ML13083A106

NRC Form 366 - Licensee Event Report (LER)

ML13083A106
Person / Time
Issue date:	04/30/2018
From:	NRC/OCIO/GEMSD/IMSB
To:
References
Download: ML13083A106 (2)

Text

NRC FORM 366 (04-2018)

U.S. NUCLEAR REGULATORY COMMISSION LICENSEE EVENT REPORT (LER) (See Page 2 for required number of digits/characters for each block)(See NUREG-1022, R.3 for instruction and guidance for completing this form http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1022/r3/)

APPROVED BY OMB: NO. 3150-0104 EXPIRES: 03/31/2020 Estimated burden per response to comply with this mandatory collection request: 80 hours9.259259e-4 days <br />0.0222 hours <br />1.322751e-4 weeks <br />3.044e-5 months <br />. Reported lessons learned are incorporated into the licensing process and fed back to industry.

Send comments regarding burden estimate to the Information Services Branch (T-2 F43), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0104), Office of Management and Budget, Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

NRC FORM 366 (04-2018)

1. Facility Name

2. Docket Number 05000 3. Page 1 OF 4. Title 5. Event Date Month Day Year 6. LER Number Year-Sequential Number-Rev No.7. Report Date Month Day Year 8. Other Facilities Involved Facility Name Docket Number 05000 Facility Name Docket Number 05000 9. Operating Mode

10. Power Level

11. This Report is Submitted Pursuant to the Requirements of 10 CFR §: (Check all that apply) 20.2201(b) 20.2201(d) 20.2203(a)(1) 20.2203(a)(2)(i) 20.2203(a)(2)(ii) 20.2203(a)(2)(iii) 20.2203(a)(2)(iv) 20.2203(a)(2)(v) 20.2203(a)(2)(vi) 20.2203(a)(3)(i) 20.2203(a)(3)(ii) 20.2203(a)(4) 50.36(c)(1)(i)(A) 50.36(c)(1)(ii)(A) 50.36(c)(2) 50.46(a)(3)(ii) 50.73(a)(2)(i)(A) 50.73(a)(2)(i)(B) 50.73(a)(2)(i)(C) 50.73(a)(2)(ii)(A) 50.73(a)(2)(ii)(B) 50.73(a)(2)(iii) 50.73(a)(2)(iv)(A) 50.73(a)(2)(v)(A) 50.73(a)(2)(v)(B) 50.73(a)(2)(v)(C) 50.73(a)(2)(v)(D) 50.73(a)(2)(vii) 50.73(a)(2)(viii)(A) 50.73(a)(2)(viii)(B) 50.73(a)(2)(ix)(A) 50.73(a)(2)(x) 73.71(a)(4) 73.71(a)(5) 73.77(a)(1) 73.77(a)(2)(i) 73.77(a)(2)(ii)

Other (Specify in Abstract below or in NRC Form 366A)

12. Licensee Contact for this LER Licensee Contact Telephone Number (Include Area Code)

13. Complete One Line for each Component Failure Described in this Report Cause System Component Manufacturer Reportable to ICES Cause System Component Manufacturer Reportable to ICES

14. Supplemental Report Expected Yes (If yes, complete 15. Expected Submission Date)

No 15. Expected Submission Date Month Day Year Abstract (Limit to 1400 spaces, i.e., approximately 14 single-spaced typewritten lines)

NRC FORM 366 (04-2018)

NRC FORM 366 (04-2018)

U.S. NUCLEAR REGULATORY COMMISSION LICENSEE EVENT REPORT (LER) (Continued)

REQUIRED NUMBER OF DIGITS/CHARACTERS FOR EACH BLOCK BLOCK NUMBER NUMBER OF DIGITS/CHARACTERS TITLE 1 UP TO 120 / 2 LINES FACILITY NAME 2 8 TOTAL 3 IN ADDITION TO 05000 DOCKET NUMBER 3 VARIES PAGE NUMBER 4 UP TO 230 / 2 LINES TITLE 5 8 TOTAL 2 FOR MONTH 2 FOR DAY 4 FOR YEAR EVENT DATE 6 9 TOTAL 4 FOR YEAR 3 FOR SEQUENTIAL NUMBER 2 FOR REVISIONS NUMBER LER NUMBER 7 8 TOTAL 2 FOR MONTH 2 FOR DAY 4 FOR YEAR REPORT DATE 8 UP TO 37 -- FACILITY NAME 8 TOTAL -- DOCKET NUMBER 3 IN ADDITION TO 05000 OTHER FACILITIES INVOLVED 9 1 OPERATING MODE 10 3 POWER LEVEL 11 VARIES CHECK ALL BOXES THAT APPLY REQUIREMENTS OF 10 CFR 12 UP TO 100 FOR NAME 10 FOR TELEPHONE LICENSEE CONTACT 13 CAUSE VARIES (UP TO 10) 2 FOR SYSTEM (UP TO 10) 4 FOR COMPONENT (UP TO 10) 4 FOR MANUFACTURER (UP TO 10)

ICES VARIES (UP TO 10)

EACH COMPONENT FAILURE 14 1 CHECK BOX THAT APPLIES SUPPLEMENTAL REPORT EXPECTED 15 8 TOTAL 2 FOR MONTH 2 FOR DAY 4 FOR YEAR EXPECTED SUBMISSION DATE 16 1400 OR 14 LINES OF TYPING ABSTRACT