Event Notification Report for March 12, 2007

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
03/09/2007 - 03/12/2007

** EVENT NUMBERS **


43113 43214 43219 43220 43223 43224 43225 43226 43227 43228

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
Power Reactor Event Number: 43113
Facility: VERMONT YANKEE
Region: 1 State: VT
Unit: [1] [ ] [ ]
RX Type: [1] GE-4
NRC Notified By: MIKE RAMSEY
HQ OPS Officer: JASON KOZAL
Notification Date: 01/22/2007
Notification Time: 22:42 [ET]
Event Date: 01/22/2007
Event Time: 19:00 [EST]
Last Update Date: 03/09/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
MARIE MILLER (R1)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N Y 100 Power Operation 100 Power Operation

Event Text

HPCI DECLARED INOPERABLE DUE TO FAULTY FLOW INDICATOR

The licensee discovered that the High Pressure Coolant Injection (HPCI) system flow control loop was degraded in such a manner that HPCI would not perform its safety function. The HPCI loop flow indicator indicated 200 GPM with no flow in the loop. The specification for that parameter is <100GPM. With the flow indicator in this condition the HPCI flow controller would perform non-conservatively (less flow into the system than was demanded), and would not perform its intended safety function therefore rendering HPCI inoperable.

The licensee declared HPCI inoperable and in accordance with Technical Specification 3.5.E.2 entered a 14 day LCO. The licensee has commenced troubleshooting and will initiate repairs as necessary to return the system to operation.

The licensee notified the NRC Resident Inspector.


* * * RETRACTION ON 03/09/07 AT 1413 EST FROM M. RAMSEY TO MACKINNON * * *

"BASIS FOR RETRACTION:

"NRC Event Notification 43113 was conservatively made to ensure that the Eight-Hour Non-Emergency reporting requirements of 10CFR50.73 were met pending the evaluation of an atypical condition observed with the High Pressure Coolant Injection (HPCI) Flow Indicator that was observed by Operators during routine monitoring of plant equipment. After comparing the observed flow indication to allowable values for meter uncertainties, it was determined that the initial NRC Notification was not required. The HPCI system was capable of fulfilling all design safety functions. Additional measures to ensure system reliability were completed that included removing and bench testing the recently refurbished 'square root converter' and calibration verification of involved components. No degraded conditions were discovered.

"ENS Event Number 43113, made on 01/22/07, is being retracted."

R1DO (Neil Perry) notified.

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

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General Information or Other Event Number: 43214
Rep Org: OR DEPT OF HEALTH RAD PROTECTION
Licensee: EMANUEL HOSPITAL
Region: 4
City: PORTLAND State: OR
County:
License #: 90014
Agreement: Y
Docket:
NRC Notified By: KEVIN SIEBERT
HQ OPS Officer: JOHN KNOKE
Notification Date: 03/05/2007
Notification Time: 15:38 [ET]
Event Date: 11/01/2006
Event Time: 00:00 [PST]
Last Update Date: 03/05/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
VINCE GADDY (R4)
G. MORELL (FSME)

Event Text

AGREEMENT STATE - PERSONNEL UNDEREXPOSURE

The State was notified by the licensee's RSO that a patient had an underexposure by 24%. The State will provide updates as licensee information is received.

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.

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General Information or Other Event Number: 43219
Rep Org: FLORIDA BUREAU OF RADIATION CONTROL
Licensee: MC SQUARED, INC
Region: 1
City: TAMPA State: FL
County:
License #: 3424-1
Agreement: Y
Docket:
NRC Notified By: CHARLES ADAMS
HQ OPS Officer: PETE SNYDER
Notification Date: 03/07/2007
Notification Time: 15:18 [ET]
Event Date: 03/07/2007
Event Time: [EST]
Last Update Date: 03/07/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JOHN CARUSO (R1)
GREG MORELL (FSME)
ILTAB (email) ()

This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

AGREEMENT STATE REPORT - STOLEN TROXLER MOISTURE DENSITY GAUGE

The State provided the following information via facsimile:

The gauge was used at a jobsite at 35050 Halls Road, Clewiston, Florida on a Seminole Indian Reservation. After being used on the jobsite, the gauge was placed in a storage trailer. The gauge is a Model 3411B Troxler soil moisture density gauge, serial number 13563. The gauge contained a 8 millicurie Cs-137 source and a 40 millicurie Am-241:Be source.

