United States Nuclear Regulatory Commission - Protecting People and the Environment

Event Notification Report for August 31, 2012

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
08/30/2012 - 08/31/2012

** EVENT NUMBERS **


48222 48224 48225 48252 48253 48255 48257 48258

To top of page
Agreement State Event Number: 48222
Rep Org: IOWA DEPARTMENT OF PUBLIC HEALTH
Licensee: BED BATH AND BEYOND
Region: 3
City: COUNCIL BLUFFS State: IA
County:
License #: GL
Agreement: Y
Docket:
NRC Notified By: MELANIE RASMUSON
HQ OPS Officer: BILL HUFFMAN
Notification Date: 08/22/2012
Notification Time: 16:35 [ET]
Event Date: 07/20/2012
Event Time: [CDT]
Last Update Date: 08/22/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
ERIC DUNCAN (R3DO)
FSME EVENT RESOURCE (EMAI)

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

Event Text

AGREEMENT STATE REPORT- 12 MISSING TRITIUM EXIT SIGNS

The Iowa Department of Public Health provided a preliminary notification that 11 or 12 tritium exit signs are missing from a Bed Bath and Beyond store in Council Bluffs Iowa. The store has replaced all its tritium exit signs with LED exit signs. The tritium exit signs were removed by an electrical subcontractor specifically instructed to keep the removed signs segregated for special disposal by Shaw Industries. The removed tritium exit signs could not be located when Shaw arrived at the store to package and ship the signs. A representative for the store believes that either the signs were mixed with fluorescent lights that were being sent to a separate recycling facility or that the subcontractor may have inadvertently disposed of the tritium signs at an unknown location. The fluorescent light recycling facility has been contacted but was unable to find any evidence that the signs were sent to their location.

The tritium exit signs were generally licensed with a nominal activity of 11.5 curies each. The sign manufacturer was Shield Source.

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

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

To top of page
Agreement State Event Number: 48224
Rep Org: WISCONSIN RADIATION PROTECTION
Licensee: BED BATH AND BEYOND
Region: 3
City: WAUSAU State: WI
County:
License #: GL
Agreement: Y
Docket:
NRC Notified By: CHRIS TIMMERMAN
HQ OPS Officer: BILL HUFFMAN
Notification Date: 08/23/2012
Notification Time: 13:00 [ET]
Event Date: 08/20/2012
Event Time: 13:30 [CDT]
Last Update Date: 08/23/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
ERIC DUNCAN (R3DO)
FSME EVENTS RESOURCE (EMAI)

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

Event Text

AGREEMENT STATE REPORT - TEN TRITIUM EXIT SIGNS DAMAGED

The following report was received from the Wisconsin Radiation Protection Section via e-mail:

"On August 20, 2012, at 1:30 pm the Wisconsin Radiation Protection Section, received a telephone notification from NRC Region III personnel that 10 tritium exit signs, that originally contained 7.5 Ci at the time of purchase 7-10 years ago, were placed in a compactor and damaged at a PSC Environmental Services, LLC facility in Detroit, Michigan (refer to NRC event notification #48205).

"The ten exit signs came from a Bed Bath & Beyond store in Wausau, WI. On August 20, 2012 at 2:00 pm, the Vice President of Loss Prevention and Safety was contacted and he informed the state that 14 tritium exit signs were being replaced with LED signs (this is being done nation-wide at all Bed Bath & Beyond stores) at the Wausau location and were intended to be returned to the manufacturer for disposal. The 4 remaining signs are in a secure location within the store.

"The Wisconsin Radiation Protection Section will be performing a site visit in Wausau to verify the four remaining signs are intact and will be performing an investigation into the root cause of this incident."

