|Entered date||Event description|
|ENS 53999||14 April 2019 06:44:00||At 0320 EDT, April 14, 2019, Sequoyah Unit 1 experienced an automatic reactor trip. The event was initiated by the trip of the 1A main feedwater pump. During the automatic unit runback, an automatic reactor trip was initiated due to low-low level in Steam Generator number 3. The Auxiliary Feedwater System (AFWS) automatically actuated as required when the expected post-trip feedwater isolation actuated. Reactor Coolant System temperature is being maintained by the AFWS and the steam dump system. During this operational cycle, one control Rod Position Indicator (RPI) for core position E-5 in shutdown bank 'A' has been inoperable, and the appropriate Condition and Required Actions of (Technical Specification Limiting Condition of Operation) 3.1.7 were complied with. Due to this inoperable RPI, the associated shutdown rod is conservatively assumed to be full out and untrippable. Consequently, boration was required to establish adequate shutdown margin. All other Control and Shutdown rods fully inserted. All safety systems responded as designed. No primary or secondary safety valves actuated during or after the reactor trip. The unit is currently stable in Mode 3. Unit 1 is in a normal shutdown electrical alignment. There was no impact on Unit 2. Due to the Reactor Protection System actuation while critical, this event is being reported as a four-hour, non-emergency notification per 10 CFR 50.72(b)(2)(iv)(B) and in accordance with 10 CFR 50.72(b)(3)(iv)(A) as an event that results in a valid actuation of the AFW system. There was no impact on the health and safety of the public or plant personnel. The NRC Senior Resident Inspector has been notified."|
|ENS 53927||11 March 2019 15:17:00|
The following was received by email from the state of Louisiana: On 03/11/2019, Georgia Pacific Consumer Products (GA-PAC) Port Hudson Operations was shutting down a process to perform a disposal decommission maintenance. In the process of securing the radiation sources for shipping and disposal, it was then discovered the shutter (on a level density gauge) would not close. GA-PAC has called a service contractor, BBP Sales, to evaluate the situation and determine the best course of action to correct the problem. GA-PAC will have BBP Sales determine the proper disposal for this device. The device was manufactured in 1967. The sources and device with shutter failure will be sent for disposal and not replaced. GA-PAC is decommissioning this unit. This is not a radiation exposure hazard and does not pose a health and safety situation for the GA-PAC employees or the general public.
THIS EVENT IS CONSIDERED CLOSED BY LDEQ. This event is being reported to the NRC as required by Regulatory Requirement 10 CFR Part 30.50 (b) (2) & LAC 33:XV341.B. The Gauge is an OHMART HM8 device/source holder, S/N 6563 with a 100 mCi Cs-137 source. LA Event Report ID No.: LA-190003
|ENS 53917||8 March 2019 15:15:00||The following is a synopsis of an email from the state of Florida: A nuclear density gauge (CPN Model: MC-1 Elite, Serial number: 30803) was not secured properly on the licensee's transport truck and released during a traffic accident with a passenger vehicle at the intersection of Knotty Pine Road and US-192 in West Melbourne, FL. The truck was on its way to a job site for further testing. Brevard County Fire and Rescue HazMat teams and the Brevard County Emergency Management radiological coordinator responded to the scene. The 10 mCi Cs-137 source separated from the gauge housing, but the 50 mCi Am/Be source was intact. No injuries or fatalities were reported. No evacuations were reported, however a 15 ft. perimeter was established around the material until surveys were completed. Surveys were 592 mR/hour at 1 inch, 23 mR/hour at 1 foot, and there was no removable contamination detected. There was no release of radioactive material during this event, and the personnel who picked up the item were surveyed and cleared. The sources were secured by the licensee, placed in a transport case (with added shielding), and taken to their permanent storage location in Sebastian. The licensee will return the gauge to CPN for repair or replacement. Florida Incident Number: FL19-033.|
|ENS 53943||18 March 2019 14:09:00||The following was received from the state of New Jersey by email: The Pennsylvania Department of Environmental Protection informed the New Jersey Department of Environmental Protection that a load of scrap metal from the John Blewett company in Howell, New Jersey set off the radiation alarm at Sims Metal Management in Morrisville, Pennsylvania. Sims rejected the load and it was returned to Blewett in Howell via a U.S. DOT special permit. Once returned to Blewitt, the load was dumped and what appeared to be the instrument panel from a World War II era plane was found to be the cause of the elevated readings. Based on readings taken at the site, it is estimated that the panel contains 61 microCi of Ra-226. The highest reading seen was 12.5 mR/hr on contact. Some of the glass covering over a gauge was broken. A gross wipe test indicated removable contamination was present. Those individuals who had touched the panel were checked for contamination or advised to check. The area where the panel had been originally placed was also checked, with slightly elevated readings discovered. All surfaces were cleaned to background levels, as well as the area where the panel had been originally secured. The panel and all items involved in the clean-up were placed in a five-gallon bucket and will be secured pending proper disposition through a waste broker."|
|ENS 53946||19 March 2019 12:13:00||The following was received from the state of Texas by email: On February 25th, 2019, the Agency (Texas Department of State Health Services) was notified by a licensee that control was lost of a Spec 150 (SN: 2472) radiography camera containing a 49 Curie iridium-192 source (Source SN: ZL1103, model G-60 manufactured by SPEC) as the result of an employee arrested for driving while intoxicated (in Odessa, TX). The vehicle containing the source was impounded. The keys to the vehicle were left with the impound yard. The vehicle was locked, alarm armed, in a fenced lot, behind a locked gate, and under video surveillance. Keys to the darkroom, where the source was stored, were located in the center console of the vehicle. No individuals accessed the vehicle while in the impound lot. The vehicle was retrieved by the licensee shortly after being notified of the arrest and impounding. The source was out of the licensee's control for approximately eleven hours. No exposures occurred as a result of this event. TX Incident #: 9657|
|ENS 53887||21 February 2019 11:28:00||The Avera McKennan Hospital mobile diagnostic truck was in an accident where the truck went off the road, the cab and box detached, and the driver was killed. The truck contained various used sources and medical materials used in nuclear diagnostic medicine. The sources, although ejected from the truck, were found nearby in their respective transport boxes with the exception of the Tc-99 used syringes (sharps). Surveys and wipe tests show no contamination. The sealed sources will be leak checked. The transport box for the Co-60 source was damaged with a small hole. Radiation readings are slightly higher in the proximity of the hole. All the recovered sources are in storage at the hospital. The sharps container was empty with the sharps strewn along the snow bank alongside the road. Residual materials may be within the sharps. Cleanup of the material is underway but may be delayed until the snow melts. The accident occurred on I-29, north of Sioux Falls, between the Baltic and Dell Rapids exits. The truck was headed north. The South Dakota Highway Patrol responded to the scene. Notified South Dakota Health Agency, DOT Crisis Management Center, DOE Ops Center, and DHS SWO.|
|ENS 53863||6 February 2019 12:46:00||On February 05, 2019 at approximately 1800 EST, candy that contained alcohol was discovered in the plant protected area. The candy was removed from the protected area by station security management. The licensee notified the NRC Resident Inspector and the State of New York Public Service Commission.|
|ENS 53860||4 February 2019 18:40:00||A licensed reactor operator had a confirmed positive random fitness-for-duty drug test. The employee's access to the plant has been terminated. The NRC Resident Inspector has been notified.|
|ENS 53808||26 December 2018 17:01:00||The following was received from the State of Illinois by email: The radiation safety officer for Combined Metals of Chicago reported that the shutter on their Data Measurement Corporation Sr-90/100 mCi gauge had failed in the closed position due to a screw that had dislodged from the shutter mechanism. The manufacturer has been called for repair services. IL Item Number: IL180044|
|ENS 53823||11 January 2019 10:08:00||The following report was received from the State of Minnesota by email: The licensee uses a static eliminator on the end of an air line. Typically the static eliminator is kept on the line and not removed. The licensee recently moved locations and not all of their stations were set up, so they were moving the static eliminator around. The static eliminator was removed from a line and placed on top of a box. It slid off the box and ended up under a nearby pallet. They noticed the static eliminator was missing on 12/24/2018. The pallet was moved and the static eliminator was found on 1/11/2019. All of the stations are now set up and the static eliminator will stay connected to a dedicated line. Material: Po-210, NRD model P-2021, 1.9 mCi on 1/10/19 State event report: MN190001 THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf|
|ENS 53772||4 December 2018 13:35:00|
EN Revision Text: HPCI INOPERABLE DUE TO MECHANICAL DRAFT COOLING TOWER FAN BRAKE INVERTER FAILURE At 0935 EST on December 4, 2018, the Division 2 Mechanical Draft Cooling Tower (MDCT) fans were declared inoperable due to failure of the over speed fan brake inverter. The brakes prevent fan over speed from a design basis tornado. The MDCT fans are required to support operability of the Ultimate Heat Sink (UHS). The UHS is required to support operability of the Division 2 Emergency Equipment Cooling Water (EECW) system. The EECW system cools various safety related components, including the High Pressure Coolant Injection (HPCI) system room cooler. An unplanned HPCI inoperability occurred based on a loss of the HPCI Room Cooler. Investigation into why the Division 2 MDCT fan over speed brake inverter failed is in progress. This report is being made pursuant to 10 CFR 50.72(b)(3)(v)(D) based on an unplanned HPCI inoperability. The NRC Resident Inspector has been notified. Fermi 2 is in a 14-day LCO for inoperability of HPCI and a 72-hour LCO for UHS inoperability.
