Event Notification Report for October 8, 2008

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
10/07/2008 - 10/08/2008

** EVENT NUMBERS **


44535 44536 44545 44546 44547 44549

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General Information or Other Event Number: 44535
Rep Org: TEXAS DEPARTMENT OF HEALTH
Licensee: METCO
Region: 4
City: HOUSTON State: TX
County:
License #: L-03018
Agreement: Y
Docket:
NRC Notified By: ART TUCKER
HQ OPS Officer: BILL HUFFMAN
Notification Date: 10/03/2008
Notification Time: 10:58 [ET]
Event Date: 09/29/2008
Event Time: 13:00 [CDT]
Last Update Date: 10/03/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RUSS BYWATER (R4)
ANNA BRADFORD (FSME)

Event Text

AGREEMENT STATE REPORT - POTENTIAL OVEREXPOSURE TO EXTREMITIES

A radiographer working for METCO was performing radiography operations at CB & I Fabricators in Houston TX. He was moving the radiography camera (a SPEC 150 with a 85 curie Ir-192 source) from one location to another. He removed the nipple off the front of the camera to test the guide tube and his dosimetry started alarming. He observed that the source had come out of the camera about 1/2 inch. At the same time, he inadvertently dropped the camera plug. He picked up the plug and unsuccessfully made two attempts to push the source back in with the plug. He then left the front of the camera and went around and turned the crank and got the source back into the shielded position and then inserted the plug. He then notified appropriate personnel.

METCO sent his dosimetry off and the results came back with a whole body exposure of 946 millirem on October 1. The RSO discussed the details of the event with the radiographer and reenacted the event to attempt to estimate the radiographer's hand exposure because to the close proximity of the source to the hand during the event. Based on the time and distance of the source to the hand, it was estimated that the exposure to the radiographer's right hand may be somewhere between 66 and 282 rem. METCO has called in a consultant to get a more accurate assessment of the exposure to the hand.

The radiographer's work for the rest of the year has been suspended. His hand does not exhibit any eurythemia. No information is available on whether blood work or medical study will be obtained.

Texas will wait for the licensee's final report before it completes and independent investigation of the event.

Texas Report I-8569

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General Information or Other Event Number: 44536
Rep Org: MA RADIATION CONTROL PROGRAM
Licensee: QSA GLOBAL
Region: 1
City: BURLINGTON State: MA
County:
License #:
Agreement: Y
Docket:
NRC Notified By: JOHN SUMARES
HQ OPS Officer: HOWIE CROUCH
Notification Date: 10/03/2008
Notification Time: 11:40 [ET]
Event Date: 10/03/2008
Event Time: [EDT]
Last Update Date: 10/03/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JOHN WHITE (R1)
ANDREW MAUER (FSME)
SCOTT SHAEFFER (R2)
STEVE ORTH (R3)
RUSS BYWATER (R4)
JOHN JANKOVICH (FSME)

Event Text

AGREEMENT STATE REPORT - DEFECTIVE COMPONENT THAT COULD POTENTIALLY CAUSE A SUBSTANTIAL SAFETY HAZARD

The following information was received from the State of Massachusetts via email:

"Prompted by a reported event, Event Number 44434, QSA Global conducted an investigation of a Model 660B camera. QSA Global concluded that the root cause of the event was a defective component on the pigtail of the camera, and has determined that more cameras contain these defective components which could contribute to future events. "

"This defect could give the user the false impression that the source is connected to the drive cable when there is only a partial connection. The operations manual does require that the user check the connection prior to use and when this is done, there is no problem. However if the user does not do a check of the connection, it may not be secure and may cause the source to disconnect in the guide tube.

The defective component was reported to the State of Massachusetts under Massachusetts code 105 CMR 120.142(B)(2)(a). The defective component is a female source connector, QSA part number 55042-1. This defect was only found in lot 0731300805. QSA sold six Co-60 sources [Model 424-14] and 659 Ir-192 [Model 424-9] sources that utilized connectors from this lot. One Co-60 source will be returned to QSA for evaluation due to a source retrieval event.

"[QSA Global] Corrective Actions:

"Customers who had received the other five Co-60 source wires from the suspected lot were contacted and arrangements were made to make a field inspection of these sources by QSA Global staff for the potential defect. Any defective source wires would be recommended to the customer for return and replacement by QSA Global.

"Customers who had received one of the 659 Ir-192 source wires that contained the suspected lot were notified and advised of this potential condition. These customers were provided with [a] notification which re-enforces the need to ensure a solid connection between the drive cable and the source prior to making any source exposures. The customer notification letter includes inspections the customer should make to determine if their source may contain this defect and advises the customer to contact QSA Global if a source is suspected of being defective to arrange for source replacement.

"It was decided that the supplier of the defective lot would be removed from the approved supplier list pending further evaluation of their production processes. This will prevent their use as a supplier for components (including Class A components) until their evaluation and re-approval at a later date."

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Power Reactor Event Number: 44545
Facility: PILGRIM
Region: 1 State: MA
Unit: [1] [ ] [ ]
RX Type: [1] GE-3
NRC Notified By: JOHN OHRENBERGER
HQ OPS Officer: PETE SNYDER
Notification Date: 10/07/2008
Notification Time: 03:01 [ET]
Event Date: 10/06/2008
Event Time: 22:24 [EDT]
Last Update Date: 10/07/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
JOHN CARUSO (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

UNEXPECTED REACTOR CORE ISOLATION COOLING ISOLATION DURING TEST

"During performance of PNPS Procedure 8.M.2-2.6.3 Attachment 1 step (65) the RCIC System isolated on a Group 5 signal when relay contact blocking devices (boots) were removed. All isolations went to completion. This isolation was not part of the planned evolution.

