULED 31Mt Daft: M/07/M MAGE lett 0.9 MEC  : E le tuktlet OvttsPtED TelP ftst. SCHEDULED stM1 DAtle 01/25/96 M AGE met 2464.0 (102.7 Ders) Dibt  : AtfutLitG M AGE. t EQUIPMENT FORCED 81 M 1 Daft 08/74/95 MAGE mla 102.1 (4.3 Deys) M EC t MuuAL 9tACf 0R SCRAM DUE 10 L0st of t>t *1t* TUntitet MlWu atACToa fit 0 Meer DutimG tuavtILLANCE it511nG. EQUIPMENT FORCED staff Datt 08/16/95 M AGt Wtl 130.4 (5.4 ters) MEC t ALIfCmAtlC REACTOR SCRAM 7094 Mlu SilAM lt0LAfl0W VALVI CLOOutt Dut TO MlW SitAM TWWtl elGN trasmikAtunt, WNICN Wu CAugED ti f ut Lost W TIIt MAciat pull 0lWG WNilLA110k ST5f tm. EVENTS AE00 CONSIDERS IMPORTANT netm 9

LASALLE 1 PREDECISIONAL PREDECISIONAL PI EVENTS NDT INCLUDED IN THE 96-2 REPORT Sr- ..,=,. u t , 00. . . ., at. M WenF tilf  : Cuelfl0W 81819 SimCE MT 19M

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ACCIDENT SEQUENCE PRECURSOR DATA ("' fees Ale 1tes DATA PYWELJAAte6ARY **) fWrt Daft: 09/14/93 CE*t 1.M . 4 DISC Scham As tos5*0f*0fflift P Wtt tytef Nft: 03/31/95 CDPt  : 7.2E+5 MSC e CW5 tWE M8e>$ FAIL (EXPAe J0lWT. SCRAM. Sf$ftst$ Af f tCTED.

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PREDECISIONAL t LASALLE 2 PI EVENTS FOR 95-3 NONE PI EVENTS FOR 95-4 *

• SEF 11/21/95 Ltte 3 N fs011 50.no: 39646 PWR W181: EVtWT OCCutttD DualhC OPitaflCN At 1001 POWtt BROUP htActDa Coat in0LA10W tootlWC SYSTEMS etar SilftM 8 RIAtttet Coat ilo utl0W C00LlWC ST8ttM MSC 8 BCit DECAME lWGPitAsit nnett A Dif fitfull AL Pettsunt wifCW FAllt0 DutlWC A glatVilLLANCE. fut IW60AA0 SitAM l&0LA110W VALVE 190 LATED DURlWC AN AfftssPT 10 EElf fut SURVilLLANCE.

PI EVENTS FOR 96-1 t

                                .                        NONE PI EVENTS FOR 96-2 NONE

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PRE 0[Cisl0NAL LASALL E 2 t.ena s=== se. mn=== Poet Group Gerwral Elecine Post.TMt "'"* Lcrw i i 93 3 to 96 2 Trende and Devisens Deviatons From Plant Peer Group Se#. Trend Moden Short Term Long Term OPERATIONS Automatic Sorems While Critical - o .- 0.67 SeWy System ActusHons - g -

                                                                                                                          .o 30 Signiflcant Events -                          0               -

0 Safety System Failures - 0 68 -

                                                                                                                            -0.20 Cause Codes (All LCRs) a amme=e w.io rne p=== =e -
                                                                                                  ] Oss            -

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                                                                                                                      !                              I Cauce Codes (NI LERs)

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0

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                                                                                                  ] 0.07            -

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0 FORCED OUTAGES Forced Outage Rate * - 0.23 ' 0 Estulpment Forced Outagesl * ~ 4 26 I ~ t 1000 Commercial Critical Hours L -l 'O 18 lW

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A DETAILED PLANT ANALYSIS OPERATIONAL PERFORMANCE DATA FOLLOWS

}(: i i i 9

LASALLE 2 PREDECISIONAL OUTAGE DATA EOulPMENT FORCED - staa M.t wit.:,

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Ntc StattATOR TARIs OFF Litet 70 Pettom stAttithAmm Eat VM Mik MhEt 18AASF0mit titCame(Cf. EQUIPMENT FORCED SIMt Mits 02/04/w M W188 149.0 (6.2 Dere) NK s Itamust REActe SWAN BLE TO Last Of CDOLlet 85 TE 'N' 80418 PthNt 7*TAN 970RIER AND 8tLINitilAmCE eu TE IMett 4 inatlW'0Drf00L VALW. EOU:PMENT FORCED ffMT M itt W/16/fl M aat east 1M.5 (7.9 Ders) NK t Ituunt atActet scum Pot stAlsitaAmu Of ful '3A* DEACTOR etcittuLAfilm FLOW toutt0L VAtyt.

                                                           . EVENTS AE00 CONSIDERS IMPORTANT isme t

9

i LASALLE 2 PREoccisIDNAL i l PREDECISIONAL PI EVENTS NDT INCLUDED IN THE 96-2 REPORT ur 1./iu. Ltt. ..rnt im, PW 918' 3 fuelflew fallite fan Am lettimienft Plate Of 114 3 GBour i NEngenCT tant castles STgfeus sacLa j ff8794 8 IntflPLE STlf pl MtC ttJt!NG M8LW6tes ACfiVities Of fee wppartsia Pont, WffiCitul IWYtutett Of Festles Mitt l At takt htclpWtetD TO CnALLiset TE IrteAtiLiff Of fut ICCS. I S8r evas/w Lane 373eeses M.rast new i PW Wl8f 8 CEIBlfte $51879 8185 NAT 1996

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• i 878T04 8 teatrTIAL SERVitt Witt 9? situ l 018 68817 i Tell SWl81 WS AttleIED 70 6A1118 i AAD 2.

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! I 1 i 1 MANUAL SCRAMS - l l I SCRAM et/N/96 Lies 374 N002 . 73#8 39936 , PW ulst t SCRAM fttBI $$170LLWlbG etnutflm tegn 1005 i httC f ut HActee takt messaatti staesses a leC9tA$ LNG OlL TItrthATWt IN fut NAIN PWit

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j . ( ACCIDENT SEQUENCE PRECURSOR DATA (* 1985 A80D 1986 DATA PYtEL3046 MARY *) { Evtui Daft N/27/92 i 8988 6.1t*6 ._ MEC fuellut Ae en f alp Wifu DtGaAMD eCIC tvist Mit: M/17/M f tape  : 3.0f=4 l DtlC nFV talPtPLUG STIAlsta)/f tlP. 70 81FW DOWu/LOFW. WPCS f All TETT. I ! OUTAGE DATA

• FORCED sfAnt patt N/79/96

)                                        W1 AGE uns: 412.1                  817.2 Days)

MSC Lasit luufDOWN DUE 10 fut ECCS As CSCS taulPultut C00LluG Sf 5f tml tilhc lW0PitAllt DUE 10 fontina seAf tal AL la f ut Stevict wife sisita fuustt (Lite 3Fe%D04). EQUIPMENT FORCED stAtt Daft: 0$/21/% ! WTAat WR$$ 95.1 (I.I Deft)

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i 1 l $ PRE-DECISIONAL j > SEMI kNNUAL PLANT PERFORMANCE ASSESHMENT ) ZION , Aasessment Perbd: 03/96 through 10/96 i l

                               $ ALP Period:          04/28/96 11/22/97                                                       l l                               PrrMW dA!# Me%g:                       OPS      3 MAINT 2

. ENG 2 i PS 2 , l I, Performance overview  ; Overall, performance at Zion during this assessment period was satisfactory, but no iroprovement was noted over the previous period, Conduct af operations was usually focused on nuclear safety; however, a previously identified trend of personnel errors

resulting from ilmtention to detail, lack of a questioning attitude, and insufficient self-

' checking continued. Both lic4nsed and non licensed operators continued to make errors.

The material condition of the plant often was a significant challenge to operators. in the 3

maintenance area, inattention to detail and failure to follow procedures and work instructions were the primary causes of poor maintenance work. One inspection also

found significant weaknesses in the maintenance technician training and qualification

processes. Recent engineering inspections identified significant weeknesses in 50.59 safety evaluations, the design modification and operability assessmen't processes, and the engineering support to the plant. These findings were in addition to the still existing, previously identified issues of weak root cause analyses and engineering corrective actions.

A notable decline continued to be evident in the radiation protection area. Some improvements in ALARA planning were diminished by inadequacies in procedure and radiation work permit adherence, control of radioactive material, and the posting of radiological hnards,. Urdt 1 started the period in Mode 5 while investigating loose parts monitor indications. On March 16, tlait 1 went on line but tripped after 40 minutes due to a defective pneumatic volume booster on the 1C main feed regulator valve. The unit went back on line on March 22 where it remained at or near full power until August 18 when it tripped due to the failure of a limit switch on the ID MSIV during valve stroke testing. The unit went back on-line on August 22 but was taken off line on August 27 to repair PORV block valves which had been assemblsd without hypold gear pins. The unit went back on line where it remained for the duration of the assessment period. Urst 2 cperated at or near full power during most of the assessment period. On May 19 an operator improperly operated the 2A emergency diesel which resulted in a reverse (' power trip and removal of the diesel for troubleshooting. With the 28 diesel already 1

ZION i,...

s inoperable, Unit 2 was taken off line. The unit was put back on line on May 22 where it remained until September 19 when the unit was taken off line for its 14th refueling outage,

11. Funettonal Area Annansmants A. Ooerations

1. Current Performance Operations performance remains inconsistent and characterized by frequent operational events. There has been some progress in improving control room standards; however, personnel errors, inadvertent changes to the status of operating equipment, and lapses in configuration control continued. Operator workarounds and the plant's poor material condition continue to challenge operators. The majority of the events in this period have either been self revealing or NRC identified. This indicates that Operations still cannot identify the problems or fix them so that they stay fixed, increased inspection effort is recommended.

2.. Assessment /lsnues The trend of personnel errors resulting from inattention to detail, lack of a questioning attitude, and insufficient self checking continued and in fact, increased. On September 18, operators did not recognize that a TS LCO for containment isolation volves had been entered, during stroke testing of the 2A atmospheric isolation valve. The operators and the unit supervisor did not recognize that the stroke testing date indicated that the valve was inoperable (IR 96014). On September 16, tering the Unit 1 startup, the inspectors identified that on several occasions dunne the withdrawal of shutdown banks, control board rod demand and rod position indication deviated by greater than 12 steps and the operator continued to pull control rods even though the control board indicated greater than a twelve step deviation (IR 96014). On September 15, the Unit 2 safety in}ection pump was briefly rendered inoperable by an equipment operator inadvertently isolating service water (IR 96014). On August 16, a non licensed operator inadvertently overflowed the OB lake discharge tank (LDT) due to the previous shift operator failing to fully close the LDT inlet isolation valve, causing a backup of approximately 7000 gallons onto the floor of the auxiliay building. This was a repeat of the January 20,1996, event. (IR 96010) On August 15, while partially clearing an out of service on the auxiliary team o 1, system, licensed operators mistakenly opened a valve which resulted in cross tying auxiliary steam with the service air system (IR 96010). 2 a

l i

• On July 26, a non licensed operator misaligned a 28 diesel generator air regulation bolation valve while performing a valve lineup verification (IR 96010). .
• On July 15, an excessive load (4.6 megawatts (MWs) vice 4.0 MWs) was placed on the 2B EDG during performance of the monthly TS surveillance caused by NSO improper manipulation of controls. This was a repeat of the May 19 ovent (IR 96008).

