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Event Notification Report for April 23, 2003








                    U.S. Nuclear Regulatory Commission

                              Operations Center



                              Event Reports For

                           04/22/2003 - 04/23/2003



                              ** EVENT NUMBERS **



39768  39769  39781  39782  39783  39784  



+------------------------------------------------------------------------------+

|Power Reactor                                    |Event Number:   39768       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| FACILITY: INDIAN POINT             REGION:  1  |NOTIFICATION DATE: 04/17/2003|

|    UNIT:  [2] [3] []                STATE:  NY |NOTIFICATION TIME: 17:34[EDT]|

|   RXTYPE: [2] W-4-LP,[3] W-4-LP                |EVENT DATE:        04/17/2003|

+------------------------------------------------+EVENT TIME:        14:35[EDT]|

| NRC NOTIFIED BY:  JOHN BAKER                   |LAST UPDATE DATE:  04/22/2003|

|  HQ OPS OFFICER:  HOWIE CROUCH                 +-----------------------------+

+------------------------------------------------+PERSON          ORGANIZATION |

|EMERGENCY CLASS:          NON EMERGENCY         |DAVID SILK           R1      |

|10 CFR SECTION:                                 |                             |

|ACOM 50.72(b)(3)(xiii)   LOSS COMM/ASMT/RESPONSE|                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE   |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|2     N          Y       100      Power Operation  |100      Power Operation  |

|3     N          N       0        Cold Shutdown    |0        Cold Shutdown    |

|                                                   |                          |

+------------------------------------------------------------------------------+

                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| LOSS OF 9 OUT OF 16 EMERGENCY SIRENS IN ORANGE COUNTY                        |

|                                                                              |

| The following information was obtained from the Licensee via facsimile:      |

|                                                                              |

| "On April 17, 2003, at 1435 hours, it was determined that 9 out of 16        |

| emergency sirens in Orange County were out of service due to a transmission  |

| line failure. Unit 2 was at 100% power and Unit 3 was shutdown. This results |

| in a degraded emergency siren notification system in one of the four         |

| counties covered by the emergency plan which is reportable under 10 CFR      |

| 50.72(b)(3)(xiii). The emergency plan had route alerting and public radio    |

| announcements available as necessary to notify the public in-lieu of the     |

| non-operational sirens. Restoration of the sirens occurred at 1709 hours.    |

| The county was notified."                                                    |

|                                                                              |

| The transmission line failure caused a loss of two substations which powered |

| the affected sirens.                                                         |

|                                                                              |

| The NRC Resident Inspector will be notified by the Licensee.                 |

|                                                                              |

| ***UPDATE ON 04/22/03 AT 1626 HOURS BY G. KELLER TAKEN BY MACKINNON***       |

|                                                                              |

| At 1230 hours on April 22, 2003, during the review of the computer records   |

| for the loss of sirens previously reported on Thursday, April 17, 2003, it   |

| was determined that, at 1636 hours, two additional sirens in Putnam county   |

| could not be sounded.  The loss of signal was not immediately evident and    |

| was due to the loss of power to repeater R-257 in Rockland county.  This     |

| resulted in Putnam county having less than 90% of the sirens available.      |

|                                                                              |

| At the time of the event this resulted in a degraded emergency siren         |

| notification system of an additional county covered by the emergency plan    |

| which is also reportable under 10 CFR 50.72(b)(3)(xiii).  The emergency plan |

| had route alerting and public radio announcements available as necessary to  |

| notify the public in lieu of the non-operational sirens.  Restoration of the |

| sirens occurred at 1659 hours.  The State of New York and the county were    |

| notified. NRC R1DO (H. Gray) notified.                                       |

|                                                                              |

| The NRC Resident Inspector was notified of this update by the licensee.      |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|General Information or Other                     |Event Number:   39769       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  OHIO BUREAU OF RADIATION PROTECTION  |NOTIFICATION DATE: 04/18/2003|

|LICENSEE:  SOLAR TESTING LABORATORIES           |NOTIFICATION TIME: 09:31[EDT]|

|    CITY:  BROOKLYN HEIGHTS         REGION:  3  |EVENT DATE:        04/18/2003|

|  COUNTY:                            STATE:  OH |EVENT TIME:             [EDT]|

|LICENSE#:  OH31210180065         AGREEMENT:  Y  |LAST UPDATE DATE:  04/18/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |THOMAS KOZAK         R3      |

|                                                |MATT KORMANN         TAT     |

+------------------------------------------------+FRED BROWN           NMSS    |

| NRC NOTIFIED BY:  MIKE SNEE                    |                             |

|  HQ OPS OFFICER:  MIKE RIPLEY                  |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|NAGR                     AGREEMENT STATE        |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| THEFT AND RECOVERY OF MOISTURE DENSITY GAUGE                                 |