The purpose of this notification is to retract EN 53772 made on December 4, 2018. Subsequent to the initial notification, the event and site Technical Specifications (TS) were reviewed further. An evaluation determined that TS Limiting Condition for Operation (LCO) 3.0.9 for barriers could be applied to the MDCT fan brakes. As a result of applying TS LCO 3.0.9 to the MDCT fan brakes, it was not necessary to declare the UHS inoperable. With the Division 2 UHS operable on December 4, 2018, the HPCI system was also operable. With HPCI operable, there was no event or condition that could have prevented the fulfillment of a safety function needed to mitigate the consequences of an accident under 10 CFR 50.72(b)(3)(v)(D). Therefore, EN 53772 is retracted and no Licensee Event Report (LER) under 10 CFR 50.73(a)(2)(v)(D) is required to be submitted. The licensee has notified the NRC Resident Inspector. Notified R3DO (Cameron).
|ENS 53775||4 December 2018 17:12:00||On 12/4/2018 at 1340 (PST), Columbia entered a planned evolution to replace the seismic monitoring system. Use of the Modified Mercalli Intensity Scale has been implemented as a compensatory measure per station procedures. The expected duration of the replacement activity will exceed 72 hours, therefore, this is being reported as a major loss of emergency assessment capability in accordance with regulation 10 CFR 50.72(b)(3)(xiii). Compensatory measures will remain in place until the seismic system replacement has been completed. The NRC Resident Inspector has been notified."|
|ENS 53770||3 December 2018 16:28:00||The following was received from the State of California by email: On 12/03/18, the RSO (Radiation Safety Officer) contacted CA Office of Emergency Services (OES) to report a stolen density gauge. The gauge involved is a Troxler Model 4640-B, S/N 1292, containing 9 mCi of Cs-137 (thin lift asphalt density gauge). The parked vehicle (in San Francisco, CA) was broken into and the gauge was stolen during overnight hours. According to the RSO, at the time of the theft, the gauge was locked inside a Type A container with additional locks securing the gauge to the vehicle. The gauge user was enroute to a field job in the area near Quality Inn where the theft occurred. The RSO has immediately notified South San Francisco Police Department of the theft (Report # 18-7086). Licensee will be posting a reward for safe return of the gauge. RHB (CA Department of Public Health - Radiologic Health Branch) will be following up on this investigation. 5010 Number: 120318 THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf|
|ENS 53768||3 December 2018 14:20:00||The following was received from the State of Illinois by email: The licensee contacted the agency on 12/1/18 at approximately 1800 (CST) to report that a tornado had struck their portable gauge storage location at 1615 (CST). Licensee was unable to locate the gauge at the time of the call. Agency inspectors arrived at the location at 1945 (CST) and began surveys. The Troxler gauge was located in its transport case beneath the rubble of the destroyed building. The following morning, an excavator was utilized to remove the debris and gain access to the gauge. Both the gauge and the transport case were undamaged. The gauge was secured by two physical barriers in another building on site. Leak tests will be taken the week of 12/3/18 and the gauge is removed from service until leak test results are received. The licensee will be submitting an amendment request for a new storage location. Pending no further developments, this matter is considered closed. IL Event Item Number: IL180040 THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf|
|ENS 53754||26 November 2018 08:31:00|
At 0816 EST, a Notification of Unusual Event was declared for Unit 2 under Emergency Action Level H.U.4 for excessive smoke in the lower level of containment with a heat signal. Onsite fire brigade is responding to the event. A command post is established. Offsite support is requested by the fire brigade. No flames have been observed as of this report. The NRC Resident Inspector and State and Local government agencies will be notified. Notified DHS SWO, FEMA Operations Center, DHS NICC, FEMA NWC (email), DHS Nuclear SSA (email), and FEMA NRCC SASC (email).
At 1036 EST, Sequoyah Nuclear Station Unit 2 terminated the Notice of Unusual Event. The licensee determined that the source of the smoke in containment was oil on the pressurizer beneath the insulation, that heated up during plant heatup. The licensee did not see visible flame during the event. The licensee is still working to determine if there was any damage to the pressurizer. The licensee will notify the NRC Resident Inspector. Notified R2DO (Rose), R2RA (Haney), NRR (Nieh), IRD MOC (Gott), DHS SWO, FEMA Operations Center, DHS NICC, FEMA NWC (email), DHS Nuclear SSA (email), and FEMA NRCC SASC (email).
Following declaration of the Notification of Unusual Event, TVA media relations communicated with the local media regarding the event. The licensee has notified the NRC Resident Inspector. Notified R2DO (Rose).
At 1036 EDT, Sequoyah Nuclear Plant (SQN) terminated the Notification Of Unusual Event (NOUE) due to initial report of heat and smoke in Unit 2 Lower Containment. At 1000 EDT, it was determined that no fire had occurred. Due to difficulty of access to some of the areas being searched, the source could not be identified prior to 1000 EDT. No visible flame (heat or light) was observed. The source of the smoke was determined to be residual oil from a hydraulic tool oil in contact with pressurizer piping. The pressurizer piping was being heated up to support Unit 2 start-up following U2R22 refueling outage. Once the residual oil dissipated, the smoke stopped. It has been concluded that no fire or emergency condition existed. Unit 2 is currently in Mode 5, maintaining reactor coolant temperature 160F-170F and pressure 325psig-350psig with 2A Residual Heat Removal (RHR) system in service in accordance with U2R22 refueling outage plan. The licensee has notified the NRC Resident Inspector. Notified R2DO (Rose).