         -      On June 12, the porteble filtration unit fell seven feet onto the transfer canal island due to a radiation protection technician's improper rigging of the unit (IR 96008).

On May 19, a 2A Emergency Diesel Generator output breaker reverse power trip was caused by a NSO's improper manipulation of the controls (IR 96007). Operator workarounds and meterial condition issues were a significant challenge to operators. On August 21, the inspectors noted a significant number of rod position indication system out of tolerance problems (45) during the Unit 1 startup (In 96010). On August 18, Unit 1 tripped due to failure of the intermediate MSIV position limit switch on the 1D MSIV (IR 96010). On May 19, the 2B Emergency Diesel Generator failed its monthly surveillance due to zebra mussel fouling in the lube oil heat exchanger and intake air heat exchangers (IR 96007). On May 19. operators were challenged when several components did not perform as expected during and after the Unit 2 shuhrov,n (IR 96007). The low power reactor trips block, P 7. did not actuate. As a result, the operators had to trip the reactor prior to the turbine /generato , per the shutdown procedure, since tripping ths *urbine would have also tripped the reactor and required entry into E 0, ' Reactor trip or Safety injection." The moisture separator reheater reheating control system could not be placed in manual operation, requiring

• local operator action to close reheat

[ control valves. The 2C main feed water pump could not be placed on the turning gear. in March, due to recurring main condenser tube problems, the licensee decreased Unit 2 power to 50 percent to address S/G foodwater chemistry problems resulting from circulating water leakage into the condensate (This was the ninth time Unit 2 power was reduced to address condenser tube problems since June of 1995) (IR 96006). { 3 l 1

On March 31, the CO, fire suppression systems to all stess were doenergized to holate a smoking solenoit' O.e: including the emergency diesels rooms, cable spreading rooms, containment spray rooms, snd auxiliary feedwater pump areas. (IR On March 16, while in Mode 1, Unit 1 operators adjusted S/G level using feedwater regulating valves. One out of 4 valves responded sluggishly. The valve subsequently overshot and caused reactor trip on high steam generator level. Driud out packing on the valve and inadequate system calibration and tuning were root causas (IR 96006) Weak performance was demonstrated in procedural adherence and inadequate procedures continue to be found. On September 22, en incorrectly positioned valve resulted in a 3,000 gallon spill of dominerallred water inside containment (IR 96014), On July 30, fuel handling personnel inadvertently dropped two new fuel assemblies during receipt inspection due to an inadequate rigging step in the procedure (IR 96010). On June 13, the inspectors noted that one of two unit supervisor's observed had weak command und control dunag the dynamic simulator examinations. Additionally, the lack of attention to detail, lack of self checking, and f ailure to use annunciator response procedures contributed to the JPM failures. One licensed operator failed two JPMs which resulted in an unsatisfactory evaluation overall (IR 96008). On May 21, operators started and ran the 28 Emergency Diesel Generator for 20 minutes without service water due to failure to follow the procedures for independent verification and return to service (IR 96007). On March 5, Unit 1 operators violated Technical Specifications (TS) by inadvertently changing n odes without meeting TS Limiting Condition for Operation. There were no cautions in the procedure to alert the operators that a transition from Mode 5 to Mode 4 could not be performed with the 8 und C main steam line upstream drain valves open (IR 96006). Good communication was demonstrated. On June 21, the inspectors noted goed communications and coordination were demonstrated among fuel handling, radiation protection, and decontamination personnel during the filtration unit retrieval evolution (lR 96008). On March 18, during a Unit 1 startup, the responsibilities of the NSO, unit supervisors, shift engineer, and nuclear engineering personnel were clearly identified and executed. The inspectors also observed consistent three way communication among the crew, and strong management oversight in the control room (IR 96006). 4 i

l 1 B. Maintenance

1. Current Performance l l Although performance in the itisinterisNe saa vts rr'unctory, weaknesses continued to '

be noted in the qualery of ruutine work actMties tutwoon to detail and the f ailure to ' follow procedures nud work mecuctions were tts primary root causes for the examples of l poor maintenenes work. itiwakrasses en+* als3 utet m the maintenance training program l with respect to trai;.ee and smatam evaluetl ors A foilowup inspection of the maintenance i training prograrri is recommerided. l

2. AnnanamentAnnues

] Craft and contractor personnel continued to demonstrated a lack of attention to detail j, while performing maintenance activities. i - On August 5, the inspectors identified that contractors had inadequately o'rected a i scaffold around the 15 containment spray pump which obstructed the operation of j the it pump's discharge valve (IR 96010). 1 l

                            -       On June 17, contractors modified a scaffold in the Unit 1 high pressure turbine l                                    which potentially adversely affected the operation of two govemor control valves

{ (IR 96008). I i On May 21, two electro hydraulic control oil spills occurred due to maintenance ! mechanics installing bolts of an incorrect length for the moisture separator rehost intercept and stop valves orifices (IR 96007). Craft personnel demonstrated a lack of adherence to procedures and work instructions. ! - On August 16, the inspectors identified that maintenance mechanics had not documented as found discrepent conditions, such as missing and loose parts during i the v.spection of the 1B centrifugal charging pump shaft-driven oil pump, as ! required by the work request package (IR 96010), i i - On April 2, the inspectors found three loose botts nn the "O" diesel generator after mechanical maintenance personnel had completed camshaft modifications and other i maintenance work. Also, en inadequate quality control inspection of the diesel L reassembly was performed (IR 96006). l Poor material condition of plant components and inadequate preventive maintenance j adversely affected plant operation. I i- - August 18, the licensee determined that the Unit 1 trip on August 17 was due to l the failure of a limit switch on the 1D main steam isolation valve. The root cause of , the limit switch failure was attributed to poor preventive maintenance (IR 96010). t l 5 l i l i

      , - _ . . - - _ _                . . . . . , _ _ _ . , . _ . _ . _ . . - . _ . . . _ . .   . . _ _ , _ . . _ _ . _ . . _ . _ _ _ , _ - . . . _ . - . _ , . _ . _ . _ . , , . _ . , -                         _ . . ~ .

On March 20, the 2A DG failed its monthly operability test due to the failure of the alt start control valve to close due to contaminating oil and sealant (IR 96006). The systems approach to training was generally effective; however, weaknesses were identified. . On March 22, inspectors determined that the systems approach to training (SAT) for the maintenance department was effective in its design and implementetion (IR 96006). Weaknesses were noted as follows: Maintenance personnel and first4ine supervisors informed inspectors that

shhough toining had been successfully completed, workers were not always j able to perform successfully on the job. Craft personnel wore not i downgraded or removed from the qualification matrix even thought they i demonstrated weaknesses which brought their qualification status into question.

i 4 i - Continuing refresher training was not used for its intended purpose. The i training appeared to be used to prevent incidents from occurring as opposed j to maintaining the skills of the craft at en acceptable level.  ! i

• Corrective actions to problems were not timely, were too narrowly focused, were compensatory in nature, and were not aimed at improving the overall

, skill of the craft. Treining feedback information was not collected using i reliable methods and not used effectively to enhance the training program. ,- The station's powerblock (action requests, corrective task, and planned task) back!og has slowly decreased since March. _ implementation of the twelve week rolling schedule sided j the licensee in working off the station's bartiog. The powerblock backlog decreased froin 2714 to 2356 this period. j

• On time starts and finishes have not yet reached the licensee goal of 80 percent.

During this period, starts and finishes hane averaged approximately 65 percent.

  !  C.      Enginaaring

1. Current Performance Overall, engineering performance was adequate. However, the inservice inspection and engineering and technical support inspections identified significant weaknesses. Examples included: an ineffective 50.59 safety evaluation process, inadequate modification controls.

inappropriate technical specification interpretations, and inadequate corrective actions for equipment deficiencies, in order to assess the licensee's corrective actions, a followup engineering and technical support inspection is recommended to focus on 50.5g safety 6 d

l evaluations, the design modification and operabiln, assessmet processes, and the er.gineeririg support of plant operations.

2. Assessment / Issues The Engineering and Technical Support inspection conducted during this period identified .

that significant problems existed with several technical areas, engineering processes, and with prompt and effective corrective action of identified deficiencies. Specific examples included:

• inadequate procedures and failure to foll'o w procedures contributed to a failure to formally identify over 100 UFSAR conformence review discrepancies (IR 96011).
• A failure to adaquately control the Technical Specification interpretation 4TSI) process resulted in TSis being approved which contradicted the approved Technical Specifications (IR 96011).

An inadequate 50.59 safety evaluation process resulted in a failure to perform safety evaluations and inadequate safety evaluations in several cases (IR 96011).

                  -               The licensee did not ensure that modifications had been properly evaluated, tested, and approved prior to placing the modifications in service. Nine safety related modifications and 19 non safety related modifications had been physically installed and placed in service even though the modification packages were incomplete. (IR 96011).                        ,
                  -               Several operability assessments were weak or inadequate. For example, the operability assessment for charging pump degradation which was identified during ECCS full flow testing was inadequate, in that, the assessment failed to consider the pump's ability to deliver the required flows at design conditions (IR 96011).

The licensee did not adequately trend, identify root cause and resolve some equipment nonconforming conditions (e.g reserve feed breaker for ESF buses, spray additive tank level instrumentation, etc.) (IR 96011).

• Based on inspector interviews with engineers and managers, management expectations were not always clearly defined, nor understood by the engineering l staff. Further, management was not aware of several engineering staff actions and responses. For example, management emoeted that system engineers evaluate lube oil analysis sample results, even thou@ the engineers had not been trained not qualified to perform this evaluation (IR 9601 i).

The ISI program inspection identified weaknesses. with the licensee's level of knowledge of ! ASME Code VT 3 inspections and augmented reactor vesselinspections, administrative errors with personnel certification, and untimely corrective actions. Specific examples tnoluded: 7 l l l l

   . - . _   .,  ___,,m.,,   . ~             __.,m . , . . _ . .   . - . . , _ . , , , . . . . . , _ , . - - . . - , , , , . , . -  ,         ..._..m_..-. _. _   . _ . , , . . . . ~ . . - .-.

The licensee did not verify clearances between hangers and the building structure during Code inspect lons of safety related piping supports (IR 96013). The licenses did not implement prompt corrective actions for steam generator tubes with weld zone Indications prior to returning the generators to service following the 19g5 refueling outages (IR 96013). - Ths motor operated valve (MOV)inspiction determined that most aspects of the GL 8910 program were acceptable (IR 96007). D. PL ANT SUPPORT

1. Curren* Performance Rad lstion protection performance was acceptable, but a notable decline continued to be evident. Some improvements in ALARA planning were diminished by inadequate proceduto and radiation work permit (RWP) adherence. In addition, the control of radioactive material and the posting of radiological hazards were weaknesses. Licensee plans to improve radiation monitor operability continued to lack station commitment and resources.

Chemistry performance continued to be strong. Although some weaknesses were identified concerning ettention to detcil, the water chemistry control program and the laboratory quality control program were wellimplemented. The results of the Operational Safeguards Response Evaluation (OSRE) indicated concoms and weaknesses in some areas i ' of the security program. Weaknesses in the fire protection program were observed concerning the control of impairments. The core inspection program should continue as scheduled, with regional initiatives in ' radiation protection. A follow up site visit by OSRE is recommended to evaluate the licensee's protective strategy, since it was modified as a result of the OSRE inspection.