"Device was used Friday 03/02/07 and placed in a storage trailer. It was noticed missing when the trailer was opened 03/07/07 [in the morning]. The trailer had not been broken into. The Seminole Reservation authorities are investigating. Licensee will submit a written report. [State of] Florida will investigate within the limits of its authority.

FL Incident Number: FL07-039

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.

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General Information or Other Event Number: 43220
Rep Org: COLORADO DEPT OF HEALTH
Licensee: CENTURA HEALTH: PENROSE- ST. FRANCES HEALTH SERVICES
Region: 4
City: COLORADO SPRINGS State: CO
County:
License #: 197-02
Agreement: Y
Docket:
NRC Notified By: THOMAS PENTECOST
HQ OPS Officer: PETE SNYDER
Notification Date: 03/07/2007
Notification Time: 18:35 [ET]
Event Date: 03/07/2007
Event Time: [MST]
Last Update Date: 02/27/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
VINCENT GADDY (R4)
EDWIN HACKETT (FSME)

Event Text

AGREEMENT STATE REPORT- MEDICAL EVENT - UNDERDOSE TO PATIENT

During a series of fractional medical treatments given to the patient on 2/13/07 through 2/20/07, a dose of 24000 centigray was administered to the dose area of the patient instead of the 31092 centigray prescribed dose. The isotope used was Iridium-192. The source strength was unknown at the time of the report.

"The HDR misadministration was the result of a failure to correct for the proper length of the type of connector used in the procedure. The error resulted in a dose more than 20% below the prescribed dose. The error in the procedure was identified during the review process following the conclusion of the last dose fraction."

The length of the connector differed from the correct length by 1.4 centimeters. The prescribing physician said that the patient will likely have a skin reaction to the treatment that will heal with time.

"The [Colorado Health] Department's inspector is scheduled to conduct an inspection at the Penrose Hospital on Monday, March 12, 2007. He was briefed with the known details of the misadministration at this date and will look further into this matter."

The state expects to provide additional information at a later date.

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.

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Power Reactor Event Number: 43223
Facility: NINE MILE POINT
Region: 1 State: NY
Unit: [ ] [2] [ ]
RX Type: [1] GE-2,[2] GE-5
NRC Notified By: ROY GREEN
HQ OPS Officer: JOHN MacKINNON
Notification Date: 03/08/2007
Notification Time: 16:15 [ET]
Event Date: 03/08/2007
Event Time: 14:50 [EST]
Last Update Date: 03/09/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(i) - PLANT S/D REQD BY TS
Person (Organization):
JOHN CARUSO (R1)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N Y 100 Power Operation 50 Power Operation

Event Text

TECHNICAL SPECIFICATION SHUTDOWN DUE TO A DEGRADED SEAL IN THE "A" REACTOR RECIRCULATION PUMP


"Reactor Recirculation Pump 'A' removed from service due to a degraded seal. TS 3.4.1 entered to meet requirement for single loop operation at 1050. When the pump was secured, the 3D monicore system failed preventing verification of thermal limits. TS 3.4.1 action D entered at 1450 required to be in mode 3 (Hot Shutdown) within 12 hours."


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


Reactor Recirculation Pump 'A' seal is degraded, no increase in leakage. Licensee is in contact with General Electric in trying to restore the 3D monicore system. All Emergency Core Cooling Systems and the Emergency Diesel Generators (all 3 divisions) are fully operable if needed and the electrical grid is stable. Nine Mile Point Unit 1 is in coastdown for a scheduled refueling outage. Nine Mile Point Unit 2 should be in Mode 3 (Hot Shutdown) by 0100 hours on 03/09/07.

* * * UPDATE AT 1241 EST ON 03/09/07 FROM CHRIS SKINNER TO MACKINNON * * *


"On March 8, 2007 at 1709, surveillance for thermal limit verification was completed satisfactorily and TS 3.4.1 was exited. The reactor was no longer required to be shutdown per Technical Specifications; however, the plant shutdown continued for performance of maintenance activities."