Sequoyah Nuclear Plant (SQN) is retracting this notification based on the following additional information not available at the time of the notification: Following a full Reactor Building inspection, it was concluded that a fire did not exist. The source of the smoke originally reported was later determined to be residual oil from a hydraulic tool in contact with pressurizer piping. Once the residual oil dissipated, the smoke stopped. The source of heat originally reported was normal heated conditions associated with the pressurizer commensurate with plant conditions. SQN reported initially based on the available information at the time and to ensure timeliness with emergency declaration and reporting notification requirements. The licensee has notified the NRC Resident Inspector. Notified R2DO (Shaeffer).
|ENS 53456||12 June 2018 22:11:00||On June 12, 2018, at 1500 CDT, a Reactor Coolant System (RCS) Pressure Boundary leak was identified during a Mode 3, hot shutdown walkdown on a High Pressure Injection Line (HPI) to Reactor Coolant Pump (P32C) drain line weld near MU-1066A HPI Line Drain Valve and MU-1066B HPI Line Drain Valve. The 3/4 inch drain line containing drain valves MU-1066A and MU-1066B on the 'C' HPI header (CCA-5 pipe class) has a through-wall defect on the pipe stub or welds between the sockolet and valve MU-1066A. The leak location is in the ASME Class I RCS Pressure Boundary. The hot shutdown walkdown was being performed as part of a planned outage to investigate excessive Reactor Building Sump inleakage. Total unidentified RCS leakage prior to the investigation was determined to be at 0.165 gpm. After the initial investigation of the leakage, the following Tech Specs (TS) were determined be applicable: TS 3.4.5 - RCS Loops Mode 3, TS 3.4.13 - RCS Leakage, TS 3.5.2 - ECCS. Unit 1 is currently in Mode 3 and in progress of an RCS cooldown to comply with Tech Spec requirements. The licensee notified the NRC Resident Inspector.|
|ENS 53736||12 November 2018 20:52:00||On November 12, 2018, at 1636 EST, with Surry Unit 1 at 100 percent power and Surry Unit 2 defueled, the 'C' Reserve Station Service Transformer (RSST) pilot wire lockout actuated during restoration of the 'C' RSST following transformer replacement. This resulted in electrical isolation of the 'C' RSST, the 'F' Transfer Bus, the Unit 1 'H' Emergency Bus, and the Unit 2 'J' Emergency Bus. The #1 and #3 Emergency Diesel Generators automatically started and loaded onto the 1H and 2J emergency buses, respectively, as designed. Operations entered the appropriate abnormal procedures and stabilized both units. This equipment operated as expected during the event. The Surry electrical distribution system was in an off-normal alignment to support 'C' RSST replacement with the dependable alternate power supply from Unit 2 station service backfeed supplying the 1H and 2J emergency buses. The 'C' RSST pilot wire lockout tripped and locked out the station service supply tie breaker to the 'F' Transfer Bus. The organization is reviewing the 'C' RSST pilot wire lockout and the required actions for recovery. Surry Unit 1 entered a 6-hour action statement to place the unit in Hot Shutdown due to this partial loss of offsite power. This clock was exited upon reset of the pilot wire lockout, restoring backfeed as a dependable offsite power source. Unit 1 remained at 100 percent power throughout the event. No radiological consequences resulted from this event. This event is being reported pursuant to 10 CFR 50.72(b)(3)(iv)(A) due to actuation of the #1 and #3 Emergency Diesel Generators. The NRC Resident was notified."|
|ENS 53693||24 October 2018 17:45:00||On October 24, 2018 at 0901 CDT, during performance of the 'Functional Test of Unit 1 Second Level Undervoltage,' a loss of Bus 13-1 and Bus 18 occurred. The 1/2 Emergency Diesel Generator (EDG) automatically started due to a valid actuation on loss of power to Bus 13-1, but did not load due to required testing alignment. The loss of Bus 13-1 caused the loss of the 1A loop of Core Spray, both loops of Low Pressure Coolant Injection (LPCI), and Bus 18. All equipment responded as expected. Bus 13-1 and Bus 18 were restored at 0911(CDT) on 10/24/18. Other affected systems are in the process of being restored. An investigation as to the cause of the event has been initiated. This notification is being made in accordance with 10 CFR 50.72(b)(3)(iv), 'Event or Condition that results in valid actuation of any of the systems listed in paragraph (b)(3)(iv)(B),' because the 1/2 EDG auto started due to the loss of power condition. This notification is also being made in accordance with 10 CFR 50.72(b)(3)(v)(B), 'Event or Condition that Could Have Prevented Fulfillment of a Safety Function,' because both loops of LPCI were inoperable for a short time period. During the ten minutes where LPCI was unavailable, Unit 1 was in Technical Specification LCO 3.0.3. Unit 1 is currently in LCO 3.8.1(b) until the EDG is restored. Unit 2 was not affected by this event. The licensee will notify the NRC Resident Inspector.|
|ENS 53691||23 October 2018 19:24:00||At 1616 EDT on 10/23/18, Salem reported to the New Jersey Department of Environmental Protection a sheen on ground water discovered during excavation in the Salem Switchyard. This discovery did not violate any NRC regulations or reporting criteria. This notification is being made solely as a four-hour, non-emergency notification for a Notification of Other Government Agency. This event is reportable in accordance with 10 CFR 50.72(b)(2)(xi). There was no impact on the health and safety of the public or plant personnel. The licensee notified the NRC Resident Inspector and will notify Lower Alloway Creek Township.|
|ENS 53690||23 October 2018 15:43:00||On October 23, 2018 at 1510 EDT, a notification to OSHA (Occupational Safety and Health Administration) was initiated due to a supplemental employee experiencing a non-work related medical event that resulted in the supplemental employee passing. When the issue was identified, the station first aid team responded to administer first aid. The supplemental employee was transported to a local hospital for additional medical support. Subsequent to the employee passing, a report was made to OSHA in accordance with federal requirements. This event is reportable to the NRC per 10 CFR 50.72(b)(2)(xi) since another governmental agency was notified of this employer medical event. The supplemental employee was in a building within the owner controlled area and was not contaminated. The licensee notified the NRC Resident Inspector."|
|ENS 53689||23 October 2018 12:39:00||The following was received from the State of Texas by email: On October 23, 2018, (a report was received by the Texas Department of State Health Services that) a consulting company servicing the equipment for a licensee found during a maintenance operation that a gauge had a stuck shutter on October 22, 2018. The device is labeled Vega, SH-F1A, 20 mCi, Cesium-137, Source Serial number 5786CN. The gauge measures vessel material levels and is mounted about 10 feet above ground level. No risk of radiation exposure to members of the public or radiation workers at the location. The gauge shutter is stuck in the open operating position. A repair company was called to contract an inspection to repair or replace the gauge. An update will be provided as information is obtained. Texas Incident #: 9624|
|ENS 53687||22 October 2018 16:24:00||The following was received from the Commonwealth of Virginia by email: On October 22, 2018, the RSO (Radiation Safety Officer) for the licensee reported an accident that morning at a construction site near Sterling, Virginia. A roller hit a portable moisture/density gauge with its rear wheels while backing up. The gauge user established an exclusionary area until the RSO arrived to perform an onsite investigation and radiation survey. The RSO reported the plastic housing of the gauge was cracked but the source rod and shielding were intact. Surveys indicated no unusual radiation levels. The licensee contacted a vendor to analyze leak test samples and to determine potential repairs to the gauge. The gauge was a Troxler 3430, serial (number) 30198, with an 8 milliCurie Cs-137 source, serial (number) 750-2497, and a 40 milliCurie Am-241:Be source, serial (number) 47-27175. VA Event Report ID No.: VA-18-007|