2. AssessmentManues Radation Protection Weaknesses were observed concerning the licensee's pos.ing of radiological hazards and control of radioactive materials.

On July 31 and August 1,1996, the NRC identified weaknesses concoming fallen radiological postings and an obscured radioactive material posting (IR 96010). On March 19,1996, the NRC identified poor control of radioactive material which resulted in an improperly posted radiation area (IR 96006). On March 7,1996, the licensee identified a steam 9enerator gasket (200 rem /hr on contact) within the Unit 1 missile barrier. The licensee had not provided adequate control of tho material and had not locally posted the area as required by Technical Specifications. The NRC identified weaknesses in pre job planning, supervisory oversight, and technician performance which contributed to the event (IR 96006). 8 4

• The licensee continued to apply reson ces to improve conterrmatior control and l source term reduction, but both ares.= continue to be a challr.pe fik 96007).

Lack of managemem supvart and station commitment contributed to the continued, poor operability of radiation.monitorr.

                                        -      The gas decat tank eftluen' n,onstor has lacked reliability mee its installation in November of VD95 (IR S6016).

Th6 licensse ideritihed nssud compensatory samples fo' three out of service monitors in July through September of 1996, resulting in one Licensee Event Report (LER) (IR 96016).

                                       -      On September 22,1996, the licensee control room radiation monitoring display system (RMDS) failed to indicate that radiation monitors were in a fail mode (IR 96016).

l

                                       -      Licensee modifications to improve radiation monitor performance have lacked

! priority and have been frequently removed from the station schedule (IR 96016), i Some improvement was noted in work planning and ALARA plans, but problems were observed concerning work site preparation and procedural adherence. ! - On March 21,1995, NRC inspectors identified deficiencies concerning tne licensee's setup for the removal of reactor coolant filters (IR 96008). 1

                                      -       Licensee ALARA plans for the fuel canal decontamination were comprehensive.

However, radiation worker performance and adherence to radiation work permits and procedures were weaknesses (irs 96007,96008). Chemistry The licensee continued to conduct a strong water chemistry control program and an l effective laboratory instrument quality control program. l

                                     -       The licensee's water chemistry program was consistent with industry guidelines, and chemistry staff provided good reviews and analysis of primary and snaondary chemistry data (IR 96006).
                                     -       Due to frequent circulating water inleakage on Unit 2 (1995 - 1996), the level of impurities (i.e. sodium, chloride, and dissolved oxygen) were slightly elevated for periods of time (IR 96008).

With the exception of some minor errors, chemistry technicians demonstrated good analytical technique; however, radiation protection contamination control practices were weak. ! 9 l

.r . . l

          -     On July 9,1996, the NRC identified that chemistry technician contamination control         I practices were not in adhercnce with licensee procedures. Technicians removed samples from a conteminated area without performing surveys or re packaging the i                 samples (IR 96008).

• On July 9,1996, the NRC identified a weakness in the labeling of chemistry -

nandards. Two iron standards were improperly labeled (i.e. a six month shelf life was assigned instead of a three month shelf life, as required by station procedures) . (IR 96008). l j i l Security i The drills observed by the OSRE team indicated weaknesses in some areas. The personnel deployment strategy devised by security for protecting against an

external adversary with the characteristics of the NRC design basis threat was not adequate.

Generally command and control of the responte force during the drills was poor indicating a need for additional tactical training or shift drilling. Emergency Preparedness No regional inspections were conducted during this assessment period. Resident inspector observations did not indicate a change in licensee performance. Fire protection No regional inspection were conducted during this assessment period. The NRC identified the improper impairment of fire protection equipment and the subsequent f ailure to document the problem in a Problem identification Form (PlF).

        -      On July 1,1996, a lack of station understanding of the 1 A emergency diesel generator CO, system resulted in the ina'dvertent impairment of the system. The licensee's staff failed to recognize that replacing the discharge timer impaired the automatic function of the system and rendered the fire barrier impaired. As a result, a fire impairment permit was not initiated in accordance with procedures (IR 96008).

4 10

l PLANT ISSUES LIST

ZION 1

l DATE l ID BY l SALP l DESCRIPTION CAUSE REF l , 10/26/96 NRC Plant Supt Poor operability of radiation monitors: chronic Material 96016 operability problems, inaccurate control room Condition / i indications, lack of station commitment in Program

;                                                         implementing action plans.

j 10/06/96 Licensee Ops During shutdown of the 1A DG the operator Human 96014 incorrectly rad generator power: from 4 MW Performance to O MW instead of required 1 MW and failed to

hold generator power at 1 MW for 15 minutes.

10/05/96 Self Mamt Poor material condition of chee.k valves: resulted Material 96014 in two radioactive gas releases in the auxiliary Condition i buildmg and the Unit 1 containment. , 10/05/96 NRC Eng Temporary fan was attacned by duct tape on the Design Control 96014 Unit 2 refWetor crane: over the refueling cavity while fuel assembiies were being moved. 10/05/96 Licensee Ops Unit 1 inadvertently entered a TS LCO: for the Procedure 96014 penetration pressurization system when a ~ 4 technician lif ted a Unit 2 lead located at the "O" pp air compressor. Not recognized immediately until pointed out by SQV personnel in the control room. (Good imdmg by SQV) 09/26/96 Self Eng 500 gallons of water was inadvertently drained: Procedure 96014 from the Unit 2 RWST to the transfer canal during testing performed by system engineering. 09/25/96 Self Maint lastrument air lost to the Unit 2 containment: as Procedure 96014 a result of a poorly planned maintenance activity to install valve blocks on the instrument air containment isolation valves.

        "t it.dicates a positivo attribute / occurrence.

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        .         l

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PLANT ISSUES LIST-ZION l DATE l ID BY l SALP l DESCRIPTION l CAUSE l HEF l 09/15/96 Self Ops Uptenned LCO entry when Esquipment Attendent Human 96014 partieEy h the 28 safety injection (Sil Performance 1 pump component cooling water flow tronomitter: i in an effort to reset the Si pump cooling water low flow annunciator. 08/26/96 Self Maint Unit 1 shutdown due to failure to insta5 the Human 96014 hypoid gear locating key for two PORV ideck Performance \ valve ddve sleeves: during the 1995 Unit 1 Procedure refuehng outage. This resulted in a PORV block valve tripping on thermal overloads. 08/22/96 NRC Eng Breakdown in modification package closure Program / 96011 process: Nine safety related and 19 non-safaty Human related modifications installed and placed in Performance service although not authorized by operations and not receeved appropriate post modificatson testing. 08/22/96 NRC Eng eneffective 10 CFR 150.59 safety evaluation Program / 96011 , process: Multiple failures to perform safety Human i evaluations, and inadequate safety evaluations. Performance ! 08/22/96 NRC Eng Week and ineslequese operahusty . Program / 96011 Three of 12 reviewed were deficient, such as Human not evaluating operability at design flow Performance conditions for charging pump degradation noted during ECCS testing. 08/22/96 NRC Eng Trending of equipment problems ..J resoluelen Program / 96011 of recurring equipnient problems was week: Human Repeated failures of containment spray sodsum Performance hydroxide spray additive tank levelindication.

radiation monitors, and the reserve food breaker for Unit 2 ESF busses without adequate followup and action. Trending by system engineers such

as lube oil analysis was inconsistent.

                                                       .    .ndicates a positivo attribute / occurrence.

l lilIll l l l F 1 0 0 0 0 E 1 1 1 1 1 R 0 0 0 0 0 6 6 6 6 6 9 9 9 9 9 l E e e e c c c S n n n U / a n a a A l o C m a arnm it ai m a nm nm r o r e k r ar o aro gmf t u g mfr mfr o r ue r ao r o PHP MC P r HP ue HP ue l t e n d e su r. t gam m ol i i g rt t a n o og . l u oe r sl ae0e l ait i n S nsr euawon hln0p t i eshT oeeu t t ci s 0eR y gc ue Rmp e aco e iT l d D 7( i uie t t a umr l ef p i

                         ~-

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                                             /

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                                                                /

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                                                                                        /

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                        /                    /                  /                       /                       /

8 8 8 8 8 0 0 0 0 0 - l " i ll

PLANT ISSUES LIST ZION DATE l OD BY l SALP l DESCRIPTION l CAUSE l REF l 08/15/96 Self Ops Licensed operators failed to include valve in Human 96010 partial clearing of OOS: on aux steam system Performance which resulted in cross-tying aux steam with service air system. 08/07/96 Licensee Eng Engineering personnel failed to include necessary Human 96010 supporting information in operability assessment: Performance to justify conclusion that 1B charging pump was  ; operable with degraded shaft-driven oil pump. 08/05/96 NRC Maint Scaffold around 1B containment spray pump: Human 96010

• obstructed operation of pumps discharge valve. Performance Corrective actions inadequate from June 17,1996 event.

07/30/96 Licensee Ops Fuel handhng personnelinadvertently dropped Programs 96010 , two new fuel assembbes: during receipt Procedures inspection due to an inadequate riggeg step in procedure. 07/26/96 Licensee Ops Non-licensed operator misabgned 28 dessel + 96010 generator air regulation isolation valve: while , performmg a valve lineup verification. Good ' finding by maintenance engmeer walking down l diesel.  ; 07/26/96 Licensee Plant Supt Licensee failed to perform compensatory Material 96016  ; l sampling: when ODCM radiation monitor (IRE- Condition / 0015) was out r;f service. See also 7/5/96 Human event. Performance , 07/26/96 Licensee Plant Supt Procedure failured to specify actions to sneet Procedures 96010 l technical specification action statement: when l containment high radiation monitor was  ; inoperable during maintenance. TS not violated i since other monitor was operable. l l i

            %.    .ndicates a positive attribute / occurrence.

j

                             .,w-----,..-..-              .

PLANT ISSUES LIST - ZION l DATE l 10 BY l SALP l DESCRIPTION l CAUSE l REF l 07/15/96 Self _ Ops Unit 2, excessive on the 23 EDG Human 96008 surveillence: caused by NSO mansputation of controls. This is a repeat of the May 19 event. 07/12/96 Licensee Ops Failure to perform posthenonce testing: on Human a Unit 2 containment isolation valve following Performance ' repairs to the valve's open limit switch. 07/09/96 NRC Plant Supt Longstanding plant practice of improperly Prograns 96008 i trx g ^'..,; chemistry samples: without i surveying the materials for surface contamination. I i 07/05/96 Licensee Plant Supt Failure to obtain and anelvaa sample: when TS Material -96016 r radiation monitor (OR-PRO 7) was out of service. Condition / I Human } Performance j 07/01/96 NRC Plant Supt Replacement of the 1 A DG CO2 discharge timer Procedures 96008 i rendered the automatic function of the CO2 I system inoperable: status was not recognized  ; by fire protection, operations, and electrical  ; maintenance personnel. I

                                                                                                                                                                                          \

06/24/96 Licensee OPS Both Unit 1 reactor cooient drain tank (RCOT) Human 96008  ! pumps were deastseeded: due to the failure to performance i realign RCDT flow path following a placement of 4 an OOS for the holdup tank (HUT) maintenance  : activity.  ! 06/23/96 NRC Eng Svstem engineer slow in instinting a PIF: for Human 96008 i holes in ductwork in the fuel transfer canal area performance [ end any bypass ..ow around the charcoal bed. l f

   '                                                                                                                                                                                      I 4

F

                .    .ndicates a positive attribute / occurrence.