R1DO (Neil Perry) notified.

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

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Power Reactor Event Number: 43224
Facility: HATCH
Region: 2 State: GA
Unit: [ ] [2] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: FRANK GORLEY
HQ OPS Officer: JEFF ROTTON
Notification Date: 03/09/2007
Notification Time: 06:23 [ET]
Event Date: 03/09/2007
Event Time: 00:30 [EST]
Last Update Date: 03/09/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(A) - DEGRADED CONDITION
Person (Organization):
GEORGE HOPPER (R2)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N N 0 Cold Shutdown 0 Cold Shutdown

Event Text

MAIN STEAM LINE FLOW INSTRUMENT LINE PRESSURE BOUNDARY LEAKAGE

"With Unit 2 in Mode 4 for a planned refueling outage, a one-inch socket weld elbow on an instrument line off the 'D' main steam line was identified as leaking water. Leakage was quantified as less than 20 drops per minute (with the main steam lines full of water).

"This elbow is on a steam line flow instrument (just below its condensing chamber) and is located in the Unit 2 drywell (primary containment).

"This item constitutes a primary coolant boundary leak discovered while shutdown."

A pressure test is planned to be performed after the repair of the instrument line elbow is completed.

The licensee notified the NRC Resident Inspector.

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Power Reactor Event Number: 43225
Facility: SUSQUEHANNA
Region: 1 State: PA
Unit: [ ] [2] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: GRANT FERNSLER
HQ OPS Officer: JOHN MacKINNON
Notification Date: 03/09/2007
Notification Time: 14:32 [ET]
Event Date: 03/09/2007
Event Time: 13:45 [EST]
Last Update Date: 03/09/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(A) - DEGRADED CONDITION
Person (Organization):
NEIL PERRY (R1)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N N 0 Refueling 0 Refueling

Event Text

SECONDARY CONTAINMENT BYPASS LEAKAGE RATE EXCEEDED

"Appendix J Local Leak Rate Testing has determined that Tech Spec Acceptance Criteria for Secondary Containment Bypass Leakage has been exceeded. During the performance of SE-259-044 the combined SCBL limit of 9scfh was exceeded. Test results were within Administrative and Acceptance Criteria for the 10CFR50 Appendix J limits of 0.6La. The leakage limit is 9scfh. The identified degraded condition is reportable as a condition of the nuclear power plant, including its principle safety barriers being seriously degraded per 10CFR50.72(b)(3)(ii)."

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

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Power Reactor Event Number: 43226
Facility: VOGTLE
Region: 2 State: GA
Unit: [ ] [2] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: TIMOTHY THOMPSON
HQ OPS Officer: PETE SNYDER
Notification Date: 03/09/2007
Notification Time: 14:48 [ET]
Event Date: 03/09/2007
Event Time: 14:23 [EST]
Last Update Date: 03/09/2007
Emergency Class: UNUSUAL EVENT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED
Person (Organization):
GEORGE HOPPER (R2)
MARY JANE ROSS-LEE (NRR)
LOREN PLISCO (R2)
JIM DYER (NRR)
DUNKER (FEMA)
McKENTRY (DHS)
YATES (DOE)
BURGESS (EPA)
DALVIEL (HHS)
JEFFREY CRUZ (IRD)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N N 0 Cold Shutdown 0 Cold Shutdown

Event Text

UNUSUAL EVENT DECLARED DUE TO RCS LEAKAGE GREATER THAN TECH SPEC LIMIT

"A Notification of Unusual Event has occurred on Unit 2 due to Reactor Coolant System (RCS) unidentified leakage greater than 10 gallons per minute."

The licensee notified NRC Resident Inspector. Notified USDA (Brzostels).

* * * UPDATE AT 1754 ON 3/9/06 FROM T. PETRAK TO P. SNYDER * * *

"No actual RCS leakage occurred and the RCS always remained intact. The additional water injection occurred and the RCS always remained intact. The additional water injection into the Reactor Coolant System was required to makeup for gases that came out of solution and accumulated in the reactor vessel head and were being vented from the RCS during a planned drain down."