|ENS 53683||22 October 2018 12:44:00||The following was received from the Commonwealth of Virginia by email: On October 20, 2018, the representative of the Virginia Radioactive Materials Program (VRMP) received a telephone call from the licensee that the guide tube of a portable nuclear moisture/density gauge (CPN Model MC-1DRP, Serial number MD50507856) was damaged (bent) by a truck while performing testing at a temporary jobsite in Sterling, Virginia. The gauge contained 10 milliCuries of Cesium-137 and 50 milliCuries of Americium-241/Beryllium. The sources were in the shielded position and the shielding integrity was not damaged. The licensee performed a survey of the gauge and readings observed were between 0.2 and 0.3 mR/hr at three (3) feet distance from the gauge. The gauge was put in its transport box and returned to the office. Wipe test samples were taken. Samples were sent to the North East Technical Services for analysis. Results are pending. The VRMP is currently working with the licensee to obtain additional information. This report will be updated when VRMP receives more information. VA Event Report ID No.: VA-18-006|
|ENS 53684||22 October 2018 14:22:00||The following was received from the State of North Carolina by email: On 10/20/18, at 1757 EDT, the office RSO (Radiation Safety Officer) received a call from a crew working a project at Kings Mountain Compressor Station in Kings Mt., NC. The qualified radiographer assigned is Technician 1, with assistant Technician 2. Upon exposure of a 3 inch weld, the source did not retract when attempting to secure the RAM to end exposure. The crew immediately verified and re-verified and secured boundaries and called the RSO as required by operating and emergency procedures. The local RSO notified the CRSO (corporate RSO) of the event at 1803 EDT and proceeded to the site. (While) in route to the project site, Technician 4 was notified to go to the Charlotte office to get spare control cables for possible use in recovery operations. Upon arrival at approximately 1830 EDT, the RSO evaluated the site and boundaries and took action to move the source and collimator assembly to a better position to allow stacking of available sand bags in order to minimize boundary area for a more condensed and controllable area. During the movement of the exposure device, positive pressure was applied to the control to prevent the source from moving out of the collimator. Once the exposure device was positioned correctly, sand bags were placed over the source assembly to reduce exposure limits. During this operation, survey meters were used to verify radiation exposures. The radiation area was reduced to 30-35 feet. A conversation with the CRSO and calls with additional Applus groups were made in order to identify the closest source recovery tools and equipment in order to attempt recovery of the source. (Personnel) added another layer of area markings for control purposes. Contractor site personnel stayed clear of the area without issue during event. No exposure to the general public occurred. The recovery kit arrived on site at approximately 1030 EDT, 10/21/18. After review of available equipment, a recovery plan was discussed. Dosimetry, equipment operation, and proper calibrations were verified. All dosimeter pencils were verified at zero at the beginning of the event and monitored at stages during recovery. Actions were broken down in order to balance and reduce exposure to each individual and modified as necessary during event. The plan of action was to create a shielded dam with available lead shot and sand bags at the open end of the guide tube, with one bag directly in front of the tube to stop the source assembly at the most shielded position, with the others providing a shielded position for the capsule of the source assembly. The last sand bag on the collimator was left in position up until the last step. Two individuals were directed to quickly remove the last shielding bag while the other utilized an extended tong device to lift the collimator assembly directly upward to propel the source to the established dam of shielding. Survey meters were used to monitor this action to verify the source moved from the previous position to the created shielding dam. All dosimeter pencils were reviewed in order to determine who would be chosen to disconnect damaged connector and then another to make the connection to the functioning control cable. The first person pulled the connection out only far enough to disconnect the damaged connector. The second person performed the re-connection. The survey meter reading at the connection area was approximately 200 mR/hr during these steps. The time of exposure to perform these two events was estimated to be less than 30 seconds, which would have equaled approximately 1.6 mR of exposure to the hands of each individual. From the safe distance of the control cable, the source was retracted to the shielded position of the device and surveyed and secured. At this time, the exposure device and control cable have been returned to the office and tagged with damage tags so no one will use it. NC tracking number: 180043|
|ENS 53665||12 October 2018 16:54:00||On October 12, 2018 at 1353 EDT, St. Lucie Unit 2 experienced an automatic RPS actuation and Reactor Trip due to a fault on the 2A1 6.9kv bus during a transfer of the bus power supply from the 2A Auxiliary Transformer to the 2A Startup Transformer. The bus fault caused a fire in the 2A1 6.9kv switchgear that has been extinguished. Offsite support was not required to extinguish the fire. The specific cause of the fault is currently under investigation. Following the reactor trip, both Steam Generators are being supplied by main feedwater. All (Control Element Assemblies) (CEAs) fully inserted into the core. Decay Heat removal is being accomplished through forced circulation. Main Feedwater and Steam Bypass Control Systems are maintaining stable conditions in Mode 3. St. Lucie Unit 1 was unaffected and remains in Mode 1 at 100 percent power. This report is submitted in accordance with 10 CFR 50.72(b)(2)(iv)(B) for the Reactor Trip. The fire was extinguished within 28 minutes. Plant loads are being supplied by the 2B Auxiliary Transformer. The licensee notified the NRC Resident Inspector.|
|ENS 53658||10 October 2018 17:40:00||During retraction of the source following an exposure inside a storage tank (at the BP Refinery, Whiting, IN), the radiographer noted the source did not retract with the drive cable as survey readings indicated the source was still exposed. An immediate call was made to the local RSO (Radiation Safety Officer), who is source retrieval trained, to report the issue. Barricades were continuously monitored while waiting for his arrival. Upon arrival and evaluation of the situation, the local RSO determined a source disconnect had occurred due to a possible broken drive cable. Source retrieval procedures were then enacted with the source safely returned to the shielded position in the exposure device at approximately 1400 CDT. The exact cause of the event is not clear at this time and the drive cable and connector are being sent to the manufacturer for evaluation. Equipment involved: QSA Ir192 model A424-9 source assembly with approximate activity 84 Curies; QSA model 880 Delta exposure device and associated equipment (drive assembly and guide tube). Approximately 4-5 individuals were involved in the retrieval process with the RSO (Authorized Source Retriever) indicating he received the highest exposure, as recorded on pocket dosimeters, of 25 mrem."|
|ENS 53876||15 February 2019 09:40:00||The following is a summary from a phone call with the licensee: The licensee decided to remove seven nuclear gauges from service. Ronan Engineering performed the removal. During the device removal on October 9, 2018, one device was found to have a stuck shutter in the open position. The gauge was removed and repaired.|
|ENS 53642||3 October 2018 19:39:00||At 1135 PDT on October 3, 2018, Southern California Edison (SCE) determined a SCE supervisor failed a random breathalyzer test for alcohol during a random Fitness-for-Duty (FFD) test. The employee's unescorted access to San Onofre Nuclear Power Plant has been suspended."|
|ENS 53706||31 October 2018 10:18:00|
The following was received via email: Specific Location Information Where Incident Occurred: Pace Analytical Services, Beaver-WV Environmental Laboratory
Incident, Amount: In (Pace's) inventory, (Pace) had six spare Agilent ECDs (Electron Capture Devices). (Pace) believes they were accidentally placed in the trash for disposal and were subsequently placed in the local landfill. The ECDs have a sealed source with approximately 15 milliCuries of Nickel 63 each. These were the ECDs only and not the entire instrument, Gas Chromatograph (GC).