PLANT ISSUES LIST ZION l DATE l 10 BY l SALP l DESCRIPTION l CAUSE l REF l t 06/21/96 NRC Ops Good communications and coordination among: + 96008 fuel handling, radiation protection, and decontamination personnel during the filtration unit retrieval evolution. 06/18196 Lic Engrg System engineer identified that scaffolding: + 96008 could potentially affect the operation of two governor control valves in the Unit 1 high

             .                                                pressure turbine area.                                                                                !

06/13/96 NRC Ops One of two Unit Sg:n':::'s command and Trawung 96008 control during the 4. z' simulator examinations was a weakness.: Additionally, the lack of attention to detail, lack of self  ; checking, and failure to use Annunciator  ! Repsonse procedures contributed to several JPM fsilures. j 06/12/96 Self Ops Portalde filtration unit fell seven feet onto the Human 96008 i transfer canal island: due to a radiation performa me  : i protectioen technecian's (RPT) improper riggsq of the unit. i 05/21/96 NRC Ops Operator Work Around List was not routinely Program 96008  : reviewed by licensed operators: to ensure awareness of all plant conditions. ( 05/21/96 NRC Ops The operations staff received insufficient training Treeneng 96008 on the newly implemented computer systemt for > administr's tive control of work activities: I (Electronic Work Control System (EWCSI), and I the PT-14 system for tracking OOS equepment [: and the workaround list. 06/19/96 Self Ops Unit 2,2A Emergency Diesel Generator Output Human 96007  ! Breaker Reverse Power Trip: caused by NSO Performance } manipulation of controls.  !

      "t. endicates a positive attribute / occurrence.

_ _ _ _ _ _ . _ . . . . . _._ . . .. _.. _ _ _. _ _ - _ _ . m . . _ _ _ PLANT ISSUES LIST , ZION i l.DATE l ID BY l SALP l DESCR4PTION l CAUSE l REF l 05/19196 Self Ops Unit 2,28 Emmgency Diesel Genwator Failwe: Material 96007 i due to zebra mussel fouleng in the lobe oil heat Condition ' exchanger and intake air heat enhangers. , 05/15196 Self Mixed bed domineralizer temperature excwsion: Material the letdown domin inlet divert valve, and the Condition CCW letdown heat exchanger temperature ' control valve, responded sloggishly while establishing Unit I letdown flow. The temperature of the resin reached 148 'F for  ! several minutes. 04/25196 Lic Plant supt U2 Inopwable containment air lock door Human 96007 exceeded 24 hour LCO: RP technicians raaking performance containment entries experienced problems with the air lock door over a period of days. No PIF, l no AR written, & Ops ingeneering not notified t until 4/25 04/21/96 Self 1C low pressure turbine reheat stop and Material 96007  ! intercept valves failed to remain closed: Condition  ! following turbine trip testing during Unit 1 t startup.  ! 04/15/96 Self Unit 1 reactor trip: low flow sensed on two of Material 96007 t three RCS loop flow transmitters. Root cause Condition of trip was entrapped gases in the loop flow i r sensing liaes, which have never been routinely vented post outage. f r i t i

           .ndicates a positive attribute / occurrence.

PLANT ISSUES UST ZION l DATE l IDBY l SALP l DESCRIPTION l CAUSE l REF l 04/10/96- NRC/Lic AE sin containsnent spray esiditive ICS) eductor Material 96006 throttle waive poeielone edifferent froen the Condtion peeletone specined in Systeen Operating Instnsctions: Licensee was not aware of discrepancy until NRC pointed it out; W ?_= 4 licensee analysis determined system eas operable. 04/08/96 'Lic leoletion valve seed water systesa check waives Personnel 96006 had not been tested: for their closeng function in Performance accordance with the IST program since the Unit I refuehng outage in fan 1995. Identified by licensee IST engmeer during data review for Unit 2 outage. 04/02/96 NRC Maint Four loa.e boots on the 'O' DG after sneintenance Persocnol 96006 and snodefication work: had been completed on Performance the DG. This deficient condition did not render the DG inoperable as the post-maintenance test (PMT) had not been performed yet on the DG. 03/31/96 Self 10 Ops CO2 fire suppreselon systems to as areas was Material None doenergized to isolete a menoking solenoid velve: Con & tion includeng the emergency diesels rooms, cable spreadmg rooms, contaenment spray rooms, and aux fath areas. 03/27/96 Lic Maent N-::xy of failure to perform resguired post- + 96006 maintenance testing eliscovered during a rewtow of weeve testing efter maintenance work: by the j inservice Testing itST) Engeneer. After notifying l operating shift personnel, operators performed PT-40A-20 and PT-20-ST and declared the Valve 1 AOV-S48870A operable and exited TS 3.0.4. (see March 12 PIL item above.

                   ..xlicates a positive attribute / occurrence.

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r, , . . PLANT ISSUES LIST  ! ZION l DATE l ID BY l SALP l DESCRIPTION l CAUSE l REF l 03/21/96 NRC Maint Maintenance engineer did not identify that an Personnel 96006 inoperable Unit 2 containment isolation valve Performance (MS 006) was a reportable condition: with the valve inoperable Unit 2 was in Technical i Specification 3.9.3, "Contairwr.ent isolation i valve." 03/21/96 NRC Improvement in the I.Tir.:ntation of the source + 96006 term reduction (STR) program: imptowed coordination and planning for the replacement of cobalt-containing components with non cobalt-containing replacemerat parts. A significant number of high prior;ty valves wer4 scheduled to be replaced during the upcoming bnit 2 refuehng outage (Sept./Nov.1996) and Unit 1 refoobng outage (Mar./Apr.1997). 03/21/96 NRC Several probians observed during removal of Personnel 96006 Unit 1 reactor coolant fihers: weaknesses in the Performance preparation and planning of the evolution. Overall, RP support for the evolution was good. . . .ndicates a positive attribute / occurrence.

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e PLANT ISSUES LIST ZION l DATE l ID BY l SALP l DESCRIPTION ' l CAUSE l REF l 03/12/96 Self Ops Unit 1 operators violated TS 3.0.4 by Personnel 96006 inadvertently changing modes without meeting Performance TS Limiting Condition for Operation (LCO) 3.9.3.a.1, "Contaenment isolation Valves." For valve 1 AOV-Sl8870A. This valve provides a contamment isciation function. 03/12/96 Self Ops Unit 1 operators violated TS 3.0.4 by Procedural 96006 inadvertently changing modes: without meeting Deficiency TS Limhing Condition for Operation (LCO) 3.9.3.a.1, "Conteenment isolation Valves." The inspector's review of the procedures indicated that no cautions were provided to alert the operators that a transition from Mode 5 to Mode 4 could not be performed with the B and C steam line ipstroom drain valves open. 03/09/96 Self Eng Unit 1 safety infection (50) frozen recirculation Design 96006 line: This condition affected both trains of St. The unit was in Mode 5. Cold Shutdown at the time; however, had the unit been operating, this condition would have resulted in both trains of Si being snoperable. 03/07/96 Lic Plant ' Steam generator gasket (about 200 rem /hr on Personnel 96006 Support contact: 2 rem /hr at 30 cm) found within the Performance missile barrier: licensee found the gasket, location was not locally posted, as required by TS. - + ... . ~,.;,;,. 2,,,;h....ince..,,,nc.

                                         .__,g.__._____.__________                                                                                      _ _ _ _ -_ . _ . -

i PLANT ISSUES LIST i ZION l DATE l- ID BY l SALP l DESCRIPTION l CAUSE l NEF' l 03/07/96 NRC Ops Recurring main condameer tube problems: 1 Material 96005 Licensee deusased Unit 2 power to 50 percent Condition to address S/G feedwater chemistry problems resultir.g from circulating water leakage into the - , j condensate. The licensee performed the power i reduction without any abnormalities occurring. However, this was the ninth time Unit 2 power was reduced to address condenser tube  ! problems since June of 1995. i 03/04/96 NRC All ' Zion Plant Perfennance Review Completed NONE PPR 03/01/96 Lic Mamt Licensee omtended outage to plug aHoceed tubes Material  ! None i in the 1 A,13, and 1C S/Ge: based on Prairie Condition i Island data that CE sleeves pulled from their SGs + had circumferential and volumetric indications and a review of sunder data at Zion. f' 02/26/96 Lic Ops Emergency ventilenion auto start function Personnel 96005 defeated: During routine control room panel Performance I walkdown, a nuclear station operator (NSO) identified that three of four control board switches for the station auxiliary buddeng charcoal booster fans were in the off position, i The fourth fan was running for post mamtenance testing.' The fan switches are normally in the L automatic position so they will start when required. However, with the fans in the off I position, the automatic start function was defeated. With the fans unable to start automatically, the plant was outside of its design basis. i io

                ..wficates a positive attribute / occurrence.                                                   .           - _ _ _ _ _ _   _ _ - _ - - _ _ _ _ _ _ _ - - _

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au oe du f i r Oto wfelat f r ec e Pyw ( n o eS , s ,r t n ehie n 1 ammoc i t _ t r pt _ e n o c Ona mar ooPmf i _ ndcTv ua n eruev t eos v wipe g az nsleitn t l . i d t nP n ha" nnt s f m r at t a; - osr d .s e Ug ee n i n iregsae yb s l N mpomSl bk a rIB sopl i b e u orPe P 2 mctceTa o e ehs e r t g _. T O I m ua s op yet r of e hwp ar swsteiPpe3 nlan o c dn ei r T t n c nSt ho sl et o n9 ue S I W P eeri d n e p ebf nn e2rp2 ct cia 3 se L hf sceiir siow s iin L n oendi i l l sn l C Tnicha nseo;r Uina eeS ii g S o dt d ne n. r v t S a wAi s ce pi t  : t a oherT r n _ E U N E D et r I cwa L e sunw i a o yn r rZcduf e ot e e e nso oE p e: v ayhsmd i . c d dr sw n r2 S O nieo o  : r r Bms l e Se 3.0.eptnhmeds nt S l I eci l ai e t

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a ve ", pd seeiTl r t r r p so l T3t nn es nu l c da n e on t _ N r uas n u b. e 2 n d n r. tr s nSeo oo na w e ie A sb y 1. th 9 enionh n a dt o i t teTmzZe rdn e an n u r et pm _ L dbl e rF. t f so geer a cg eeimht eql t e Pa P sOe1 p et eaa i t t e yi n vr ta det et unr LM cc nr r at nsdmiae i i s e o 2. tomo Mhrp4t r eeu n noyni ecsasmh A; l t i l Floogvd l I t S32 c e _ n e P r r u L _. A S t n c c - i s s o a p p l l / e M O O A t u _. l b i r _ t t a Y e B v . i D C i t _ I C f l R s o c R e p i L N S N _ l a s e E 6 6 6 t a

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PLANT ISSUES LIST ZION i l DATE l ID BY l SALP l DESCftIPTION l CAUSE l 51EF l 02/13/96 Self Maint EDG failure to start: During surveillance testing, Material 96005 - the 28 EDG did not start automatically upon Condition demand. The licensee declared the EDG anoperable and investigated the problem. The 28 i EDG did not start during surveellence testing due to the failure of the right bank air start cylender. The distributor rotor seized to the distributor t body causeng the drive shaft coupleng to shear.

• 02/13/96 Lic Eng Steam generator foreign metodel (search): The + 96005 action plan was detailed and the investigation was thorough. The licensee exhausted all potential investigative approaches prior to restarting the unit.