Wisconsin Report: WI120011

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

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

To top of page
Agreement State Event Number: 48225
Rep Org: NC DIV OF RADIATION PROTECTION
Licensee: FRYE REGIONAL MEDICAL CENTER
Region: 1
City: HICKORY State: NC
County:
License #: NC #018-0377-
Agreement: Y
Docket:
NRC Notified By: RANDY CROWE
HQ OPS Officer: BILL HUFFMAN
Notification Date: 08/23/2012
Notification Time: 16:50 [ET]
Event Date: 08/06/2012
Event Time: [EDT]
Last Update Date: 08/23/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
WILLIAM COOK (R1DO)
FSME EVENT RESOURCE (EMAI)

Event Text

AGREEMENT STATE REPORT - POSSIBLE MEDICAL EVENT RELATED TO USE OF I-125 SEED MESH IMPLANT

The following report was received from the North Carolina Radiation Protection Section via e-mail:

"On August 6, 2012 [the North Carolina Radiation Protection Section, NC-DHHS, RPS] received notice of a possible device failure. [Follow-up by NC-DHHS, RPS was conducted on August 8, 2012, by contacting the Authorized Medical Physicist (AMP)].

"A patient was given an invasive procedure (to right lung) using a mesh that contained permanent I-125 seeds attached as an implant. The implant contained 50 seeds with 5 strands of 10 seeds per strand. The total activity was 16.4 mCi on May 31, 2012.

"The patient was discharged from hospital on June 9, 2012.

"[The] patient was readmitted to the hospital on July 4, 2012. On July 7, 2012, x-rays revealed an abscess in the right lung with approximately 38 notable seeds in place. On July 9, 2012, the radiation oncologist requested chest and abdomen films. At that time, 35 seeds were noted in the right lung with 3 located in the abdomen. Per the patient; he was coughing up phlegm and subsequently swallowing it. The patient was made aware of seed mobility.

"On July 18, 2012 (decayed to 0.187 mCi/seed), there were 13 seeds confirmed in the lung and 17 seeds in the abdomen (total 5.62 mCi).

"Upon out-patient visit on July 4, 2012, there were 6 seeds remaining in the chest and 8 in the abdomen; there were no appreciable side effects noted per the radiation oncologist.

"Nine seeds were recovered during the patient's hospitalization and placed in the Nuclear Medicine Hot Lab.

"The device manufacturer was notified by immediate supervisor.

"The above information was received August 6, 2012 via electronic mail and August 10, 2012 via letter.

"The below information was received August 20, 2012 via electronic mail.

'This is the follow-up letter as requested in our conversation on Aug 08, 2012. To review, on May 31, 2012, fifty Iodine-125 seeds were implanted in a patient as a permanent implant in the right lung. The activity was 16.4 mCi on that date. Upon re-admission into the hospital, a chest x-ray was done on July 07. Approximately 38 of the 50 original seeds were visible on that date. If one merely accounts for the change in seed count (38/50), the area of the right lung implant received 76% of its intended dose. Therefore, the total dose delivered differs from the prescribed dose by 20% or more.

'This describes a Medical Event, as defined by section 15A NCAC 11.0364 (1) (A).

'On August 08, the patient came to the Radiation Oncology department. Final x-rays revealed no seeds within the lungs or abdomen.

'As an additional note, the failure of the device has been reported to the FDA by our hospital administration and the company that manufactures the device.'

"(Intended dose appears to be 25 Sv/hr at .1 cm (contact) on June 9
50 seeds = 16.4 mCi = 25 Sv/hr@ .1 cm (contact)
.328 mCi/seed initial activity

"On day number 25 (July 4) 38 seeds remain in lung (.328 mCi/seed with 1/2 life factor = .245 mCi/seed)
38*.245 mCi= 9.31 mCi = 14.67 Sv/hr@ .1 cm (contact)

"If all seeds were intact the result would be 12.25 mCi -> resulting in a 9.31 mCi/12.25 mCi = 76%

"A device NMED notification maybe required and have requested such from the AMP. More to follow."


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.