|                                                                              |

| The following information was received via facsimile from the Ohio           |

| Department of Health:                                                        |

|                                                                              |

| The licensee reported the theft and recovery of a Humboldt Scientific        |

| moisture/density gauge (model 5001, serial #750) containing a 44 millicurie  |

| Am-Be source and a 11 millicurie Cs-137 source.  The gauge was stolen during |

| the early hours of April 18, 2003 from the back of a truck parked at an      |

| employee's residence in Brooklyn Heights, Ohio. The truck and gauge case was |

| broken into.  The licensee notified police and the Ohio Department of        |

| Health.   At 8:45 AM on April 18, the employee discovered the gauge on the   |

| side of the road a short distance from his residence where the theft         |

| occurred.  The gauge did not appear to be damaged.                           |

|                                                                              |

| Notified R3DO (T. Kozak), NMSS (F. Brown), NSIR IAT (M. Kormann)             |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|Fuel Cycle Facility                              |Event Number:   39781       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| FACILITY: PORTSMOUTH GASEOUS DIFFUSION PLANT   |NOTIFICATION DATE: 04/22/2003|

|   RXTYPE: URANIUM ENRICHMENT FACILITY          |NOTIFICATION TIME: 15:10[EDT]|

| COMMENTS: 2 DEMOCRACY CENTER                   |EVENT DATE:        04/22/2003|

|           6903 ROCKLEDGE DRIVE                 |EVENT TIME:        14:51[EDT]|

|           BETHESDA, MD 20817    (301)564-3200  |LAST UPDATE DATE:  04/22/2003|

|    CITY:  PIKETON                  REGION:  3  +-----------------------------+

|  COUNTY:  PIKE                      STATE:  OH |PERSON          ORGANIZATION |

|LICENSE#:  GDP-2                 AGREEMENT:  N  |MONTE PHILLIPS       R3      |

|  DOCKET:  0707002                              |TRISH HOLAHAN        NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  ERIC SPAETH                  |                             |

|  HQ OPS OFFICER:  JOHN MacKINNON               |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|NONR                     OTHER UNSPEC REQMNT    |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| OFFSITE NOTIFICATION TO THE OHIO EMERGENCY PROTECTION AGENCY                 |

|                                                                              |

| "On 04/22/03 at 1341 hours, while taking # 3 boiler off line, the average    |

| opacity reading was above 20% on two occasions within a one-hour period.     |

| This requires a verbal notification to the Ohio Environmental Protection     |

| Agency (OEPA).                                                               |

|                                                                              |

| "At 1451 hours, the Plant Shift Superintendent notified OEPA of the X-600    |

| Steam Plant opacity exceedance.  UE-RA-RE1030, App. D, section P, requires a |

| 4 hour NRC event when other government agencies are notified."               |

|                                                                              |

| The NRC Resident  Inspector was notified of this event by the licensee.      |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|Hospital                                         |Event Number:   39782       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  HARTFORD HOSPITAL                    |NOTIFICATION DATE: 04/22/2003|

|LICENSEE:  HARTFORD HOSPITAL                    |NOTIFICATION TIME: 15:12[EDT]|

|    CITY:  HARTFORD                 REGION:  1  |EVENT DATE:        04/18/2003|

|  COUNTY:                            STATE:  CT |EVENT TIME:        16:00[EDT]|

|LICENSE#:  06-00253-04           AGREEMENT:  N  |LAST UPDATE DATE:  04/22/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |HAROLD GRAY          R1      |

|                                                |JOHN GREEVES                 |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  PETER J. MAS                 |                             |

|  HQ OPS OFFICER:  DICK JOLLIFFE                |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:                                |                             |

|10 CFR SECTION:                                 |                             |

|LDIF 35.3045(a)(1)       DOSE <> PRESCRIBED DOSA|                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| SOURCES INCORRECTLY POSITIONED IN A PATIENT.                                 |

|                                                                              |

| The following is submitted as a medical event record for Hartford Hospital,  |

| Hartford, CT.  This occurred late Friday, April 18, 2003 and it involved the |

| use of the 3.5 French, 40 mm Novoste Beta-Cath unit with a Beta-Rail         |

| catheter.  Novoste had a representative onsite to provide training to the    |

| interventional cardiologist.  The radiation oncologist and the medical       |

| physics staff were experienced in the handling of the 3.5 French Beta-Cath   |

| unit.  The Novoste representative was not in the cath lab operatory at the   |

| time of the insertion of the Beta-Rail catheter, or, of the sources.  He was |

| observing from the adjacent control area and he thought the interventional   |

| cardiologist understood the markings on the new style catheter.  The         |

| interventional cardiologist imaged the patient (using fluoroscopy) and       |

| determined that the sources were incorrectly positioned.  At approximately   |

| 60 seconds into the treatment, the sources were withdrawn.  The catheter was |

| correctly positioned and the sources were reinserted for the accurate        |

| treatment of the cardiac vessel.  No adverse effects were seen to occur to   |

| the patient, and, none are expected to occur.  A written report will be      |

| submitted to the Region I offices within 15 days as required.                |

|                                                                              |

| Notified R1DO Harold Gray and NMSS EO John Greeves.                          |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|Other Nuclear Material                           |Event Number:   39783       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  US ARMY ROCK ISLAND                  |NOTIFICATION DATE: 04/22/2003|