02/12/96 Self Ops inadvertent TS entry: Unit 2 containment Personnel 96005 electrical penetration Zone 3 was made Performance i snoperable during maintenance due to a - configuration control error. The unit i inadvertently entered TS 3.9.2.a, " Penetration Pressurization Systems."  : i 02/10/96 Lic Ops inadvertently rendered both SI anners of Devision Personnel 96005 247 inoperable: and then, mistakenly, entered Performance into a four-hour to hot shutdown LCO in accordance with Technical Specification 3.4.5,

                                                          " Safeguards instrumentation and Control."
 -   "-    .sdeentme a notitium attrihaste/necterrant*n

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PLANT ISSUES UST l ZION l DATE l ID BY- l SALP l DESCluPTIOtf l CAUSE l REF l 01/26/96 Lic Mamt inoperaide valve: Thermal overloads were Personnel 96005 reissing in the breaker assemtdy for the loop "A" Performance main steam line drain valve, 2MOV-MS170. The valve did not operate _when tested because the l missmg overloads resultad in an open circuit m i the start circuitry for tne motor. 01/25/96 Lic Mamt Debris (FRE-paper / sering): found in the 1 A St Personnel pump recirc line orifice 18th occurrence in last 4 Performance years) 01/23/96 Lic Ops inadvertent noenipuistion: Operator starts 1 A Personnel Charging pumps auxiliary tube oil pump instead Farformance of the 1 A turbine driven feedwater pump auxiliary lube oil pump by inadvertent marupulation of controis (in the same cabenet). 01/22/96 Lic Eng Battery survoumace mientifies 4eyedeelen: + 96005 During a review of quarterly battery survemances, the system engmeer (SE) identified low specific gravity en several cells and low voltage on two cells of 125 Vdc battery 211. The SE's review also identified a negative trend on Cou No. 34. The inptors consedered anis c good finding by the SE.

         ~
               .Micates a poshive attrikte/occmence.
 - _ ______1 -

PLANT ISSUES LIST ZION 3

   .l    DATE        l     IO BY       l       SALP    l                     DESCRIPTION                    l     CAUSE                         l   REF l   i 01/30/96         Lic               Maint           Inoperable -h pressure channels: Unit                Personnel                           96005 2 - During maintenance on reactor                    Performance protection /engeneered safeguards circuitry (Eagle partial trip boards), redundancy requerements for contaenment pressure channels could not be met.
                                                        'TS LCO 3.4.1 was not met. Instrument                                                               l mechanics replaced a faulty circuit board which contaened the containment pressure channels, however, it was not recognized that replacing the board would result in one untrW enoperable contaenment pressure channels.

01/30/96 NRC Ops inadvertent neede changes: Whde operators Personnel 96005 were performing PT-78-ST, " Auxiliary Feedwater Performance Pumps (AFW) B & C System Tests (Normal Header Abgnmenti," Revesson 7, Unit 2 transitioned from Mode 2 (Het Standbyl to Mode 1 (Power Operation) while in LCO 3.7.2,

                                                         " Auxiliary Feedwater Purr.p System,*. The mode change was a violation of TS 3.0.4 which prohebets a mode. change whde in a LCO. Also, during the test, the operators overfilled the 2A S/G which resulted in actuation of reactor protection system circuitry.

01/29/96 NRC Ops Unit 2 etartup: the inspectors observed the weis 96005 controlled evolution. The shift engeneer, unit supervisor and nuclear engineers were present in the, control room to oversee the activity. A member of the licensee's safety qualification verification group was also present in the control room. Generally, the startup was well controlled and communecations were good. + L

    =     .,,6, ata= a nnai*iva attribute / occurrence.                   ,,

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F E R l E e e e S c c c n n ean l U ea l ea n l A nmr nm l o C n oo n r ai i t nmr n sf oo sf ri ed oo r r r r t n sf ee ee ao r r ee l PP PP MC PP i R kS e al a ggr ey y Hce r n se t ht 2 Reh ht aivr - t f i nt . ts c) hsea c usl i i t ol ag r a os w tyfos i i et g - yunsf evi ec r s af x a t on t i d i cou a dalndiafeo f cier t s er my st d in epr se Bmo e w k nivcahr or aet o yl we%c r a sr cg c ieer i el gb t t n t okaect uoh  : v<la t snis al nf i n naalae r e ve a c toai nnt io N yet a a r e Bi l heis ops 1 ngrdean St ei nd i O r e t o w pO e c s u yh g e t in T I T

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_ t . haoo S P rd f t eeno e o ss aadi e I L I R t siu nn e sr :wdr o e t vt o e onrp r pi r ot s ed sh elacdeb paro es e S C l ko , tut ad t hp , eg wonpsm T dt r , _ E S E ms a o ot f r eor vl pl po u lo2lonc a 2s uin  : saleca ehr o r U N D uivg t o g wlapcr e S S O I pr Rpkeicle ne d or ni a k v f eignmlat era vCepshsg la R cAuo i f n iein t x ds n eisn i _ Z Huo non0e n unh I . Rspr af a a 6m vn ed e o vn r sb e of T N t gle eait t y t t t l o5p l ba k l a ae.o h r ri esdso nr n rnil eih ce eeeoq r nn f u i a vgbt l t ir nl ze a ee A t r ewdf t tr t r u e g. nl e o t onin n ato ear pr a L ee e eedpuyn r o tr r e n,e w P vnper n vv , i i t e i pit n s e epoh. n vioiTa dimag n nuhiemaancf e ddk k t eld i s ntamse e u o slnl oa u erecu a d m pd . sa ri t l iept t iit nna bsb aau Qbicqwf o n omd idia%w e c P n L e r A r u S c s p s g s c p n p o O O E O

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         -                                                                                                                        PLANT ISSUES LIST                                               I i

ZION ' l DATF. l ID BY l SALP l DESCRIPTION l CAUSE l REF l 12/23/95 NRC All SALP Period 13 Ended NONE 96001 i 12/08/95 Lic Ops Si timer failure to reset: While performing TSS Material 15.6.35-1, allloads block loaded onto bus 149 Condetson except two reactor contaenment fan coolers. l This problem was due to the safety injection sequence temer not having reset from a previous periodic survedence. 12/06/95 Lic/NRC Ops Questionalde inteletive: An inoperable safety Personnel

• injection system rigid pipe support was Performance i identified. Following NRC questioning as to the -

status of the pipe support, the licensee re-entered contaenment to inspect the hanger and j correct it, but not until January 5. 11/02/95 Uc PS

                                                                                                                                                                                                 /

Worker contamination: an the containment due to Personnel i opening of wrong filter canister by the worker. Performance ' The proper filter canister was valved out by i another worker. 10 - 40 gallons of water i sprayed out in the contaenment basement. 11/02/95 Ops Operators drain 800 gesons from reactor coolant Personnel i j system: during refueleng due to improper valve Performance ' leneup. i i c

                            ,      ..uficates a positive attribute / occurrence.                                                                                                                  ;

6

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PLANT ISSUES LIST ZION l l l DATE l ID BY l SALP l DESCRIPTION l CAaJSE l REF l J FALL . Eng Sept.-Dec. Outege extended: approxima tely Material OUTAGE three weeks to perrtut sleeving and plugging Coruhtion l

                                                         - 1200 tubes, much more than planned for.                                                               l i

09/95 Lic Eng Three more eEpped fuel pump cam lobes on the Material 1 A,18, and 0 diesel generators: although a Condition  ! proposed fix has been recommended, the root  ! cause of lobe slippage is not understood. Licensee considers 2A and 28 DGs operable but  ! will inspect by year's end.

09/95 Eng inadeguate work review

Initial Unit 1 outage Personne', -l l work combines switchyard work, control cabenet Performance  ;

work and degraded contaenment integrity without adequate review.

08/95 Eng Enforcensent decretion granted

for the failure to Personnel 1

test many containment penetrations in Perfsinance [ accordance with the requirements of 10CFR50,  ! Appendix J. j 08/95 Ops The Econoce inadvertently entered into two 4- Personnel hour to hot shutdown LCO: action statements on Performance  ; safety injection pumps whde performing ground [ checking on Unit 1. l l 07/95 Ops Unit 1 Auxiuery Building (A8) Equipment Personnel l' l Attendent fEA)inedwortently pieced the Unit 2 Performance casica bed in service: vice the Unit 1 cation bed.

The EA understood the assegned task, had the procedure in-hand and went to the wrong unit.

06/95 Ops Without fouewing appropriate procedures: to Personr.e4 control the change, operators increase the relief Performance setpoint of stator water cooieng relief valve (2GC-0521). I

            .adicates a positive attribute / occurrence.                                                                                                        !

7__ _ PLANT ISSUES LIST ZION l DATE l 30 8Y l SALP l DESCRIPTION l CAUSE l REF l 06/95 Ops Enforcement discretion granted: when the Personnel licensee identified that all five diesel generators Performance were inoperable due to their not being tested in > accordance with the requirements of Technical Specification 4.15.1.B.3, " Auxiliary Electric t'ower System." 05/13/95 Maint impropwfy repaired damaged steam generator Personnel  ! manway bolt hole: resulted in the bolt jamming Performance halfway into the hole when it was reinstalled. The licensee had to cut the bolt head off and I thread the bolt head to install a nut, to of fact a i temporary repoir until the next refueling outage. 05/95 Eng Axial cracks in the roll transition area of steam Material generator tubes reported flate) to the NRC. The Condition , cracks were found during inspections prior to 1994. NRC interim approval was again sought and granted until the next refueling outage, after implementation of compensatory measures. 05/95 Maint Main feedwater pump vibrations caused by Personnel repairs: performed during the recent refueling Performance outage Manuary - April 1995) caused pump vibrations when the pump was put in service. j The vibrations were due to errors made by ' maintenance personnel when aligning the pump. i 05/95 Eng Auxiliary feedy ater system rebatulity is. the Material lowest quartib: of industry performance, due to Condition a variety of equipment malfunctions in the , systern. l i I i

                 . .ndicates a positive attribute / occurrence.

i i PLANT ISSUES LIST l i  ! ZION  ! l l DATE l' ID BY l SALP l DESCRIPTION l CAUSE l REF l 04/28/95 Ops Resin and water leak through a damaged Personnel , eBaphragm: caused by operator ignoring Performance i

procedural stop to c.m an outlet valve on the t j deborating demoneralizer prior to opening the [

inlet valve.  ! 04/26/95 Maint Electricien injured: whde improperty cleaneng in PersonnrA an energized portion of a 480 voit electrical Performance  ! equipment cabenet. [ 04/24/95 Lic Ops NRC interine approval was again sought and Personnel  ! , granted: severalincomplete portions of Performance safeguards instrumentation and control channel lr i functional tests, dating back to 1990. } i 04/18/95 Eng Failure to isolete relays: During modification Personnel  ! testing on the neutral ground transformer, the Performance Unit 2 high pressure turbone tripped due to failure l to isolate the relays beeng tested in accordance j with the testin0 procedure. ! 04/12/95 Ops inadequese RCS temperature centrol: Whde in Personnel hot shutdown, a steam generator safety valve Performance lifted when operators failed to property control reactor coolant system temperature. 03/25/95 Ops Unit 2 high pressure turbine was resed to 100 Personnel rpm in cold aleusdown: when operators allowed Performance instrument maintenance personnel to conduct l l timeng tests on the high pressure turbone governor and stop valves.  ! 03/23/95 Lic Eng special NRC inserini approval required: the turbene driven auxiliary feedwater pump could not be (and had not been) tested quarterly as required by the technical specifications, since at least 1985.