To top of page
Power Reactor Event Number: 48252
Facility: CALVERT CLIFFS
Region: 1 State: MD
Unit: [ ] [2] [ ]
RX Type: [1] CE,[2] CE
NRC Notified By: TOM JONES
HQ OPS Officer: JOHN KNOKE
Notification Date: 08/30/2012
Notification Time: 00:31 [ET]
Event Date: 08/29/2012
Event Time: 19:30 [EDT]
Last Update Date: 08/30/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
JOHN ROGGE (R1DO)

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

Event Text

PRIMARY PLANT COMPUTER OUT OF SERVICE

"Calvert Cliffs Unit 2 Primary Plant Computer (PPC) is out of service. The PPC provides monitoring capability for the Emergency Response Data System and Safety Parameter Display System. The loss of the PPC requires alternate monitoring methods, as described in plant procedures, to be used. Therefore, appropriate assessment of plant conditions, notifications and communications can still be made, if required, during the time that the PPC is unavailable.

"This report is being made in accordance with 10 CFR 50.72(b)(3)(xiii) which is any event that results in major loss of emergency assessment capability, offsite response capability, or offsite communications capability. As previously stated, alternate means remain available to assess plant conditions, make notifications and accomplish required communications, as necessary."

The licensee has notified the NRC Resident Inspector.

To top of page
Power Reactor Event Number: 48253
Facility: BRUNSWICK
Region: 2 State: NC
Unit: [1] [2] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: MIKE O'DELL
HQ OPS Officer: DONG HWA PARK
Notification Date: 08/30/2012
Notification Time: 02:34 [ET]
Event Date: 08/29/2012
Event Time: 21:34 [EDT]
Last Update Date: 08/30/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
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
2 N Y 100 Power Operation 100 Power Operation

Event Text

LOCAL CONTROL CAPABILITY OF EMERGENCY DIESEL GENERATOR #2 NOT AVAILABLE UNDER CERTAIN CONDITIONS

"On August 28, 2012, during planned maintenance on Emergency Diesel Generator No.2, a post-maintenance continuity testing associated with the Alternate Safety Shutdown (ASSD) switch on Emergency Diesel Generator No.2 (EDG 2) revealed unexpected results when the switch was taken to the LOCAL position. Troubleshooting activities determined the switch to be operating properly, meaning the contacts are actually open. However, a current path preventing isolation of the control room circuit remained. It was determined that a wire, not identified in EDG wiring diagrams, created a short between two ASSD switch contacts.

"At 2134 hours Eastern Daylight Time (EDT) on August 29, 2012, it was concluded that the condition may impact the ability of EDG 2 to perform its intended ASSD function. In the event of a fire, an induced fault could potentially affect the ability to locally control EDG 2. Local control of EDG 2 is credited in the safe shutdown analysis. Therefore, this condition is being reported in accordance with 10 CFR 50.72(b)(3)(ii)(B) as an unanalyzed condition.

"This condition did not result in any adverse impact to the health and safety of the public. This condition has no affect on the Technical Specification operability of EDG 2 and it was fully capable of performing its intended design basis accident response functions given the as-found condition of the circuitry.

"The initial safety significance of this condition is minimal. This condition has no affect on the Technical Specification operability of EDG 2 and it was fully capable of performing its intended design basis accident response functions given the as-found condition of the circuitry.

"Repairs to the ASSD switch wiring have been completed. Post maintenance testing is occurring at this time. Planning is in progress to inspect the remaining Emergency Diesel Generators for similar conditions."

The licensee has notified the NRC Resident Inspector.

To top of page
Power Reactor Event Number: 48255
Facility: WATERFORD
Region: 4 State: LA
Unit: [3] [ ] [ ]
RX Type: [3] CE
NRC Notified By: JESSE BOHNENKAMP
HQ OPS Officer: DONALD NORWOOD
Notification Date: 08/30/2012
Notification Time: 14:13 [ET]
Event Date: 08/30/2012
Event Time: 06:20 [CDT]
Last Update Date: 08/30/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
DAVID PROULX (R4DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
3 N N 0 Hot Shutdown 0 Hot Shutdown

Event Text

EMERGENCY OPERATIONS FACILITY AND EMERGENCY NOTIFICATION SYSTEM PHONE OUT OF SERVICE

"This is a non-emergency notification being made under 10CFR50.72(b)(3)(xiii) due to the potential loss of emergency preparedness capabilities due to the effects of hurricane Isaac.