The licensee terminated the Unusual Event at 1751 on 3/9/07. The licensee notified the NRC Resident Inspector, state, and local government agencies. The licensee will remain in Mode 5 for their planned outage.

Notified R2DO (G. Hopper), NRR EO (M. Case), IRD (T. Blount), NRR (J. Dyer), DHS (McKentry), FEMA (Biscoe), DOE (Wyatt), EPA (Burgess), HHS (Dalviel), USDA (Giles).

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Power Reactor Event Number: 43227
Facility: CALLAWAY
Region: 4 State: MO
Unit: [1] [ ] [ ]
RX Type: [1] W-4-LP
NRC Notified By: DAVID G. LANTZ
HQ OPS Officer: JOHN MacKINNON
Notification Date: 03/09/2007
Notification Time: 15:02 [ET]
Event Date: 03/09/2007
Event Time: 10:43 [CST]
Last Update Date: 03/09/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
VINCENT GADDY (R4)
JIM DYER (NRR)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 M/R Y 100 Power Operation 0 Hot Standby

Event Text

MANUAL REACTOR TRIP AT REDUCED POWER DUE TO INADEQUATE FEEDWATER CONTROL

"At approximately 0803 Central Standard Time (CST) on 3/9/2007, Callaway Plant received indications of a condenser tube leak. At approximately 0826 CST, a power reduction from 100 percent to less than 5 percent was initiated in accordance with the Secondary Water Chemistry Program. At 1043 CST, with the reactor at approximately 30 percent power, a manual reactor trip was initiated due to inadequate feedwater control to the C steam generator. There was indication of feedwater flow to and increasing level in the C steam generator with both the main feedwater reg valve and its bypass valve closed. Cause of the inadequate feedwater control is under investigation.

"All safety systems functioned as designed with the exception of the digital rod position indication for control rod K10 which failed during the trip due to an existing problem. Control rod K10 is believed to be fully inserted, but is being treated as indeterminate at this time. Main feedwater isolation and motor-driven auxiliary feedwater actuations occurred as expected. Both trains of the emergency diesel generators and the offsite power supplies are available.

" Callaway plant is currently stable in Mode 3 at normal reactor coolant system parameters.

"This notification is being made in accordance with 10CFR50.72(b)(2)(iv)(B) for manual reactor trip (RPS actuation), 10CFR50.72(b)(2)(xi) for offsite notification and 10CFR50.72(b)(3)(iv)(A) Specified System Actuation.

"The licensee informed the resident inspector of the event and will be making State notifications. A press release is expected."

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Power Reactor Event Number: 43228
Facility: SUSQUEHANNA
Region: 1 State: PA
Unit: [ ] [2] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: RICH KLINEFELTER
HQ OPS Officer: JOE O'HARA
Notification Date: 03/10/2007
Notification Time: 00:14 [ET]
Event Date: 03/10/2007
Event Time: 00:30 [EST]
Last Update Date: 03/10/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
NEIL PERRY (R1)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N N 0 Refueling 0 Refueling

Event Text

PLANNED MAINTENANCE FOR UNIT 2 SPDS AND ERDS SYSTEM

"At 0030 hours, on 03/10/2007, the Unit 2 SPDS and ERDS system will be removed from service for planned maintenance outage on the power supply. The duration of work is expected to be approximately 12 hours. (Scheduled for completion at 1230 hours on 03/10/2007). During this time, control room hardwire indications will be available.

"Since the Unit 2 SPDS computer system will be unavailable for greater than 8 hours, this is considered a Loss of Emergency Assessment Capability and reportable under 10CFR50.72(b)(3)(xiii).

The licensee has redundant indication in the control room and will notify the Operations Center when the planned maintenance work is complete.

The licensee notified the NRC Resident Inspector.

* * * UPDATE ON 03/10/07 AT 2019 EST FROM RICH KLINEFELTER TO MACKINNON * * *

"This is a followup courtesy notification to EN # 43228. The Unit 2 SPDS and ERDS systems, as noted (above), have been restored to normal as of 19:50 on 03/10/2007."

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

NRC R1DO (Neil Perry) notified.

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