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 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0104 EXPIRES: 03/31/2020 (04-2018) 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 LICENSEE EVENT REPORT (LER) 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 (See Page 2 for required number of digits/characters for each block) 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, (See NUREG-1022, R.3 for instruction and guidance for completing this form Washington, DC 20503. If a means used to impose an information collection does not http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1022/r3/) 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.

1. Facility Name 2. Docket Number 3. Page 05000 1 OF

4. Title

5. Event Date 6. LER Number 7. Report Date 8. Other Facilities Involved Sequential Rev Facility Name Docket Number Month Day Year Year Month Day Year Number No. 05000 Facility Name Docket Number

- - 05000

9. Operating Mode 11. This Report is Submitted Pursuant to the Requirements of 10 CFR §: (Check all that apply) 20.2201(b) 20.2203(a)(3)(i) 50.73(a)(2)(ii)(A) 50.73(a)(2)(viii)(A) 20.2201(d) 20.2203(a)(3)(ii) 50.73(a)(2)(ii)(B) 50.73(a)(2)(viii)(B) 20.2203(a)(1) 20.2203(a)(4) 50.73(a)(2)(iii) 50.73(a)(2)(ix)(A) 20.2203(a)(2)(i) 50.36(c)(1)(i)(A) 50.73(a)(2)(iv)(A) 50.73(a)(2)(x)

10. Power Level 20.2203(a)(2)(ii) 50.36(c)(1)(ii)(A) 50.73(a)(2)(v)(A) 73.71(a)(4) 20.2203(a)(2)(iii) 50.36(c)(2) 50.73(a)(2)(v)(B) 73.71(a)(5) 20.2203(a)(2)(iv) 50.46(a)(3)(ii) 50.73(a)(2)(v)(C) 73.77(a)(1) 20.2203(a)(2)(v) 50.73(a)(2)(i)(A) 50.73(a)(2)(v)(D) 73.77(a)(2)(i) 20.2203(a)(2)(vi) 50.73(a)(2)(i)(B) 50.73(a)(2)(vii) 73.77(a)(2)(ii) 50.73(a)(2)(i)(C) 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 Month Day Year

15. Expected Submission Date Yes (If yes, complete 15. Expected Submission Date) No Abstract (Limit to 1400 spaces, i.e., approximately 14 single-spaced typewritten lines)

NRC FORM 366 (04-2018)

NRC FORM 366 U.S. NUCLEAR REGULATORY COMMISSION (04-2018)

LICENSEE EVENT REPORT (LER) (Continued)

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

ICES VARIES (UP TO 10) 1 14 SUPPLEMENTAL REPORT EXPECTED CHECK BOX THAT APPLIES 8 TOTAL 2 FOR MONTH 15 EXPECTED SUBMISSION DATE 2 FOR DAY 4 FOR YEAR 16 1400 OR 14 LINES OF TYPING ABSTRACT NRC FORM 366 (04-2018)