            ,   .ndicates a positive attribute /occuerence.                                                                                                          f:

1 l PLANT l' SUES LIST l ZION l l DATE l ID BY l SALP l DESCRIPTION l CAUSE fREF l 03/03/95 Ops Operators inadvertently connected the RCS Personnel

                          ,                             through the volume comrol tank to the RWST:          Performance which resulted in approximately 500 gallons of water being transferred from the Unit 2 RCS to the RWST.

02/95 Eng 2B emergency diesel generator camshaft had Materia: severallobes slip during post-maintenance Condition testing. Causes were poor work procedures and inaoaquate quality control. 10/21/94 Eng Unit 1 shutdown to perform temporary repairs on Material handhole leaks in two steam generators. Condition 08/03/94 Maint 2A emergency diesel generator speed sensor Personnel shaft failed again. Inadequate installation Performance contributed to first event, design inadequacies cont ibuted to both. Shaft was redesigned after second event. 07/12/94 Eng 2A emergency diesel generator speed sensor Material shaft failed, causing the diesel generator to trip. Condition l

  ".-   . ndicates a positive attribute / occurrence.

l PREDECISIONAL

                                                                                                                                                    .        4 o
                                                                        .       ZION
                                                                            .                                                                                r High Number of Reportable Events Personnel Performance Problems 1

Administrative Control Problems Procedure Problems Weak Program Controls l

PREDECISIONAL EION 1 FI EVENTS FOk 954 SSF 06/0*/95 (tte 29595D16 $6,ne 29179 Pd hills LateP (Vikt DCCutatD Dutths Orleaflom A1 1001 *%60

              $ts)(M         i (MitLIWCf COPt C00Lisa sisitMS &atur                                                                                                                                              i btSC              alta Pettsutt SAffit IWJEClite 5tltts.                                                                                                                                           l 8 DOIN NP51 PtmPS W tt it*0 Pit.Attt. Wilt Out Ptaa e

OPihtD 10 LOCAlf A DV$ GROUW Faust,thADVitif ulL1 titett'D lucPflLAttt W PI EVENTS POM 95-4 SSA 11/13/95 MSC  : Lies 29595022 $0.73# 29592 Put alsts COLD siair>0ww i **

                              '81AtttD.

18dDieu4f t. fMC NPll PLPer luJtcitb APPeatletAttLt SW tsALLDh5 lul0 let Atla t

                                                                                                                                                     . INI P90CEDutt Wat I

J FI EVEttTS FOR 95-1 l i 8SA 01/20/96 Lttt 29596001 $0.T28: Dtst  : Pwe eIsta etau fnteflows af 991 WMitt DuelNCLiutD A It$1lW$ UP ACllVlft. fot (CCS IWJLC110N, AN kNR PUMP AU10 SfMitt 45 tut AtlVL10F A Ptt$0NWil SSF 02/te/96

 ,                                                           Lies 295M006 lo.ns: 30026 l

PWR Ct0JP Mills IVthI DitCWlat0 Ik C060 SMufDOWW SPtml FUtl silitM$ Ca0UP SilitM t fvtt tulLDlWC INVIRONMtWTAL COWit0L liittM 01h Di&C UWit 1Mll (Viki Wel Altl&WID 10 UWill 1 Amo 2. i i 1 Woutp INil (V1W1. wot NAVt STAttto DN A4 AU10MAllt slG4AL. fut Litf ullt W i SSF c3/ce/96

.                                                           tras 20596007 So.Tre: 3006a PWR C#00*    mists       CON 011 tow IXllit( lb ALL 800($ UP 10 1901                               POWR SIWCl IN111AL OPERAllow

• Inittisti Coal C00LitC Sf$ttMS GaDup St%11M 1 HICM Pettlutt 1AFlit ihJEC110w Sil1(M 01m UWilt 1 mil fytWI Wal AlslGWID 10 Uwlil 1 AWD 2.

Dtst  : A likCLE C0wol?l0N COVLD haVI etN0f tfD IMt L&f ttt ikJtC110N topoiou SAf tfi ItJttilow Kase t!CitCULAtlow Liwt 60VitD IN'(UC6 jh($llAh!,$1%?tM & Poalloh Of 188 susCtPfilit it Jett!!LG, ' *! P. *( t 1.'* *.

• t t; t ? Ptt i.'.* . A l SCRAM C3/tain .ts, poteg m 5;,n ,, 301?? r.* et m P: t s u . c a.

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A 19 0 61,.14 ':' 189 wCCWuD (* alta 6n itsit, a sigtsa19 y pf' 6 y.' '

P'0*l t.t swP *tly.,ttp le tal alga glygg , t.ig g,9g, ygg ,,y,r* se a '6s ,s..-*. 7 h*, . .. . . . . i

;                           L'.?t1D h *e1 .4..'!.                                                                                                                              .' '. , * * " 

PI EVENTS FOR 96-2 SCRAM Ou17/tt .tse i19 6*,15 $C.?ie 30299 Dt&t  : twt sil1 ::.1: ..g .41;t,q e ., A taguteslgtp was tilP OCCuatlD Cat le futon LOOP A sstatious LW tt COOL A61 f tw SILh&L lhf*tInt CALOO 6 PADCfDut4 Gulbakti. tlou istisettiation $twslet L igig ogsup p.; es..U5t ..p;rD' e sisl$

                                                                                                                                                                                  ,. int.vtut SSF              D'/23/%                        st** 29596016 50. 4 8: 30u6 PWR      N151       COW 01110w f allitD 14 ALL se0Dil UP $0 10Q% PQWgP $lh(t IWlll&; D*l Pall 0%

CADJP  : Isaf ettsti CNI FA.th; Jt$1te'l G40gP tilita 1 tw Pat 1Mt 48 tit thJIC110= listin Co. Uwit; la.i) I.fi' .4'. J';;.%:' 10 usiti 1 aw (. r;<t v i : t .,' .a .t h s tr' .:Im *r gress utt 1 g * **% e*p u .6 !*s% *.s ett,iki.- h.P4t 3 & A6Mul a .n < s .e ' : 4.. il 4 J. ; . .,,; ; . ' , . * .

• 4 WJ Ill ? C b"6. 4* k . s. .

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

4 ZION 2 i PREDECISIONAL DEVIATION ANALYSIS REPORT USTED BELOW ARE EXPLANAT)ONS FOR THE NEGATIVE'Bl.iCK I

   ;                             CAUSE CODES ADMIN q                                                        tot nominisitAllyt CAunt tapt MVi&11b fat tuttA110h&L Ptll0D$ St9ULItD f 90M $9 (Vikl$

Disititutt0 fecM 10/M 10 t/M. MANT Of 14 Evtall Wat Atto CLAS$178t0 AS ADuluttitAtivt CAust EcDt tylull fon WIT 1. Nvletita (Waf t Wet TituulCAL

                                                        $PECiflCAf ttu (18) VIOLAllent. Stylt Of WICN INVOLVED mitKD Acil0N STAf tENI$, allMD a

autyllLLANCts. Amp A Mpett nel taulfftD On 114. AuctWe fivt IVluft INVOLVED punytlLLAmCE/tttfl#C f aAt WS NOT lu ciprLl44C8 W11N 18. Of TN 0fM8 NYtt PLANil IW T4 Ptte emeur, tica 1 ting 14 entt PLAN 1 thAT inPitltmCfD mcat ADMigl$f tAflVI CAU$t CEst EYtats taas tism 2. 1 0 s P 4 l t I l ( I l 4 i l

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4 P:tDLCl$10NAL L*9'ho ZION 1 5""*****""i '""" C Refuehng R Operatson C**;l 93-3 to 96 2 In0ustfy Avg tfeno Owenerir Data ShutDowet MMI hot snown using op cvcie A*MW

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                 ,                                    Automsee Screms While Cettical                                                            Safe *f System Actuations e

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• 3 . '

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R e . D13 k t' MF 1' E3 kt F B12' kt k3 t' HE Year. verter W3 ki Year = umrter 20- Signmcant Events *

                                                                                                                          ,                      &atety System Failures j t.s.
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Equ6pment Forced Outagest F

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9 ,. . . .p.g. . g, s.s g;g., ... { j v..r. o u.n., g Cause Codes

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l

ZION 1 PREDECISIONAL OUTAGE DATA EQUIPMENT FORCED * * ' 31681 D611 03/16/W - *

• DUTA M mela 137.3 (n.? Ders)
• M SC uwlt 1 Auto filPP(D (m 1C litAM Mm(ta10e 6tvit al al .

SCHEDULED S1 hat Dall: 02/19/96 OUTAct mest 6A4.0 (26.4 Deys) M SC i Unit Witt Off List ica Loost PAets le iM le sites Muttaton 05). (218: SCHEDULED . STAtt DAlit 09/09/95 RJ1AM uts: 2391.0 (99.6 Ders) Mlt i Uul1 OfI tlkt 70s ef futtluG OUTAM. EVENTS AE00 CONSIDERS IMPORTANT wo e 9 em W 4 (

 > - , . - , .v.- ,  ,      ,         -
                                                        ,.c-   --,w ,__        y ., - . , - .            ,      1.--.

PRC0tCtt'otat ZION 1 ternd S:mw s.ge.=e Peer Gro.sp n'iesting%vse Der 4-Loop se -s 913 to 167 " *"' C 1renos and Dembons tow m Deviations From Plant Peer Group self. Trend Medien Ghott Term Long letm OPERATIONS (includino startup) Automatic Scrams While Critical - . 0.64 - 0 01 Safety System Acts stions - 0 16 *

                                                                                                                         -015 Significant Events -

0 - 0 Safety System Failures a 0.32

• O 16 Cause Codes (All LERi) aAm. rie cwwh -

OM e ur ove n sawi - M .4M M 0.15 - J 0.10 e ce= Pww as sm - e- a P es e - 0 il [ - 4Ds[ 0.90 e t=Sevc.a.rws - - ennu ev.s a -

                                                                                          ]O09 E               0 59 C 017 s es i.e.a     -

SHUTDOWN ]0.16 - 0 22 [ Safety System Actuations - , _l 0 23 0 10 Significant Events -' l

                                                                                                                                  .)0 o

i i I ' S tute 3yst.rm T..tuees -

                                                                                           .o 74           .   .

0 (? Cause Codes (Att LERs) { '

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                                                                                                                                    .o FORCED OUTAGES                                      l

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                                                                                                         ;                     - i-
                                                                                  .a                     ;

Forced Outage Raic * -

                                                                       .n y, i
                                                                                                                                    ,            4.<,..

