Event Notification Report for August 25, 2003

AGREEMENT STATE REPORT - IRIDIUM-192 SOURCE UNINTENTIONALLY DISCONNECTED FROM DRIVE CABLE

The following report was received via fax from the Arizona Radiation Regulatory Agency:

"On August 25, 2003, at approximately 5:30 PM, while making an exposure at valve #14 (Iverton Rd. and Contractors Way in Tucson, Arizona) the source assembly unintentionally disconnected from the drive cable in the end of the six foot collimating guide tube. The exposure device being used was an INC - IR100, SN-4015, containing a 61 Curie IR-192 source, Model #87703, capsule #08809B. A 35 foot set of NDT [Non Destructive Testing] drive cables and a NDT guide tube were being used. The source was removed from the guide tube and collimator, reattached to the drive cable and cranked back into the exposure device, plugged, locked, and the drive cables removed. Pocket dosimeters indicated that whole body exposures were approximately 30 mR [millirem] and a hand exposure to the individual recovering the source was calculated to be 200 mR. The exposure device and drive cables are being sent back to AEA in Baton Rouge, LA to determine the cause of the disconnect."

LOST NUCLEAR MATERIAL DURING DELIVERY

The licensee reported five I-123 capsules that were lost when they fell out of the back doors of a panel van during shipment by Associates Couriers International (ACI). This occurred in Bridgeton, MO at Lindberg Boulevard at Blake. The I-123 capsules each contained 600 microcuries during precalibration and were calibrated for noon at 8/26/03 for 100 microcuries. The capsules are used for diagnostic thyroid disorders. The licensee indicated there was no significant health aspect of this event due to the short half life (i.e., 13 hours) of I-123 and the relatively low activity level.

AUTOMATIC TURBINE TRIP/REACTOR TRIP DUE TO A SUDDEN PRESSURE RELAY SIGNAL FROM MAIN TRANSFORMER BANK "1C"


"On August 25, 2003, Watts Bar (WBN) Unit 1 was operating at 100 percent power when there was an operation of a "Sudden Pressure Relay" for Main Transformer Bank 1C. The actuation of the relay resulted in a turbine trip and a subsequent reactor trip at approximately 0945 EDT. The cause of the relay actuation is under investigation at this time. All control rods inserted as required and the safety systems actuated as designed including the motor and turbine driven pumps for the Auxiliary Feedwater (AFW) System. AFW pump 1B-B was inoperable at the time of the trip due to work on an area cooler. However, the pump was available for service and started as required. Unit 1 is currently stable in Mode 3 and will remain in this mode until the completion of the investigation into the cause of the trip."

At the time of the Sudden Pressure Relay for Main Transformer Bank 1C, an oil sample was being taken of the Transformer. Fire Brigade was sent but there was no fire and no explosion to the Transformer. The electrical grid is stable, and Emergency Core Cooling systems and the Emergency Diesel Generators are fully operable if needed. At this time only the 1B-B Motor Driven Auxiliary Feedwater pump is still operating.

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

3 CURIE COBALT-60 SOURCE DISCOVERED DISCONNECTED

"At approximately 9:30 AM MST August 25, 2003, the Agency was informed by the Licensee that they had discovered a source had disconnected from a rod in the Process Leaching Vessel. The source contains 3 Curies of Cobalt 60 as of October 2001. The licensee has made measurements and determined the radiation levels outside the vessel are not excessive. The device is a ThermoMeasure Tech Model 5031 L SN B43. Even though the source is disconnected, because it is trapped within a sealed source guide tube, it is still secure from inadvertent removal. The estimated date for full repair is October 21, 2003. Repair will be made by the device manufacturer. The Licensee has agreed not to drain the vessel without Agency notice and approval.

"The Agency continues to investigate this incident."

The Agency is: ARIZONA RADIATION REGULATORY AGENCY.

First Notice: 03-13

XENON-133 RELEASED TO COLD TRASH

THE EVENT BELOW WAS REPORTED TO NRC REGION 2 BY DAN HILL OF THE STATE OF WEST VIRGINIA.

Initial notification to NRC Region II by State of West Virginia. Source was recovered by the licensee and State of West Virginia on 08/25/03. Activity measured in the licensee's dose calibrator was 10.49 millicuries at approximately 3 PM on 08/25/03. Outer pig still had radioactive marking and listed 100 millicuries of activity. Pig originally contained 5 vials, 20 millicuries each (nominal). Only one vial remained in the improperly disposed pig. Trash was normal waste, not biomedical. Discovered when a landfill alarm was set off.

* * * Update on 09/05/03 at 1130 EDT by Licensee Ashford Broadwater III to MacKinnon * * *

Ashford Broadwater III of Camden Clark Memorial Hospital stated that on 08/26/03 at approximately 0845 EDT he was notified by the State of West Virginia Radiation Protection that a dumpster from their Hospital set off a radiation alarm at a local land fill. Mr. Broadwater III met a representative from the State of West Virginia at the landfill around 1130 EDT. The dumpster was dumped and an unused vial of Xenon-133 was found along with the lead pig that it came in. The total activity of the Xenon-133 on 08/20/03 at noon was 20 millicuries. Its half life is 5.3 days. The vial of Xenon-133 was taken back to the Hospital by 1230 EDT. The licensee has revised their procedures to prevent this incident from happening in the future. NRC R2DO (Paul Fredrickson) & NMSS EO (Tom Essig) notified.