|LICENSEE:  US ARMY ROCK ISLAND                  |NOTIFICATION TIME: 16:14[EDT]|

|    CITY:  NEWTON FALLS             REGION:  3  |EVENT DATE:        04/22/2003|

|  COUNTY:                            STATE:  OH |EVENT TIME:        12:00[EDT]|

|LICENSE#:  12-00722-06           AGREEMENT:  Y  |LAST UPDATE DATE:  04/22/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |MONTE PHILLIPS       R3      |

|                                                |JOHN GREEVES         NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  JEFF HAVENNER                |                             |

|  HQ OPS OFFICER:  JOHN MacKINNON               |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|ICON 30.50(b)(1)         UNPLANNED CONTAMINATION|                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| M1A1 COLLIMATOR TRITIUM FILLED TUBE FOUND BROKEN.                            |

|                                                                              |

| This event probably occurred the weekend of April 19-20, 2003 at the Ohio    |

| National Guard facility located in Newton Falls, Ohio.                       |

|                                                                              |

| Ohio National Guard were unpacking an M109 Howitzer issue box at the         |

| receiving dock. The guardsmen were placing the unpacked packing material in  |

| a dumpster.  As they were unpacking the box they noticed broken glass inside |

| the plastic bag containing a collimator, which contains a 10 curie source.   |

| The National Guard contacted the on site Radiation Safety Officer (RSO).     |

| The RSO wipe tested the collimator and its case, then double bagged it and   |

| placed it into the radiation storage shed located outside of the shop.  They |

| then wiped tested and double bagged all packing materials associated with    |

| the crate and retrieved the packing materials from the dumpster.  Wipe tests |

| of all affected areas were also taken and submitted to Radiological          |

| Engineering Laboratory for analysis.  Analysis results indicated significant |

| contamination within the storage area.                                       |

|                                                                              |

| The Ohio Army National Guard RSO is being provided with the analysis results |

| and decontamination procedures.  They have also been advised to place those  |

| individuals closely involved with the significant contamination, on tritium  |

| bioassay program until it can be determined whether tritium exposure         |

| occurred or until tritium levels are eliminated.                             |

|                                                                              |

| Decontamination procedures will be performed and contamination radiation     |

| surveys of all affected areas accomplished until contamination levels are    |

| reduced to acceptable levels or eliminated.                                  |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|Power Reactor                                    |Event Number:   39784       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| FACILITY: LIMERICK                 REGION:  1  |NOTIFICATION DATE: 04/23/2003|

|    UNIT:  [1] [] []                 STATE:  PA |NOTIFICATION TIME: 05:29[EDT]|

|   RXTYPE: [1] GE-4,[2] GE-4                    |EVENT DATE:        04/23/2003|

+------------------------------------------------+EVENT TIME:        02:07[EDT]|

| NRC NOTIFIED BY:  TOM DOUGHERTY                |LAST UPDATE DATE:  04/23/2003|

|  HQ OPS OFFICER:  ERIC THOMAS                  +-----------------------------+

+------------------------------------------------+PERSON          ORGANIZATION |

|EMERGENCY CLASS:          NON EMERGENCY         |HAROLD GRAY          R1      |

|10 CFR SECTION:                                 |                             |

|ACCS 50.72(b)(2)(iv)(A)  ECCS INJECTION         |                             |

|ARPS 50.72(b)(2)(iv)(B)  RPS ACTUATION - CRITICA|                             |

|AESF 50.72(b)(3)(iv)(A)  VALID SPECIF SYS ACTUAT|                             |

|                                                |                             |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE   |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|1     M/R        Y       100      Power Operation  |0        Hot Shutdown     |

|                                                   |                          |

|                                                   |                          |

+------------------------------------------------------------------------------+

                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| RPS ACTUATION WHILE CRITICAL                                                 |

|                                                                              |

| "At 0207 EDT on April 23, 2003, a loss of feedwater occurred on Unit 1.      |

| Operators initiated a manual reactor scram at 15 [inches] RPV level (auto    |

| scram signal = 12.5 [inches]). The high pressure coolant injection (HPCI)    |

| and reactor core isolation coolant (RCIC) systems initiated as designed at   |

| -38 [inches], and injected into the RPV.  RPV level was restored to the      |

| normal band, HPCI and RCIC secured, and a reactor feed pump was returned to  |

| service.  The following isolation signals were received;  Groups IB, IIA,    |

| IIC, III, VIB, VIC, VIIB, VIIIB, and HVAC.  RPV and containment parameters   |

| are normal with an RPV cooldown in progress.                                 |

|                                                                              |

| "The loss of feed resulted from sequential trips of all 3 reactor feed pumps |

| on low suction pressure due to an apparent isolation of the condensate deep  |

| bed demineralizers.  The cause is under investigation."                      |

|                                                                              |

| The licensee notified the NRC Resident Inspector.                            |

+------------------------------------------------------------------------------+