Equmment f orced Outagest * ,,. 10M Commerei:st ' ritics? Hourr * ' ' i

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t ZION 1 PREDECISIONAL DEVIATION ANALYSIS REPORT USTED PELOW ARE EXPLANA110NS FOR THE NEGATTVE BLACK DEVIATION B CAUSE CODES 4WlH fut Aamlul514Ativt CApat CEst MVI Allem Pea UPitAtltasAL Pttim8 tituLtto Faces 23 tytutt Dilititu1ED ften 9/9610 3/M. Ishaf Of TNE tvtutt Wtt Alto CLA851 Fit 0 A8 ADMitilitAtlW CApet test tygets Pet teilt 2. TM MJ0tif f of tut EVistl (10) Wat fttualCAL t>tClf t'Catten its) ylgLAtilart,11 Of WICW twvetWD ulttfD AC180s STAtteEutt, RISSED SURvtlLLANCES, atPOR18 et supellt3D tal flait, As RfvitW5 tot PetPOEIED. AnotMt F M EW W18 INv0LVl4 EURytlLLAst1/ttsfles thAt ut mot lu (EpFLIANCE Willt 15. Tull PLAmt (EPf tltsCAD stat tyttAttenAL ADNikllthAllyt CAUlf CODE tyttt$ thAN Auf Of tut ettet style PLAmit tu tut Pett acuP. tut Mylatital 704 sans19the Pitl005 bisWLTED feet 11 tytuts ptsititutta pagt 5/M 10 3/96. titut of IN tytutt CCCuesto lleCE 9/95. f th* IVtW18 Wtti ALtc ttAltlfitD Al AtatultitAlivt CAust CODE tytW18 fem uvlt t. 1M MJORitt of int IWkt$ (WINE) Wet il v10LA110us, fivt 0F Witu IWwolvtD MillteACAlu, ! SLAVilLLANClllettevitt ttttles. tull PLANT tsettituttp noat lettfDthe Apuluttttativt CAult CODE IVlull inAN Amt OF TM Of Nie Stvt# PLA418 Ik f ut Pitt G#0VP. 9 w

ZION 1 PREDtCIsI0 sat PREDECISIONAL PI EVENTS NOT INCLUDED IN THE 96-2 REPO est umin Pbst hist Llan res u02t io.nos u' na ' ' sitair t compitlen tall 1LD la ALL 8 CMS UP 101001 PWit $1s;t tulTIAL OPERAtlDW 1 IsiinG4uct AC/pc pgutt ststises gecuP 11511M Olli LNil 1 IEEDit**W0tf ACK pedte ST5ftet

• CLASS 11 M SC 4 IRll iVik1 WS AlliEdst010 Wul181 Aas 2.

8 A liteGLE 9AlL421 It tiet 00u1004 Cintullt POR tut SLACICtfl Mittflias LOCit WtuLD

    .                       Ofillit PO48. Complilos titutflb tecat inADiskatt GRislhAL PLANI MEIEW.Ai/1 SCRAM           wits /w PWR WlST                             Lets re m021 H.Tre 3en09 Mlt              Po48 cettAtleet At 1901                                                         .

4 A et IRIP OCCutett cm LW S4 teLitt Ltytt Wutu Air NBlv Ctents FURIMER TRAW ttP(cite DutitG tt$ ting. full met tekt taute 31 thaMautTL Pktytellyt stAluftaAntt. MANUAL SCRAMS DIOttE ACCIDENT SEQUENCE PRECURSOR DATA (*" 1996 AND 1996 DATA PRE 1Jef6 MARY '") tvtW1 DAtt: 11/06/90 CDPA 1.41 5 Ditt t tho 0# inalt cit $tt clutaatons lapteAstt Ivtwt patti 10.e?$fM CD*e  : 1.0t.4 ,

         *f*:

f *fr':st ';f t?. es: ;;c r*,=er* A.stt. s t s *.* '#_ lttett 1 OUTAGE DATA

-        EQUIPMENT FORCE'D' EJatt Dalt: 06/27/h Cu1&Ct ht$t 109.3               te 6 Days)

DISC t NAnvAtti 14lDPt010 atPalt int Pony stocs WAtyt, EQUIPMENT FORCED sinet nait, esite/u CUlaCl #t1: M.6 ( I . fa fie y'. I til St

                      . AW D trl> 6its.rst tel tistttet o.af tlesws 3 . *e.rt i 4 ets'tra Pt011C11tm 1ptr.          tillfm 5165tB *al tin. lCW 5t!..Iatnuie

• EQUIPt.tEttT FOflCED

        *1481 Dais : fu/17/%
        " a Cf 6 P;- 2,'" .

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PREDECISlot4AL contributing fa; tor was the absence of supers ision in the field to monitor operations and maintenance personnel and provide guidance dunng the performance of safety related activities. (IR 96-07) - Administrative Control Problems Administrattve Exsmplas are: control problems cor.sisted of insuffuent procedures and weak program controls. Insufficient procedural gu'idance for backfi!Iing reactor coolant loop now sensing lines after maintenance allowed trapped airto remain in the lines. This caused a falso low now

                             @nal during power operation, resulting in a Unit i reactor scram. (LER 295/515) l The licensee made incorrect mode changes at Unit 1 because they failed to perform post.

maintenance testing on two containment isolation valves. The licensee attributed these two erTors to deficient procedures for the inservice testing program. (LER 295/%11) The licensee commenced heating up the Unit i reactor without dosing main steam line drain valves as required. The operating procedures did not require closing the valves until after entering Mode 4. A 1993 change to the updated final safety analysis report added the valves to the list of containnec.9 isolation valves. The change process did not contain sufficient rigor to ensure that all affected procedures were identified and revised. (LER 295/608) Lack of procedural controls for inoperable containment penetration pressurization zones caused an inadvertent entry into TS 3.0.3 at Unit 2. The licensee performed a surveillance test on one zone while another zone was already inoperable for maintenance. The procedure did not provide cautions or a method to track inoperable

                         . zones. (LER 304/96-02) 4 i

i

 ?

• I 4

I,

 .                                                                                                                                                                                                         PREDECIStotML j                                  PLANT:-                           ZION, Units 1 and 2, September 1996 AEOD CONCLUSIONS:                                                                                                                                                                                                                           -

1

-                                A review of information relating to plant operation since August 1995 reves!ed a high number of i

reportable events. Personnel performance problems and administrative control problems were  ! the dominant causes. These problems resulted in several incorrect plant modo changes, including an unintended mode change. The personnel errors usually involved inatterttion to  ! detail. NRC inspectors identified many examples of poor control of plant or safety equipment status by licensed operators, involving failure to follow procedures or inattention to detail. While the licensee attributed many events to management defleienales, these were usualy administrative control problems that consisted of deflaient procedures and weA program ' controls. The licensee corrective actions typically addressed the speal6c event; te. ore was no evidence of a licensee initiative to improve procedures or programs. PROBLEMSt - I Personnel Performance Problems Inattention to detail and failure to follow procedures resulted in many personnel errors. NRC inspectors noted a contributing cause of insufficient supervisory oversight. Examples are: With one emergency diesel generator (EDG) inoperable, Unit 2 licensed operators rendered a second EDG inoperable, requinng a unit shutdown. While testing the second - ' EDG, a licensed operator incorrectly selected the govemor control switch instead of the t voltage adjustment switch when attempting to adjust voltage This caused the EDG to l trip, rendering it inoperable, which required the plant shutdown Subsequently, the operators incorrectly suspended performance of another technical specification (TS) "

   ~,

required power source availability test. The operators failed to reference the TS for. applicabikty of the test during Mode 3, and failed to communicate the test suspension to ~ contiol room supervision or ine oncoming shift personnel. (LER 304/96-05)  ! An unintended mode change occur 7ed at Unit 2 dunng an auxiliary feedwater system troubleshooting test. Although system engineering personnel recommended use of a + special troubleshooting procedure, operations personnel decided to use a routine surveillance test procedure. During the test, an excessive amount of cold water was ' pumped into a steam generator, causing a power increase and the unintended mode [ change. Poor communication during the test briefing and a tumover of shift supervision during the test contributed to the event. (LER 304/96 01)

                                     * - An unexpected auto start of a Unit i residual heat removal pump occurred when a system engineer inadvertently caused contacts in a timer to close The engineer was                                                                                                                                                  l cnecking the timer for proper operation at the time Despite considerable exponence and                                                                                                                                              '

training with this type of timer, the engineer incorrectly assumed the contacts could not c:csc it the timer was deer.ergized fLER 295/96 01) NRC inspectors cited the licensee for operational errors and unplanned changes to the i status of safety equipment Tne events involved fundamental errors by operators who ' demonstrated insufficeent attention to detail and failure to follow procedures A i k yW* Nag - W85 ruTR y O' **ir='s@=+P'-9+**T---YM-pr- DT

• rm 9

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PIEDECIS10tdAL 21ON 2 te n. Sia s u Sy.r nce a+1 Poet Group Westnphouse 06 der 4-Loop 913 to 942

                                                                                                                         "# C 1renos and Denatons                                                                & ow r*"-~~

Devistions From .

                                                                            %nt                              Peer Group Self Trend                             Medan Stort Term                            Long Term

_ OPERATIONS -

                                                                  %,                 w                  wme                  teme'            '

Automatic Setems While Critical - 4 0 - 0 90 Safety Systsm Actuet6ons - 0 - { 045 Significant Events - o - 0 Safety System Failures - fj 0 68 - 0.15

                          .Ceuse Codes (All LERs) a am.          camew p == -

3 0.18 - 4 4e e um e opw = sa- - M 0d;9 - 4.10 e os= >manami sa-s - 0 - 0.54 ~ s an mmaa p ==e - e := se n-- one maman p

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0 06 ( 0 SHUTDOWN [ 0 85 I Safety System Actuation. - 0 0 10 i Significant Events - i C s' 0 Safety System Failures - i 0 30 f; t0 i t i Cause Codes (All LERs) l l f

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DON 2 PREDECISIONAL PREDECISIONAL PI EVENTS NOT INCLUDED IN THE 96-2 REPORT SEF c"a/rs'/M Lies 295M022 $0.72e 30922 PWR 880L8P 8151 : CoWDlitou taisite la ALL seMs uP 10 1905 PMt SIWCf lulflAL tetaatitu I E8EttetWCY AC/DC Padte sisisses escur 8T518m t IEDIL84 WOLTAat PedLa Sflftst

• CLAtt it ett MSC Unit : Talg twyt ung Aggleut010 Uniff 1 AND 2.

t k litGLE f AILWkt it Int testack Cittulit fat fut DLAttatt Mittflom LOGit WER/LO Petvist Ailiclealit steuristles et Land $ gu fut EsCluttttp 84ftff f tAfutt OL/IES DutlhG A LMS Of Of f $ lit Pindtt. tsuel11 tat aggLtite taopt is4Maatit celslut PLAuf MtlGa. MANUAL SCRAMS soet ACCIDENT SEQUENCE PRECURSOR OATA (* 1986 AAC 1996 DATA PREUMeetApty **) fvtut DAftt 03/07/M CDPt  : 2.3t l *

• Dtst t tmavalLAtlLiff of funtlet*Delvts AuslLlatt titDwitt Pump Awp (MitCtsCT Dit5tt CluteA104 IVtut Daft 06/11/91 CDPR  : 1. 01 5 M SC malt titDwita Psaw tale Vita cut Atw P6mp talttD tvtW1 04i(: 03/21/91 CDee + i 2.it.4 DISC LO15 08 Of f $ lit PWtt Wilk (Wt Dit$tt CluteAfDe DJ1 Of $!'VICI OUTAGE DATA EQUlPMENT FORCED staan 0418: D5/19/96 Outact res: 74.s (3.1 Ders.-

DESC i Unit GthtCat0R$ 2 WASWERE MAmuALLY 18tP*t0 NCAust of toutMat f Altunt. tat 2A nuo 28 bitsit DtCtattD lh0Pte44tt. SCHEDULED Statt Dalt: 07/01/ % ou1Act mes 69.9 (2.9 Det:1 M EC i Wil was latt e 08 f L luf top C WM kil t fUpt atPalet. SCHED'AED llati DAlt: 01/13/96 DJ1&CT *t%: 4$4.2 (18.9 04ytl M SC

9411 2 Off tikt 108 CCwM h$ta It46 kttA!st ( NeC2).

e.

                         -----,,,--n..               . , -      --          ,                    - - ,  --  -.