"The Group 5 isolation was reset and RCIC was placed in stand by line-up at 2327 on 10/6/2008. Investigation is continuing."

The licensee notified the NRC Resident Inspector.

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Power Reactor Event Number: 44546
Facility: FITZPATRICK
Region: 1 State: NY
Unit: [1] [ ] [ ]
RX Type: [1] GE-4
NRC Notified By: GENE DORMAN
HQ OPS Officer: HOWIE CROUCH
Notification Date: 10/07/2008
Notification Time: 13:13 [ET]
Event Date: 10/07/2008
Event Time: 06:35 [EDT]
Last Update Date: 10/07/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
JOHN CARUSO (R1)

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

Event Text

SPECIFIED SYSTEM ACTUATION DUE TO LOSS OF POWER DURING TESTING

"On October 7, 2008 at approximately 0635, the James A. FitzPatrick Nuclear Power Plant was shutdown and operating in the Cold Shutdown mode (Mode 4). Testing was in progress on the trip and lockout (86) relay associated with circuit breaker 71-10402, normal station service transformer T-4 feeder breaker to electrical bus 10400. While technicians were performing the test, the 10400 bus, which was feeding power to the 10600 Emergency Bus, lost power. This loss of power to the 10600 bus resulted in an automatic actuation of the 'B' and 'D' Emergency Diesel Generators. The generators started, force paralleled, and closed in to the 10600 Bus as designed. As a result of the loss of the 10600 bus the 'B' Reactor Protection System (RPS) also lost power resulting in a half scram signal and a Group II Primary Containment Isolation System (PCIS) actuation. This actuation resulted in closing containment isolation valves in multiple systems and isolating Reactor Water Clean-up (RWCU). Based on these system actuations the event is reportable under Criterion 10 CFR 50.72(b)(3)(iv).

"The event has been entered into the corrective action program and a Licensee Event Report (LER) will be filed within 60 days as required by 10 CFR 50.73(a)(2)(iv).

"The [NRC] Resident Inspector has been briefed and the State Public Service Commission (PSC) will also be notified."

At the time of the event, the 'B' shutdown cooling system was in service. Shutdown cooling was lost for approximately 35 minutes which resulted in a 6 degree rise in water temperature. At that time, the licensee calculated 19.5 hours to boil. Shutdown cooling has been restored.

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Other Nuclear Material Event Number: 44547
Rep Org: WAL-MART
Licensee: WAL-MART
Region: 4
City: BENTONVILLE State: AR
County:
License #: GL
Agreement: Y
Docket:
NRC Notified By: RICH DAILEY
HQ OPS Officer: HOWIE CROUCH
Notification Date: 10/07/2008
Notification Time: 16:54 [ET]
Event Date: 10/07/2008
Event Time: [CDT]
Last Update Date: 10/07/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
20.2201(a)(1)(ii) - LOST/STOLEN LNM>10X
Person (Organization):
DALE POWERS (R4)
MARK DELLIGATTI (FSME)

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

Event Text

LOST TRITIUM EXIT SIGNS

Wal-Mart is conducting a worldwide audit of their tritium exit signs. This morning they discovered three missing signs.

The first missing sign was located at the store in Noblesville, Indiana. The serial number is 301651, manufacturer unknown. Curie content unknown. The sign was last inventoried in the spring of 2008.

The second sign was located at the store in Charlotte, Michigan. The serial number and manufacturer were unknown. Curie content unknown. The sign was last inventoried in the spring of 2008.

The third sign was located at the store in Yankton, South Dakota. The serial number is 293214, manufacturer unknown. Curie content unknown. The sign was last inventoried in the spring of 2008.

All three stores were searched for the signs without success.

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.

This source is not amongst those sources or devices identified by the IAEA Code of Conduct for the Safety & Security of Radioactive Sources to be of concern from a radiological standpoint. Therefore is it being categorized as a less than Category 3 source

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Power Reactor Event Number: 44549
Facility: GRAND GULF
Region: 4 State: MS
Unit: [1] [ ] [ ]
RX Type: [1] GE-6
NRC Notified By: CHRIS MILLER
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 10/07/2008
Notification Time: 23:13 [ET]
Event Date: 10/07/2008
Event Time: 20:00 [CDT]
Last Update Date: 10/07/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
50.72(b)(3)(xii) - OFFSITE MEDICAL
Person (Organization):
DALE POWERS (R4)

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

Event Text

INJURED, CONTAMINATED INDIVIDUAL TRANSPORTED TO HOSPITAL

"A contractor fell and was injured while working inside the condenser. He was working in a contaminated area and is being transported via ambulance to River Regional hospital. The individual's protective clothing was slightly contaminated but his body was not contaminated. The State of Mississippi and Claiborne County are government agencies that have been notified of this incident."

The individual's protective clothing read approximately 80 counts above background. A Radiation Protection technician is accompanying the contractor to the hospital. He is suspected to have suffered a broken ankle and broken arm. The licensee is investigating the accident.

The licensee notified the NRC Resident Inspector.

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