ECDs / Models: F6470 / 19233 F6526 / 19233 L2643 / 19233 L7189 / 19233 F4602 / 19233 F6242 / 19233
Date of Lost/Misplaced ECDs, Last Time Seen: Identified as missing October 1, 2018. Confirmed to be missing October 3, 2018 Last seen September 26, 2018. Believed to be placed in the laboratory trash September 26th-29th, 2018.
Root Cause: During a clean-up/lean event employees were going through the lab and reorganizing/disposing of unneeded materials. The six ECDs were used as reserves for GC instrumentation and placed in a bag in efforts to not dispose of them. At some point later in the week, it is believed that either an employee or cleaning person mistook the bag as garbage and threw them away.
Measures to Recover: Upon discovering the lost ECDs, Pace contacted the trash hauler - Raleigh County Solid Waste Authority. They stated that, due to the length of time that has passed since disposal, the likelihood of recovery is essentially zero. Due to the process of filling hollow-like areas, anything disposed has approximately 20 feet of additional material over it, and they have no way of knowing where the truck would have dumped the materials. THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf
|ENS 53618||24 September 2018 11:29:00||The following was received by the State of Florida by email: (Boca Raton Regional Hospital Women's Imaging Center) Radiation Safety Officer, contacted (the State of Florida Bureau of Radiation Control) by phone on Friday, September 21, 2018 at approximately 1500 EDT to report the potential loss of a 170 microCurie Iodine-125 seed, from Boca Raton Regional Hospital Women's Imaging Center. ISOAID Seed Company has been contacted to assure the seed was not received in an earlier shipment. Seed can be tracked to the Nuc Med Hot lab. Staff has confirmed it is not in the patient or in the Pathology lab. Sealed source certificate will be sent later. Full investigation report will be submitted within 30 days. Florida Incident Number: FL18-124 THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf|
|ENS 53682||22 October 2018 12:24:00||The following was received from the State of New York by fax: Terracon Consultants reported that a moisture/density gauge (Troxler model 3430P, serial #70428, containing 0.30 GBq (8 mCi) Cs137 and 1.48 GBq (40 mCi) Am-Be source) was damaged at a mass fill project in Rochester, NY. The source manufacturer and serial number are not yet available. While at a mass fill project in Rochester, NY, a technician had completed a round of density testing and placed the gauge within a roped off area at the end of the fill area. He then walked to his truck approximately 100 feet away to get water. During that time, a 10-ton single drum roller moving in reverse headed towards the roped off area and gauge. The technician noticed the operator approaching the gauge as he walked back towards it and yelled and tried to gain the attention of the roller operator. The rear rubber tire of the roller impacted the side of the gauge and damaged the plastic covering. The technician cordoned off the area 15 feet around the gauge and surveyed the operator and roller. The technician called their office manager and a regional manager (who happened to be in their office) and went to the site and surveyed the gauge and all parties/equipment involved and it did not appear that the gauge was leaking. The gauge was visually inspected for damage and it appeared that only the top case was damaged, the gauge was still operational, and the source rod was fully enclosed in the gauge. The gauge was returned to its transport case and returned to its permanent storage location in Rochester, NY. The gauge will be transported for repair and leak testing. An internal root cause analysis and follow up training with the technician will be set in place with their corporate RSO (Radiation Safety Officer) in the next few days. NY EVENT REPORT ID NO. NY-18-02|
|ENS 53575||31 August 2018 16:04:00||The following event description is based on information currently available. If through subsequent reviews of this event additional information is identified that is pertinent to this event or alters the information being provided at this time, a follow-up notification will be made via the ENS or under the reporting requirements of 10 CFR 50.73. This event is being reported pursuant to 10 CFR 50.72(b)(3)(xiii) as a Loss of Emergency Preparedness Capabilities at Palo Verde Nuclear Generating Station (PVNGS) Unit 2. On August 31, 2018, at approximately 0544 Mountain Standard Time (MST), the Unit 2 control room experienced an unplanned loss of Steam Generator #1 steam line monitor (RU-139), Channels A and B. This main steam line monitor is used in the PVNGS Emergency Plan to perform dose assessment in the event of a steam generator tube rupture. The NRC Resident Inspectors have been notified."|
|ENS 53576||31 August 2018 23:26:00||This notification is being provided in accordance with 10 CFR 50.72(b)(2)(iv)(B). On August 31, 2018 at 2105 CDT, Unit 2 Reactor Manual Scram signal was inserted due to Main Condenser vacuum degrading. The turbine was tripped following the scram. Main Condenser vacuum is at 6 inches of backpressure slowly improving following the scram and turbine trip. During the scram, one Control Rod (30-31) did not fully insert. Control Rod 30-31 has been manually inserted to position 00 with the first position identified as position 24. Plant is in a stable condition with reactor pressure being maintained by the Turbine Bypass valves. Reactor water level is being controlled with feedwater. Investigation into the cause of the elevated condenser in leakage is in progress. The Senior NRC Resident has been notified."|
|ENS 53574||31 August 2018 14:28:00||A patient was prescribed 86.9 milliCuries Yittrium-90 Theraspheres to the liver, but a malfunction in the kit prevented the Theraspheres from travelling to the dose location. There was no contamination detected on the patient or equipment. The patient was notified and rescheduled for this procedure next week. The manufacturer of the kit was notified and the hospital pulled all kits in that lot. A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.|
|ENS 53557||22 August 2018 11:23:00||At 0943 EDT on August 22, 2018, the Watts Bar Unit 2 reactor automatically tripped while operating at 100 percent power. All control and shutdown bank rods inserted properly in response to the automatic reactor trip. All safety systems including Auxiliary Feedwater actuated as designed. The plant is stable with decay heat removal through Auxiliary Feedwater and Steam Dump Systems. The reactor automatically tripped due to a main turbine trip signal. An investigation is in progress. The automatic actuation of the Reactor Protection System (RPS) is being reported as a four-hour report under 10 CFR 50.72 (b)(2)(iv)(B). The expected actuation of the Auxiliary Feedwater System (an engineered safety feature) is being reported as an eight-hour report under 10 CFR 50.72 (b)(3)(iv)(A). The NRC Senior Resident Inspector has been notified for this event."|
|ENS 53556||22 August 2018 02:00:00||At 2322 EDT, Limerick Generating Station notified the Pennsylvania DEP (Department of Environmental Protection) that our plant waste water pond (holding pond) overflowed due to heavy rainfall in the area. Plant alignment changes were made and the holding pond stopped overflowing at 0017 EDT. Limerick Generating Station has not determined this release to contain oil, grease, or pollutants hazardous to the public. The licensee notified the NRC Resident Inspector.|
|ENS 53661||11 October 2018 15:37:00||This 60-day telephone notification is being made per the reporting requirements specified by 10 CFR 50.73(a)(2)(iv)(A) and 10 CFR 50.73(a)(1) to describe an invalid actuation of a general containment isolation signal affecting more than one system. On August 16, 2018, at approximately 1736 CDT, Browns Ferry Nuclear Plant (BFN), Unit 2 experienced an unexpected loss of the 2B Reactor Protection System (RPS). This resulted in Primary Containment Isolation System (PCIS) groups 2, 3, 6, and 8 isolations, and initiation of Standby Gas Treatment Trains A, B, and C and Control Room Emergency Ventilation System Train A. All affected safety systems responded as expected with the exception of the Unit 1 Refuel Zone Supply Fan Outboard Isolation Damper, 1-FCO-64-5, that failed to indicate closed position. Plant conditions which initiate PCIS Group 2 actuations are Reactor Vessel Low Water Level (Level 3) or High Drywell Pressure. The PCIS Group 3 actuations are initiated by Reactor Vessel Low Water Level (Level 3) or Reactor Water Cleanup Area High Temperature. The PCIS Group 6 actuations are initiated by Reactor Vessel Low Water Level (Level 3), High Drywell Pressure, or Reactor Building Ventilation Exhaust High Radiation (Reactor Zone or Refuel Zone). The PCIS Group 8 actuations are initiated by Low Reactor Vessel Water Level (Level 3) or High Drywell Pressure. At the time of the event, these conditions did not exist; therefore, the actuation of the PCIS was invalid. The cause of the RPS MG (Motor Generator) Set trip was a failed (shorted) operating coil associated with the 480 VAC motor starter inside the control box. There were no safety consequences or impact to the health and safety of the public as a result of this event. This event was entered into the Corrective Action Program as Condition Reports 1440047 and 1440050. The NRC Resident Inspector has been notified of this event."|
