Event Notification Report for May 30, 2012

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
05/29/2012 - 05/30/2012

** EVENT NUMBERS **


47943 47946 47972 47973 47975

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Agreement State Event Number: 47943
Rep Org: COLORADO DEPT OF HEALTH
Licensee: PUBLIC SERVICE COMPANY OF COLORADO
Region: 4
City: HAYDEN State: CO
County:
License #: 032-01
Agreement: Y
Docket:
NRC Notified By: MEGAN BROWN
HQ OPS Officer: DONG HWA PARK
Notification Date: 05/22/2012
Notification Time: 13:02 [ET]
Event Date: 03/23/2012
Event Time: [MDT]
Last Update Date: 05/22/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
BLAIR SPITZBERG (R4DO)
ANGELA MCINTOSH (FSME)

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

Event Text

AGREEMENT STATE REPORT - POTENTIAL OVER EXPOSURE DURING GAUGE REMOVAL

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

"On May 21, 2012, the Colorado Department of Public Health and Environment was notified of an incident which occurred at Public Service Company of Colorado, Colorado License 032-01. The event occurred at the Hayden Station located in Hayden, CO on March 23, 2012. During boiler repairs, two contract workers removed six radiation level detector fixed gauges from an ash hopper without authorization. The gauges were discovered the following day by plant personnel, and it was noted that the shutters were in the open position. Each gauge, Texas Nuclear Model 5197, contained 100 mCi of Cesium-137. Based on dose reconstruction estimates provided by the licensee, it is likely that at least one of the contract workers received an exposure in excess of 2.0 mrem in one hour and up to 6.0 mrem in one hour. No other details are available at this time.

"Event Report ID No.: CO12-I12-09"

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

Note: This device is assigned an IAEA Category 3 value based on the actual radioactivity of the source, not on the device type. (Reference IAEA RG-G-1.9)

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Non-Agreement State Event Number: 47946
Rep Org: UNIVERSITY OF MICHIGAN HOSPITAL
Licensee: UNIVERSITY OF MICHIGAN HOSPITAL
Region: 3
City: ANN ARBOR State: MI
County:
License #: 21-00215-04
Agreement: N
Docket:
NRC Notified By: MARK DRISCOLL
HQ OPS Officer: JOE O'HARA
Notification Date: 05/22/2012
Notification Time: 16:35 [ET]
Event Date: 05/17/2012
Event Time: 08:00 [EDT]
Last Update Date: 05/22/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(1) - DOSE <> PRESCRIBED DOSAGE
Person (Organization):
DAVID HILLS (R3DO)
BRIAN McDERMOTT (FSME)

Event Text

MEDICAL EVENT - PATIENT INJECTED WITH WRONG RADIOPHARMACEUTICAL AND QUANTITY

A patient scheduled for a lymphoscintigraphy procedure was incorrectly injected with 25 milliCuries of Tc- 99M Medronate instead of the prescribed 3 milliCuries of Tc-99 Sulphur Colloid. The cause of the event was human error. The patient and physician have been notified. The physician believes there will be no long term adverse effects due to this error. In order to prevent reoccurrence, the nuclear medicine staff will add this event to staff training to ensure that staff double check the label and the dosage and drug. Other options are still being assessed.

The licensee also notified NRC Region 3 (Bob Gattone).

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: 47972
Facility: BROWNS FERRY
Region: 2 State: AL
Unit: [ ] [ ] [3]
RX Type: [1] GE-4,[2] GE-4,[3] GE-4
NRC Notified By: DAVID HALL
HQ OPS Officer: VINCE KLCO
Notification Date: 05/29/2012
Notification Time: 07:22 [ET]
Event Date: 05/29/2012
Event Time: 03:31 [CDT]
Last Update Date: 05/29/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
MARVIN SYKES (R2DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
3 A/R Y 75 Power Operation 0 Power Operation