"At approximately 0735, the Emergency Operations Facility (EOF) diesel generator was discovered to be tripped and not available, leaving the primary EOF without AC electrical power and, therefore, unavailable since normal AC power was also lost due to weather conditions. Efforts to repair the EOF diesel generator have been initiated and personnel have verified the Alternate EOF is functional. State, local and federal agencies have been informed of the plan to use the alternate EOF in case of an emergency preparedness activation.

"With essential personnel being sequestered at the Waterford 3 power block, the critical EOF functions can be performed from the on-site Technical Support Center (TSC), which is housed within the Control Room ventilated envelope.

"At approximately 0620 CDT, Entergy Operations, Inc. Emergency Preparedness staff discovered that the NRC Emergency Notification Systems (ENS) was not working. NRC Headquarters was notified at approximately 0715 CDT and was given an alternate phone number to contact Waterford 3. The ENS phone had previously been verified functional at approximately 0330 CDT. The NRC Health Physics Network (HPN) telephone line was verified to be functional at 0922 CDT."

The licensee notified the NRC Resident Inspector.

To top of page
Fuel Cycle Facility Event Number: 48257
Facility: HONEYWELL INTERNATIONAL, INC.
RX Type: URANIUM HEXAFLUORIDE PRODUCTION
Comments: UF6 CONVERSION (DRY PROCESS)
Region: 2
City: METROPOLIS State: IL
County: MASSAC
License #: SUB-526
Agreement: Y
Docket: 04003392
NRC Notified By: MICHAEL ABEL
HQ OPS Officer: STEVE SANDIN
Notification Date: 08/30/2012
Notification Time: 17:45 [ET]
Event Date: 08/30/2012
Event Time: 15:45 [CDT]
Last Update Date: 08/30/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
40.60(b)(3) - MED TREAT INVOLVING CONTAM
Person (Organization):
STEVEN VIAS (R2DO)
MICHELE SAMPSON (NMSS)

Event Text

UNPLANNED MEDICAL TREATMENT OF A CONTAMINATED EMPLOYEE

"An employee was transported to the dispensary with a laceration to his left hand approximately at 1540 CDT. The plant nurse evaluated the employee and decided to transport the employee to a regional hospital. Contamination was detected on the employee's plant clothing. The maximum contamination was present on the employee's left boot, 12,682 dpm/100cm2. The employee's plant clothing was removed, and the employee was re-surveyed. No contamination was detected on the employee prior to loading the ambulance. Additionally, the gurney and ambulance personnel shoes were surveyed upon loading the ambulance; no contamination was detected."

The contamination was from Uranium ore concentrates. The licensee informed RII (Richard Gibson) via voicemail.

To top of page
Power Reactor Event Number: 48258
Facility: FITZPATRICK
Region: 1 State: NY
Unit: [1] [ ] [ ]
RX Type: [1] GE-4
NRC Notified By: CHRIS ADNER
HQ OPS Officer: DONALD NORWOOD
Notification Date: 08/30/2012
Notification Time: 17:48 [ET]
Event Date: 08/30/2012
Event Time: 12:15 [EDT]
Last Update Date: 08/30/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
JOHN ROGGE (R1DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N Y 95 Power Operation 95 Power Operation

Event Text

HPCI INOPERABLE DUE TO FAILED PRESSURE CONTROL VALVE

"At 1215 EDT on August 30, 2012, with the James A. FitzPatrick Nuclear Power Plant (JAF) operating at 95% reactor power, High Pressure Coolant Injection (HPCI) was declared inoperable due to the failure of a pressure control valve on the HPCI oil cooling system. The failure of this pressure control valve results in a safety-valve lifting and releasing approximately 75 gallons per minute to the reactor building equipment drain tank. There was no release to the environment.

"This failure meets NRC 8 hour reporting criterion 10CFR50.72(b)(3)(v)(D). Reactor Core Isolation Cooling (RCIC) and other Emergency Core Cooling System (ECCS) systems remain operable.

"The NRC Resident Inspector has been notified."

Page Last Reviewed/Updated Friday, August 31, 2012
Friday, August 31, 2012