|ENS 53664||12 October 2018 15:04:00|
EN Revision Text: INTERIM PART 21 REPORT - EVALUATION OF MOTORS The following information was received by from ABB Motors and Mechanical INC by facsimile: Pursuant to 10 CFR 21.21(a)(2) this letter provides an interim report concerning an evaluation being performed by ABB Motors and Mechanical Inc. (formerly Baldor Electric Company) on three 40 ft-lb, 56 frame, 2-pole AC electric motors. The issue being evaluated pertains to the abnormal appearance of cracked paint and minor deformation around the stator pin which is located in the motor housing shell. The three motors were supplied to Flowserve - Limitorque on a single purchase order in April 2013. The issue being evaluated was identified after MOV production set-up and testing at the valve manufacturing facility. The equipment had not been supplied to a nuclear power plant and thus had not been placed into service. The discovery date of the condition being evaluated is August 2, 2018. Evaluation of reportability cannot be completed within the initial evaluation period due to the need to perform additional inspections of motors manufactured in the same period. ABB is working with Flowserve - Limitorque to expedite the additional inspections and testing. It is anticipated that this will be completed by 01/11/2019. An initial review of ABB's records indicate that since 1998 ABB has supplied approximately 670, 56-frame AC electric motors of 40 and 60 ft-lb. to Flowserve - Limitorque. Flowserve - Limitorque communicated to ABB that there have been no previously reported occurrences of this issue nor any reported motor failures related to this issue. (i) Name and address of the individual or individuals informing the Commission. Sheldon Thomas QA Manager ABB Motors and Mechanical Inc. Flowery Branch, GA 30542 (678) 947 7350 (ii) Identification of the facility, the activity, or the basic component supplied for such facility which fails to comply or contains a defect. The basic components being evaluated are Class 1E 40 ft-lb, 56 frame, 2-pole motors supplied to Flowserve - Limitorque for installation on valve actuators to be supplied into nuclear plant applications, to date, no basic components have been determined to contain a defect. (iii) Identification of the firm constructing the facility or supplying the basic component which fails to comply or contains a defect. The basic components being evaluated were supplied by ABB Motors and Mechanical Inc. (formerly Baldor Electric Company) ("ABB"), No basic components have been determined to contain a defect. This is an interim report. (iv) Nature of the defect or failure to comply and the safety hazard which is created or could be created by such defect or failure to comply ABB was contacted by our customer Flowserve - Limitorque regarding three 40 ft-lb, 56 frame, 2-pole AC electric motors which were reported to have an abnormal visual appearance of cracked paint and minor deformation of the motor housing material around the stator pin. The motor stator pin is installed through the motor housing shell into the stator assembly. ABB's initial inspection of the three motors suggested that the deformation around the pin may have occurred when the motor was operated during actuator and/or MOV production testing. ABB is evaluating whether this abnormal condition of the stator pin interface with the motor frame constitutes a defect that could potentially affect the safety related function of the motor. To date, no basic components have been determined to contain a defect. This is an interim report. (v) The date on which the information of such defect or failure to comply was obtained. The discovery date of the condition being evaluated is August 2, 2018, (vi) In the case of a basic component which contains a defect or fails to comply, the number and location of these components in use at, supplied for, being supplied for, or may be supplied for, manufactured, or being manufactured for one or more facilities or activities subject to the regulations in this part. At this time, no basic components have been determined to contain a defect. (vii) The corrective action, which has been, is being, or will be taken; the name of the individual or organization responsible for the action; and the length of time that has been or will be taken to complete the action. None at this time, (viii) Any advice related to the defect or failure to comply about the facility, activity, or basic component that has been, is being, or will be given to purchasers or licensees. None at this time.
The following information was received via fax: This letter is a follow-up to the initial Interim Notification dated October 12, 2018 (Ref. ML18302A229). ABB continues to work with Flowserve-Limitorque to expedite the additional inspections of motors in the field and testing of motors pulled from inventory. The testing is necessary to assist in determination if the abnormal appearance and deformation constitutes a defect which would cause a substantial safety hazard. It is anticipated that this will be completed by February 28, 2019. At that time, motor testing should be complete and analysis of results conducted. ABB will then be able to determine if the nature of the condition is a substantial safety hazard and reportable. If further time is necessary for evaluation, a follow-up to this report will be filed. Since discovery of the condition, and to the date of this report, ABB and Flowserve-Limitorque are not aware of any confirmed field inspections by Flowserve-Limitorque's customer or the results of such inspections. Notified the R1DO (Bower) and Part 21 Reactors Group (via e-mail).
The following closeout was received by fax: ABB has completed the evaluation of the abnormal appearance of the three motors identified in this notification with the determination that this condition does not constitute a defect that would affect the safety related function of the motor. Notified the R1DO (Werkheiser) and Part 21 Reactors Group (via e-mail).
|ENS 53495||9 July 2018 10:29:00|
The following information was received from the Commonwealth of Virginia via E-mail: On Monday July 9, 2018, at approximately 0900 EDT the licensee reported to the Virginia Radioactive Materials Program that a construction trailer, containing a Troxler Model 3440 (serial number 17396) moisture density gauge (portable gauge) was stolen over the weekend from a road construction site in Thornburg, VA. According to the licensee's Radiation Safety Officer (RSO), the gauge was secured inside its case which was secured to the floor of the trailer by lock and chain. The theft of the trailer was discovered on Monday morning (July 9th) when workers reported to the construction site to begin work. The gauge was last seen when secured inside the trailer at approximately 1500 EDT on Friday, July 6, 2018. The gauge contains (nominally) 9 milliCuries of Cs-137 and 44 milliCuries of Am-241. The construction site is located on State Route 606 (Mudd Tavern Road), approximately 1 mile west of I-95. The Virginia State police were notified by the licensee on Monday morning, July 9, 2018. The Virginia Radioactive Materials Program has encouraged the licensee to issue a press release. The purpose of the press release is to inform the perpetrator(s) that the gauge is of no value to anyone that is not licensed by the U.S. Nuclear Regulatory Commission or an Agreement State, such as Virginia. Virginia Event Report ID No: VA-18-003
The following update was received from the Commonwealth of Virginia via E-mail: On Tuesday, July 10, 2018, the licensee's RSO informed the Virginia Radioactive Materials program that the stolen portable gauge had been recovered by the Virginia State Police. As of 10:30 AM, the licensee's technician was in route to the Hampton Roads area to retrieve the stolen trailer and the portable gauge. The police detective informed the licensee that the trailer was broken into but the gauge appeared to be intact. A final update will be provided once the gauge is retrieved and its safe configuration is verified. Notified R1DO (Bower), ILTAB and NMSS Events Notifications via E-mail.