Event Text

AUTOMATIC REACTOR SCRAM DUE TO MAIN GENERATOR LOAD REJECT SIGNAL

"On 5/29/2012 at 0331 [CDT] the Unit 3 reactor scrammed due to turbine control valve fast closure initiated by a load reject signal on the Main Generator. The cause of the load reject signal is Main Transformer differential relay 387T. Reactor power at the time of the SCRAM was approximately 75%. All systems responded as expected to the load reject signal. Main Steam Isolation Valves remained open and reactor pressure is being controlled on the Main Turbine Bypass Valves. No Main Steam Relief Valves lifted during the transient. No Emergency Core Cooling System (ECCS) or Reactor Core Isolation Cooling (RCIC) reactor water level initiation setpoints were reached. Primary Containment Isolation Signals (PCIS) Groups 2, 3, 6 and 8 were received. The lowest reactor water level observed was -41 inches. Reactor water level was restored to and is being controlled by the Feedwater system in the normal band.

"This event is reportable within 4 hours per 10CFR50.72(b)(2)(iv)(B), 'any event or condition that results in actuation of the reactor protection system (RPS) when the reactor is critical except when the actuation results from and is part of a pre-planned sequence during testing or reactor operation.' It is also reportable within 8 hours per 10CFR50.72(b)(3)(iv)(A) and requires an LER within 60 days per 10CFR50.73(a)(2)(iv)(A).

"This event is documented in the station corrective action program on SR# 557947.

"The NRC Resident Inspector has been notified."

All control rods inserted into the reactor core. Electrical power is being back fed from offsite power through the 161 KV feeder line. The reactor is being cooled down within the Technical Specification rates.

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Power Reactor Event Number: 47973
Facility: HARRIS
Region: 2 State: NC
Unit: [1] [ ] [ ]
RX Type: [1] W-3-LP
NRC Notified By: JOHN CAVES
HQ OPS Officer: HOWIE CROUCH
Notification Date: 05/29/2012
Notification Time: 14:44 [ET]
Event Date: 09/21/2011
Event Time: 11:22 [EDT]
Last Update Date: 05/29/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
STEVEN VIAS (R2DO)

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

TECHNICAL SUPPORT CENTER VENTILATION SYSTEM INOPERABLE

"On Sept. 20, 2011, with the reactor at 100% power in mode 1, a scheduled test of the technical support center ventilation system revealed that the adsorber stage leak test did not meet acceptance criteria. The system was returned to service on Sept. 21, 2011, following corrective maintenance and a satisfactory test. It was not recognized at the time that the condition met 10 CFR 50.72(b)(3)(xiii) reporting criteria for the emergency filtration function.

"The system was returned to service within approximately 30 hours of discovery. Investigation of Condition Report 526951 in the Harris Corrective Action Program determined that this event should have been reported upon discovery.

"The NRC Resident Inspector has been Informed."

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Part 21 Event Number: 47975
Rep Org: ABB INC
Licensee: ABB INC
Region: 1
City: CORAL SPRINGS State: FL
County:
License #:
Agreement: Y
Docket:
NRC Notified By: DENNIS BATOVSKY
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 05/29/2012
Notification Time: 17:07 [ET]
Event Date: 03/29/2012
Event Time: [EDT]
Last Update Date: 05/29/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21(a)(2) - INTERIM EVAL OF DEVIATION
Person (Organization):
HIRONORI PETERSON (R3DO)
PART 21 GROUP ()

Event Text

PART 21 NOTIFICATION - PROTECTIVE RELAYS MAY NOT BE QUALIFIED FOR HARSH ENVIRONMENTS

The following report was received via fax:

"During the commercial grade dedication process for a unit that was returned for repair, the unit was found to be in nonconformance with ABB specifications. The ABB specifications require that two (2) particular components, integrated circuits (ICs) of plastic construction, are replaced with 2 ICs of ceramic construction during the assembly process. The chips found on the harmonic filter circuit board (HF Board) of the relays were of plastic construction. While plastic ICs are approved for use in commercial relays, they have not been qualified for safety-related applications. Relays in this condition will function normally in mild environments, but have not been qualified for harsh environments, or for elevated radiation environments."

The affected solid state relays are 27N and 59G shipped between August 1, 2010 and October 15, 2010.

"Eighteen (18) Relays (Material number: 211T4175-HF-1E) were sold to ABB Florence who in turn shipped the same to Detroit Edison's Fermi 2 Power Plant."

Page Last Reviewed/Updated Wednesday, March 24, 2021