                     ._ _u _           _ . _
           ~

Average Daily Power Level Braidwood 1 (01/01/95 - 08/31/96) 120 . 8 - 100 - 7 ,a t7 7p p~ 7. - _ y , _ 80 - 60 - t T T T 20 - b N'/l __ _ j O oist eles e3r:2 earts es/2 est2s 07tio see3 sees stint 2n? esi2t e2r S e3rit esos este sti 4 eer.s e=22 ser27 same Menimacn Cw.1".S Cepecity - , II20 MWe I No dose evellebae forJan ory 7 med.ccoinedtrsh an . c,,.* A hoess pump 2 Unii sheidews for sneinemace estage to ellow ror kapection or . steam generevor tubing 1 3 Unit tdyped due to raihre or instrument leverser 11 POSE r 4 AlR05 RefIseling Osesse fi 5 Bene'y 112 was dec8ered i inoperable and the unit [ i g was shistdown E

  ~

6 vat e tes srce n,6co. fine to becarne sv. .. yid I

4

     ~

Average Daily Power Level Braidwood 2 (01/01/95 - 08/31/96) 120 WOE 1- r 11= mq r--< 3G I y" ~{ T ' s, .( p - y <r 4 80 - I , 60 - n 1 40 - 3 g ._ l l 20 - - l 4^-- I 0 -

               ** 41 9295 93/12 94/16 95/21 96/23 97/30 9993 19gs lit!2 12rt7 et/28 82r2$ #Vil 932$ M # 771 4 rWi* N f Mt     *&

Maxirmen N-- " "_L Capacity ll20 MWe

                                                                                                                                 ~

l No date svollable foe January 2 Unit was forced so shusdown due to a leak in valve packing on volve 2RC8003C l 3 Reduced load at the resquest of the Loed D' ._.16 to follow system aq.' . u.,.e , 4 TsJ- -w Isolation Velve, l 2fWMB. valve se'usw hydraulic pump failed 5 Refoet Otrsge I

Average Daily Power Level

                                                           , Byron 2 (01/01/95 - 08/31/96) 120 1

100 T Tyw i1 -- g g(T rj g i W M i -iv-- N % , so - 9 i , 0 - i ' 60 - b y i 40 E ]

                 -                                                                                                                                                                                  1

2. -

[B B . ;. etet e2es oy:2 eerse est2 ent2s e70s ese? tw sin 2 t2n? et/2: a2/25 ev3s **$ apa *?nd ast' -w22 s"2' s =8 mi oe,e d.uec en7 1 1105 MWe l 1 Began Caesadown to B2ROS 6 Marien!erip due to Ion or ' ensiec powerdue en 2 RefuelOwenge waterinerusion h,eo bus does 3 Reduced Power to 35% to 7 Force ovengedue to becrended leek Investissee Prirnary Plant racein the2A S/G laakset  : 8 Rermet ovinge i 4 med.ced tmd to Add on * , i to2D Resciar Coolant i i f 5 Redeced Imd to Replace ' Vokage Regulator .  : i

E Average Daily Power Level

                                                                    ,, Byron 1 (01/01/95 - 08/31/96) 120 100      qm,                   7m,              _
                                                                            -3 ,                 _m-y                    ,                               [

80 - 60 _{

                                                                              .                                        ,                                 [

40 20 , I-.

• 3 ~ ~~

                                                                                                            - l
                            -                                 -                                               g 0                                                                                                    - - -

Stet 02.93 91/12 94f16 95/21 06/25 07130 0*93 feet litt2 12/37 9t!28 *274 GMt eW mm wie es1s .w6 to n ?:w Maximum dew'e Capacity . Il05 M% - r-I chemis=y Clean Up orshe 5 Reduced Lead to Investigase Steam Generators Tebe Leakin 1CCW Box 2 Redeced toad to 20% RX 6 Mideyle impcesion or Pwr 6e Pepel: hessure Switch on S/O tubes

Fwv)9A Valve 7 Refuel Ouente 3 Reduced Load to Repair a Ixaking Pipe Cap on 8 RcFeelOntage Ended IFWO90A and traking  !

Valve IC V222 9 Oilleak en turbine gm.we j sir side sealoilcooler 4 Reduced Power to Repair FW Viv $10 t

s; Average Daily Power Level

• Dresden 3 (01/01/95 - 09/13/96) 120 100 -

ww y e p.,

                                                                                       ~

80 - 2 L s -- 60 - - g h 40

                                                                 ~

4 . 7 ' 20 - 9 s 7 g T " 0 , etet e2ms ev12 earle es/21 ontzs ofr3o e,e3 toes t art 2 2n? etr2 c2r25 ores oses osne e7ns een, eer23 torre 2m2 Liimum Dependeble CapecWy 3 772 MWe

                                                                           .s I

I Main Turbine tnpred 5 Rx trip due 30 tubine trip 9 negin c.>c-.. 2 t.oad drop was started for 6 Unit scrammed due so 10 Scram- 3D FRV Failure control rod drive scram generatorload reject 11- Unit vnenuelly sWna Joe 3 Thermal reactor power was 7 Unit menuelly sheedown to 4 KV Dreaker Problems i limited due so feedwater i temperature 8 3A FRVisolated to  ! ! repak leaks 4 Began load drop for drywell entry e

g.

                                                       .                                                                                                             .I .

Average Daily Power Level - Dresden 2 (01/01/95 - 09/13/96) 120 - t 100 - 80 - r . 60 - e - 2 ' 40 - 1 I_ 20 - 3  ; , l 7 g ' O - olet 0221 93/12 04/18 01'28 06/23 07/30 0973 1044 tift 2 82ft 1 08/28 02/23 p198 0$>U6 Ovte 97/I1 08/t9 09'23 w 82m2 Maximism Dependeble Cape ~eiDy 772 MWe l l I t.e:J drop was inkieed to 6 saanup perform weekly serveiLe.c 7 Shuidowe so repeir 2 Durmg mainienance Terr.perature ree controlsystem(5/25) Control Valve an Instnement Mecitanic incorrectly operated 8 Mamsalsrram ($/31)ce: low temperature seveldunog FW testing 3 Shutdosti due to inoperable ED 9 Startup (W30) 4 l't.mt restart delay 5 nerveloutage DIRI4

t. t , - e

                                                                 ~
                                                                                                                                   ~                                                        ,

Average Daily Power Level - - LaSalle 2 (01/01/95 - 08/31/96) 120

                  - - .                                                          1 0 *
                               .                              'y.              I 80 I

i

                                                                                                           -         T 60 4tl                                                                    .'
                                                                            .!                   ['.i                                                      '
                                                       ;                                                                          0                                                           !

{ l 20 g . . . _ _ . d

                                                                          'I 0

_.i.L___ b U 1 [ ._ as as .-2

• e.' s 2 owis c5/2 =-15 a' 'a ~'a' taas ts t2 tritt et 2: a2r2s otist osas esa e7sta earts cer22 serzt tres alasiamm IAWie Capsewy .

10% MWe i Refuel Ontare 7 53 nkkven for EllC m4k...; e 2 hiaintam i.utage so receir 2A 3 Rotart , Rc.= t..e thirr Ihne umtrol s Ir

8) I serttd sInttedowrt due to Service 1 pu r red fist sese'stg to identify Water TtrnnelI~imling a p ntale fistf favfore 4 At mial wram due to higli tenip

                ..n mam peiwer transferrner S           Ge..cr.it.w taken cfTIme to                                                                                              ,

pct f.-rm ma'ntetisace est the Al .n l'.m er transformer diwim. (a l'. .sv eohnf ihr rmreine

Average Daily Power Level ~ LaSalie 1 (01/01/95 - 08/31/96) , 120 100 ,

                                   '1" " N ',J " .           y-

).' -

y 80 - j  ; i D- - 2 1 , 1 (sil ~ .

l. .

I t  :

                                                                           ,3 40
                          .l_                                                                       l                           ,___

20 - rr1. L tb W_ __ _ i. L'_I .i IT1 s y g _ .. _r at al n2 r* e.t.12 oct6 e5/2 'w25 at to n9is t teve I42 32?:1 012t 02'23 03/3I c545 0m9 07tt4 estis 09/21 1or2' '2me . blatemirm I)epernlabic Capscity . It 36 MWe I I ..rceil cutsFe for 7

                             ~

Mamralscram en high rspair oI umisinment isolation eterbine vibiatire 2 l'.m t rtwhictiim for roit set 3 Startirp itchyctisine to ElitJ arwl pst 6.rmance themistry problern

     .I         I. mlomtsee for replacement                 9       I ortcsl simidmtsi doe s.. Service
               ..I a l.im ; scam i<clation Water linmcl l'oulmg. 6-23 V ilve vitesw.hls                                  Irectcctled by an automatic ses am
                                                                   .Itre so a calibration problem 4         Ausswiuiic Reactor Scram die-                       serirclattd te. SW corriamittati.3ri s.. I.n. et IU S btes                               .*t 6-261                                                  -

5 M inn.it reactor scram due h. Imin aver Irlcontr transiesit

f. kslesIout.epe

, , .c l Average Daily Power Level Quad Cities 2 (01/01/95 - 08/31/96) . 120 - 2 100 - T. ir ,p c ., .

                                                                             ~

80 -J - I b

                 -(                                     b                                                                                         l 60                                                                                                                                          .

s p l 40 - l 20 - s - T - 8 ' 9 13 0 = - 0t48 02/CS 03/12 04/16 05/28 fw25 07/30 9993 tosis s tr:2 32rts Der 2 02/25 e)tte p<ct 09,0 07:34 parte ett22 ItF27 1298 Maximum Dependable CapocWy 769 MWe - 1 1 Drop loed R,:B condessene 7 Avec Scrnn dunog DiC sessing kmeerainer beckwash 8 Cm...ed Recire Flow Test - 2 Dropload for B condenseee demeeralizer for high silies 9 Shutdown due to design issue on serem dis vellevellogic

 'I          tenddrop forcondensate demaueralizer y,aa.a                    10              Turbine trip 4           to.d drop due so condectivity           II              Control Rod deep /sliat=>w swap 5           Refuel Outage                           12             n2 TCv cycling 6           Manual Scram due so BIC

• 13 .%edown due en tomalaitenage

I Average Daily Power Level , Quad Cities I (01/01/95 - 08/31/96) , 1 120 j 100 - p Nriving g ( M so - 4 gg 6G -

                                                      -                  S e                  _                    ,y 40   -

1 - T

                                                                                                                -                se 20   -
                                                                                                                              -e T

e _ O 0141 e2e5 e3rt2 serie esr21 08/23 e7:30 0943 teos Itn2 62r:7 og/2t e2t25 a3.*i t avis en** c'rt e 6stte eer22 t*27 12 71 Maximum DependeMe Capacky 769 MWe I Conteued forced outage 7 Turbi=c:csiing and traveling I3 Refueliniew screen insp.ction 2 tmo drop ror I A2 Flash Tank Repair 8 Control rod ponern adjustomet 3 Repair 1B2 Htr 9 Manuel scranidoe to design Emergency Drain Valve issue on Scram discharge veheneleve! logic l l 4 Reduced load doe to Bok Power operseens 10 continued rarced owiege 5 Buk Power Operstmo Request II FeJ .L HesserRepairs 6 CC- Flow Reversal 12 TrouMeshooting ICI Hesser and TurbineTestieg ReliefValve t.cak e 8 _ _ _ _ _ _ . _ _ _}}