The following update was received from the Commonwealth of Virginia via E-mail: On Thursday, July 12, 2018, a Virginia Radioactive Materials Program Inspector conducted a reactive inspection in Thornburg, VA. The inspector verified that the stolen portable nuclear gauge was retrieved by the licensee and that the gauge is intact. This is the final update to the subject report. Notified R1DO (Bower), ILTAB and NMSS Events Notifications via E-mail. THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf
|ENS 53481||1 July 2018 08:24:00||On July 1st, 2018 at 0100 (EDT), a portion of the Division 1 Emergency Core Cooling System (ECCS) Loss Of Coolant Accident (LOCA) initiation logic was declared inoperable due to the discovery of a blown fuse. The fuse was replaced at 0215 on July 1st, 2018 and the Division 1 ECCS LOCA initiation logic was declared operable at 0230 on July 1st, 2018. The blown fuse caused the loss of a portion of the Division 1 ECCS LOCA initiation logic which would have prevented the initiation of the Emergency Closed Cooling (ECC) A system. ECC A and supported systems were declared inoperable. Low Pressure Core Spray (LPCS) was one of the supported systems that were declared inoperable. LPCS is considered a single train safety system. Inoperability of LPCS is considered an event or condition that at the time of discovery could have prevented the fulfillment of the safety function of structures or systems that are needed to mitigate the consequences of an accident. The blown fuse also caused the loss of a portion of the Division 1 ECCS LOCA initiation logic which would have prevented the automatic isolation of Nuclear Closed Cooling and Instrument Air to the Containment. The loss of Containment isolation capability is considered an event or condition that at the time of discovery could have prevented the fulfillment of the safety function of structures or systems that are needed to mitigate the consequences of an accident. This event is being reported in accordance with 10 CFR 50.72(b)(3)(v)(D) The NRC Senior Resident Inspector has been notified."|
|ENS 53448||7 June 2018 16:09:00||The following was received from the State of Oklahoma by email: We (the Oklahoma Department of Environmental Quality) were just informed of a medical event and abnormal occurrence that happened yesterday at Southwestern Regional Medical Center dba Cancer Treatment Centers of America (OK-27041-01) in Tulsa, OK. The incident involved a patient who was supposed to receive a 110.8 Gy dose of Yt-90 SIR Spheres to the right lobe of the liver. A CT (scan) of the patient after the procedure showed that the microspheres had actually been delivered to the left lobe. A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.|
|ENS 53394||8 May 2018 14:33:00||During a periodic inventory check at the Columbia Falls, MT location, the Facility Radiation Safety Officer discovered two Ohmart SHF1 source holders with inoperable shutter mechanisms. Both Cs-137 sources (10 milliCuries and 50 milliCuries) are in areas where exposure to the sources is minimized by their inaccessible locations. Weyerhaeuser has been in contact with the manufacturer of the level gauge (Ohmart/Vega) about removing the inoperable source holders and replacing with two (2) new source holders. The licensee contacted NRC Region 4 (Torres).|
|ENS 53371||30 April 2018 14:53:00||At 1124 CDT, Braidwood Unit 1 experienced an automatic Reactor Trip. The cause of the Reactor Trip was a Turbine Trip with reactor power greater than P-8. The turbine trip was actuated as a result of a Turbine Motoring Generator Trip. The cause of the generator trip is unknown at this time and is under investigation. After the Reactor Trip occurred, the 1A Auxiliary Feedwater pump was manually started to provide feedwater flow to all four steam generators. The 1A Auxiliary Feedwater pump was subsequently secured and placed in standby when the Startup Feedwater pump was placed in service. Train A Main Control Room Ventilation Filtration system shifted to Makeup Mode due to a spurious actuation signal. No secondary relief valves lifted and no secondary steam was released as a result of the Reactor Trip. The Main Steam dump valves are in service to the Main Condenser to provide heat sink cooling. The plant is being maintained at normal operating pressure and temperature. AC power is being provided by Offsite Power with the Diesel Generators in standby and all safety systems available. There is no impact to Unit 2. This report is being made per 10 CFR 50.72(b)(2)(iv)(B) for a RPS actuation, 4-hr notification, and per 10 CFR 50.72(b)(3)(iv)(A) for a manual actuation of the Auxiliary Feedwater system, 8-hr notification. The licensee notified the NRC Resident Inspector and Illinois Emergency Management Agency.|
|ENS 53368||28 April 2018 15:18:00||The following information was obtained from the state of Texas via email: On April 28, 2018, the Agency was notified by the licensee's radiation safety officer (RSO) that a Troxler model 3430 moisture/density gauge had been stolen from a company truck (in Houston, TX). The gauge contains a 40 milliCurie cesium - 137 source and an 8 milliCurie americium source. The gauge was not in the transport case. The RSO did not know if the source rod was locked in the shielded position. The technician who had checked the gauge out had taken the gauge to his apartment (against company policy) and had placed it in the front seat of the truck to recharge it. When the technician came down the next morning to leave, they found a front window of the truck broken and the gauge gone. Local law enforcement has been notified of the theft. Additional information will be provided as it is received in accordance with SA-300. TX Incident #: 9565 THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf|
|ENS 53366||26 April 2018 20:23:00||This is an eight-hour, non-emergency notification for a loss of emergency assessment capability. This event is reportable in accordance with 10 CFR 50.72(b)(3)(xiii) because planned maintenance activities were performed on April 23rd through April 25th on the seismic monitoring system without viable compensatory measures established. There was no impact on the health and safety of the public or plant personnel. The NRC Resident Inspector has been notified.|
|ENS 53365||26 April 2018 18:50:00||River Bend Station experienced an inadvertent initiation and injection of High Pressure Core Spray (HPCS) at 1531 (CDT) on 4/26/2018 while operating at 100 percent power. During replacement of Level Transmitter B21-LTN081C 'Reactor Vessel Low Water Level 1', Main Control Room received an inadvertent initiation and injection of High Pressure Core Spray. The HPCS injection valve was open for approximately 40 seconds before the operators manually closed the valve. Feedwater Level Control responded per design and maintained Reactor Water Level nominal values. The Division 3 Diesel Generator (DG) also automatically started in response to the actuation signal. The DG did not automatically connect to the Division 3 switchgear since there was not a low voltage condition on the bus. The manual closure of the injection isolation valve caused the system to be incapable of responding to an automatic actuation signal. The manual override of the injection isolation valve was reset approximately 16 minutes after the event, restoring the system to its standby condition. This event is being reported in accordance with 10 CFR 50.72(b)(2)(iv)(A) as a condition that caused ECCS (Emergency Core Cooling System) discharge to RCS (Reactor Coolant System) and 10 CFR 50.72(b)(3)(v)(D) as a condition that caused the loss of function of the HPCS System. The Senior NRC Resident inspector has been notified.|
