Event Notification Report for December 26, 2023

AGREEMENT STATE - LOST PACKAGE

The following information was provided by the Illinois Emergency Management Agency (the Agency) via email:

"On December 14, 2023, the Agency was contacted by G.E. Healthcare in Arlington Heights, IL (IL-01109-01) to advise of a radiopharmaceutical package missing in transit. The last known location was the Memphis, TN [common carrier] hub where it was scanned on December 12, 2023. The carrier has declared the package lost. This package does not represent a significant public safety hazard and there is no indication of intentional theft or diversion.

"The subject package is 16 centimeters square, labeled Yellow-II (TI of 0.1), UN2915 and contains a single 3 mL shielded vial of In-111. The activity was 5.210 millicuries at the time of shipment but has since decayed to approximately 1.154 millicuries. It was offered for shipment on December 8, 2023, for delivery to a customer in Clovis, CA on December 11, 2023. Upon failure to arrive, the licensee contacted the carrier and was informed the package was currently unaccounted for."

Item Number: IL230035


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

AGREEMENT STATE REPORT - LOST TROXLER GAUGE

The following was submitted by the California Radiation Control Program via email:

"Licensee reported the loss of a Troxler 4640-B # 1383, containing a sealed source of 8 mCi of Cs-137, on December 14, 2023, in the evening. Los Angeles (LA) County-Duty Officer took the initial call from the assistant radiation safety officer. The report was forwarded to LA County Radiation Management and the [State of California] Radiologic Health Branch-South. It was reported that the operator of the device drove only about one mile from the jobsite before realizing the gauge was not in his vehicle's enclosed camper-shell. The driver turned around to search for it and was unsuccessful. The LA County Sheriff's office was also contacted."


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

NON-AGREEMENT STATE - POSSIBLE EXPOSURE ABOVE LIMIT (TEDE > 5 rem)

The following is a synopsis of information provided by the licensee via phone call:

On December 15, 2023, at 0652 EST, JAN X-ray Services received notification from the laboratory performing regularly scheduled analysis of their employee's thermoluminescent dosimeters (TLDs) that one of the units is indicating an employee received a dose of 5.729 rem. The limit is 5.0 rem. The worker is not normally involved in radiography. The licensee is investigating how the employee received the indicated dose.

AGREEMENT STATE REPORT - STUCK SOURCE RACK

The following information was received from the Illinois Emergency Management Agency (IEMA-OHS) via email:

"The IEMA-OHS Operations Center was contacted at 1712 CDT on December 17, 2023, by the radiation safety officer for Sterigenics to report a stuck source rack. The rack reportedly became stuck around 2300 on December 16, 2023, with approximately 10 percent of the sources above the pool level. The area was isolated with an additional restricted area established to maintain occupational exposures within limits. At this time, no public or occupational exposures above regulatory limits have been reported. This matter has a 24-hour reporting requirement under 32 Ill. Adm. Code 346.830 which was met by the licensee. IEMA-OHS inspectors will arrive at the facility on 12/18 to evaluate timelines for corrective action and the efficacy of safety systems. Staff will also evaluate the site and review staff dosimetry, potential impacts to source capsule integrity, any anticipated heat impacts, and plans for quality assurance of the impacted system(s)."

Source type: sealed source irradiator
Radionuclide: Co-60
Activity: 24 MCi (888 PBq)
Model no.: C-188

Illinois report no.: IL230036

* * * UPDATE FROM WHITNEY COX TO DAN LIVERMORE ON 12/19/23 * * *

The following information was received from the Illinois Emergency Management Agency (IEMA-OHS) via email:

"Agency staff arrived at the site on 12/18/23 and surveys indicate no public or occupational exposure levels above normal operation. The source rack is still stuck in the unshielded position. The Agency continues to monitor the situation and will update when additional information is available."

Notified R3DO (Edwards), NMSS (email)

AGREEMENT STATE REPORT - LOST SOURCE

The following summary of events was received via phone call and email from the New Mexico Environment Department, Radiation Control Bureau (the Bureau):

The licensee reported a lost source to the Bureau on December 7th, 2023. The source was described as a mixed gamma button source S/N 64820-570, 25.4 mm diameter, 1/8 inch thickness, containing multiple isotopes of low activity. The isotope with the highest present day activity was Am-241 with an activity of 0.253 microcuries. All of the other isotopes had a negligible activity by the Bureau's reporting criteria. The source was shipped by the licensee and considered lost on December 7th after receiving an email from the common carrier that they were not able to locate the shipment. There is no evidence that any individual was potentially overexposed as a result of the lost source.

New Mexico Incident #: N/A

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

PART 21 - FUEL OIL PIPING DEFECT

The following summary was provided by the licensee via phone and email:

On December 21, 2023, VC Summer determined that the original equipment manufacturer of its Emergency Diesel Generator (EDG) did not provide adequate documentation for an exception to ASME Code, Section III, Class 3 for the on-skid EDG fuel oil system. Specifically, the on-skid fuel oil threaded piping design used a code-allowed exception without providing adequate evaluation documentation supporting threaded Schedule 40 piping. On November 2, 2022, the 'A' EDG fuel oil piping failed during routine testing, requiring it to be declared inoperable until repairs were implemented.

The NRC Senior Resident Inspector has been notified.

Corrective actions: VC Summer has compensatory measures in place and is scheduled to implement a modification during the first quarter of 2024.

The following additional information was obtained from the licensee in accordance with Headquarters Operations Officers Report Guidance:

In addition to VC Summer, it was discussed via phone that Farley has a similar design for its on-skid EDG fuel oil system and potentially might be affected by this Part 21 report. No other sites have been discussed at this time.

The EDG manufacturer is: Fairbanks-Morse Corp. EDG Model: Colt-Pielstick 12-Cylinder PC-2.2

VC Summer POC for additional information: Justin Bouknight, Licensing Engineer, (803) 941-9828, justin.bouknight@dominionenergy.com.

PART 21 REPORT - DEFECT IN VALCOR SOLENOID VALVES

The following is a synopsis of information received via facsimile:

Valcor Engineering Corporation (VEC) identified a defect with Valcor solenoid valves with part number V52600-5890-1 on October 23, 2023. The defect identified is that stroke matching of internal components was not performed in accordance with internal procedures causing valve flow coefficient (Cv) to be only approximately 50 percent of the minimum required Cv of 2. Substantial safety hazard could be created if the flow rate through the solenoid valve exceeded a certain threshold.

VEC has identified two of these solenoid valves at La Salle County Nuclear Generating Station (LSCNGS) with serial numbers 33 and 34.

For corrective actions, VEC repaired and returned the valve with serial number 34 to LSCNGS. To prevent recurrence, VEC intends to improve the training program for production personnel and, if needed, review and revise the stroke matching procedure including enhancing quality assurance oversight of that process. VEC estimates it will take 30 days to complete corrective actions.

Currently, LSCNGS is the only known affected facility. Valcor is in the process of identifying and notifying affected customers.

For additional information, please contact Mike Swirad, Valcor Engineering Quality Assurance Director (973-467-8400 x 7223), email: mikeswirad@valcor.com