|ENS 53367||27 April 2018 12:48:00||The following report was excerpted using information provided via email: On Thursday, April 26, 2018, a crew was performing radiographic operations. At approximately 12:30 p.m. (CST), the crew experienced an incident wherein a 2-inch diameter, 8-foot long pipe rolled off a 2-1/2-foot tall table, resulting in the guide tube being used by the crew to be smashed (under the) pipe. The dent in the guide tube prevented the source from being returned to the fully shielded position. Exact Location of Event: Pennsboro, WV Licensed Material Involved: SPEC-150 Exposure Device (s/n 2056) SPEC G-60 Source (s/n ZA0905) lr-192 45 curies Corrective Action Taken/Planned: To immediately correct the problem and retrieve the source, allowing it to be returned to the fully shielded position, the black sheathing on the outside of the guide tube was removed in the damaged area. Using a hammer, the damaged area was rounded out enough to allow the source to be returned to the fully shielded position. The guide tube involved in this incident has been removed from service and will be destroyed as to prevent it from being reused. Retraining on these types of situations will be provided to all employees, and this incident specifically, will be discussed during this quarter's safety meetings within all company locations. To prevent a reoccurrence of an incident of this type, we have made plans with the company for whom we were providing radiography for to stage and brace piping moving forward. Extent of Exposure: The personnel responsible for performing source retrieval recorded a total dose of 60 mR during the retrieval. As soon as this event occurred, the crew performing radiographic operations immediately reassessed and set up appropriate 2 mR/hr boundaries, notified their Site RSO (Radiation Safety Officer) and Branch Manager, and maintained constant visual surveillance until source retrieval personnel arrived at the jobsite. At no time were any unmonitored employees in any immediate danger of being overexposed, nor were any of our company personnel, all of whom were utilizing proper radiation detection equipment.|
|ENS 53364||26 April 2018 17:36:00||The following was received from the state of Texas via email: On April 26, 2018, the Agency (Texas Department of State Health Services) was notified by the licensee's radiation safety officer (RSO) that while performing routine testing of an Ohmart Vega model SH-F1 gauge containing a 5 milliCurie cesium - 137 source, the shutter would not fully close. The RSO stated open is the normal operating condition for the gauge and it does not create an exposure risk to any individual. The gauge is used for level indication. The RSO stated they have contacted a service company and they will be on site on April 27, 2018, to inspect the gauge. Additional information will be provided as it is received in accordance with - SA-300. TX Incident #: 9564|
|ENS 53329||13 April 2018 06:07:00||On 4/13/2018 at 0227 (EDT), the Oconee Unit 1 Reactor was manually tripped from 24 percent power due to the inability to control main feedwater flow through the Main Feedwater Control Valves using the Integrated Control System. Due to the RPS actuation while critical, this event is being reported as a 4-hour Non-Emergency per 10 CFR 50.72(b)(2)(iv)(B). Following the reactor trip, multiple Main Steam Relief Valves failed to reseat at the expected pressure. Using procedure guidance, Main Steam Pressure was lowered by 115 psig, resulting in the closing of all Main Steam Relief Valves. All other post-trip conditions are normal and all other systems performed as expected. Unit 1 is currently in Mode 3 and stable. Decay heat is being removed by the steam generators discharging steam to the main condenser using the turbine bypass valves. Units 2 and 3 are not affected by the Unit 1 reactor trip. The licensee notified the NRC Resident Inspector.|
|ENS 53263||15 March 2018 10:54:00||The following notification is an excerpt from the received report: Pursuant to 10 CFR Part 21, section 21.21(b), Rosemount Nuclear Instruments, Inc. (RNII) is writing to inform you that a total of eleven (11) Model 1154 and 1154 Series H output range code 4 pressure transmitters whose model code includes special option suffix N0026 or N0087 and five (5) 01154-0153-0002 Amplifier Circuit Card Assemblies may not calibrate at all the published values. Name and address of the individual providing the information: Mr. Gerard Hanson Vice President & General Manager Rosemount Nuclear Instruments, Inc. 8200 Market Blvd Chanhassen, MN 55317 Nature of the failure and potential safety hazard: During evaluation of two returned 01154-0153-0002 Amplifier Circuit Card Assemblies (CCAs), it was observed that a single resistor (R316) on each affected Amplifier CCA had an incorrect resistance value. The N0026 and N0087 special options enable a standard upper range limit (URL) of a transmitter with output range code 4 to be increased from 150 inches water to 210 inches water, in combination with a minimum span of 75 inches water. This R316 resistor allows the transmitter to achieve performance specifications, calibration ranges, and spans as indicated by the special option drawing. In the sub-assembly process, the R316 resistor on a standard Amplifier CCA is replaced to create a new Amplifier CCA part number (01154-0153-0002). The R316 resistor enables the standard lower range limit (LRL) of a transmitter with output range code 4 to be decreased from -150 inches water to -210 inches water (negative pressure values imply pressure applied to the low-pressure side of the transmitter), in combination with a minimum span of 75 inches water. This R316 resistor allows the transmitter to achieve performance specifications, calibration ranges, and spans as indicated by the special option drawing. The new resistor's material traceability information is recorded on the traveler. In final assembly, each transmitter with special option suffix N0026 and N0087 is assembled using one of these 01154-0153-0002 Amplifier CCAs. It then receives a factory calibration check at 135 inches water to 210 inches water and customer specified calibrated range, to ensure conformance to the minimum span and maximum URL specifications, as defined by the special option drawing. Appropriate manufacturing paperwork is used to document and record each Amplifier CCA serial number, as well as each final assembly transmitter. To meet site specific application requirements, transmitters may be field recalibrated to different upper and lower range values and/or spans. Model 1154 and 1154 Series H transmitters with special option suffix N0026 or N0087 and Amplifier CCAs whose R316 resistors were not replaced during the sub-assembly process, will have incorrect resistance values and may not calibrate to all upper and lower range values and/or spans published for the applicable special option. However, if an affected transmitter has been successfully calibrated, having the incorrect resistance value will not adversely affect transmitter performance specifications during normal operation or accident conditions. The manufacturing records for the two returned Amplifier CCAs, part number 01154-0153-0002, were carefully reviewed. The sub-assembly traveler lacked the required material traceability information, indicating that the R318 resistors were not replaced. RNII reviewed all sub-assembly travelers for part number 01154-0153-0002. The issue has been isolated to one lot which included (16) Amplifier CCAs. On March 8, 2018, RNII concluded that a substantial safety hazard may exist. The corrective action which has been taken; the name of the individual or organization responsible for that action; and the length of time taken to complete that action: (a) RNII previously discontinued manufacturing 01154-0153-0002 Amplifier CCAs, there are no Amplifier CCAs currently in production or finished goods. (b) RNII examined all manufacturing paperwork for all 01154-0153-0002 Amplifier CCAs, and other than the single lot of (16) Amplifier CCAs described above, no additional discrepancies were found. Any advice related to the potential failure of the item: The end user is advised to determine the impact of this potential non-conformance on its plant operations and safety and take action as deemed necessary. Affected 01154-0153-0002 Amplifier CCA(s) and transmitter(s) can be returned to RNII for rework. Contact RNII to facilitate the return process. If there are any questions, or you require additional Information related to this issue, please contact: Mike Dougherty (206) 665-1112, Paul Schmeling (952) 949-5359, or Brian VanderWoude (952) 949-5207. Shipped as piece parts (P/N 01154-0153-0002) to Arkansas Nuclear One and Waterford. Shipped as part of transmitter (N0026 and N0087) to Palo Verde, St. Lucie, and Calvert Cliffs.|