Event Notification Report for October 15, 2008
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
10/14/2008 - 10/15/2008
Fuel Cycle Facility
Event Number: 44569
Facility: WESTINGHOUSE ELECTRIC CORPORATION
Region: 2 State: SC
Unit: [] [] []
RX Type: URANIUM FUEL FABRICATION
NRC Notified By: RALPH WINIARSKI
HQ OPS Officer: JOHN KNOKE
Region: 2 State: SC
Unit: [] [] []
RX Type: URANIUM FUEL FABRICATION
NRC Notified By: RALPH WINIARSKI
HQ OPS Officer: JOHN KNOKE
Notification Date: 10/16/2008
Notification Time: 07:47 [ET]
Event Date: 10/15/2008
Event Time: 14:40 [EDT]
Last Update Date: 10/16/2008
Notification Time: 07:47 [ET]
Event Date: 10/15/2008
Event Time: 14:40 [EDT]
Last Update Date: 10/16/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
PART 70 APP A (c) - OFFSITE NOTIFICATION/NEWS REL
10 CFR Section:
PART 70 APP A (c) - OFFSITE NOTIFICATION/NEWS REL
Person (Organization):
STEVEN VIAS (R2)
CHRISTOPHER REGAN (NMSS)
STEVEN VIAS (R2)
CHRISTOPHER REGAN (NMSS)
OFFSITE NOTIFICATION TO SC-DHEC
"On October 14, 2008, Westinghouse received the vendor chemical laboratory analysis for the Total Suspended Solids (TSS) parameter result for the October 1st, 2008, NPDES liquid effluent 24-hour composite sample. The sample result indicated that the wastewater discharged from the Westinghouse Columbia plant to the Congaree River during the 24-hour period preceding the October 1st sampling contained 64.07 pounds of TSS, which exceeds the Daily Maximum permit limit of 64.0 pounds per day.
"Preliminary information indicates the parameter exceeded the permit limit due to dredging of lagoon solids during the week preceding the October 1st sample. It should be noted that process samples taken the day before did not indicate a problem with TSS prior to discharge. Typical averages for TSS in 2008 are 12.3 pounds per day, which is well below the permit daily average limit of 32 pounds per day. The dredging campaign has since been completed, and the following weekly sample analysis (dated October 8, 2008), indicates that TSS values are back to normal, around 15 pounds.
"Liquid discharges from the Columbia Plant are regulated with regard to chemical pollutants through the SC-DHEC/EPA administered NPDES permit SC#0001848. WEC is required to notify SC-DHEC of non-compliance conditions which exceed any daily maximum effluent limitation. ' Any event or situation, related to the health and safety of the public or onsite personnel, or protection of the environment, for which a news release is planned or notification to other government agencies has been or will be made shall be reported to the NRC Operations Center concurrent to the news release or other notification.'
"Liquid discharges from the Columbia Plant are regulated with regard to chemical parameters through the SC-DHEC/EPA NPDES Permit #SC0001848.
"Liquid effluent discharges are being temporarily halted while reviews are being conducted to verify no potential for recurrence of the event. The event will be entered into the plant's Corrective Action Process and a thorough review will be performed to identify the cause of the event. The problem was identified by Westinghouse EH&S personnel. At no time was the health or safety to any employee or member of the public in jeopardy.
SC-DHEC has been notified."
"On October 14, 2008, Westinghouse received the vendor chemical laboratory analysis for the Total Suspended Solids (TSS) parameter result for the October 1st, 2008, NPDES liquid effluent 24-hour composite sample. The sample result indicated that the wastewater discharged from the Westinghouse Columbia plant to the Congaree River during the 24-hour period preceding the October 1st sampling contained 64.07 pounds of TSS, which exceeds the Daily Maximum permit limit of 64.0 pounds per day.
"Preliminary information indicates the parameter exceeded the permit limit due to dredging of lagoon solids during the week preceding the October 1st sample. It should be noted that process samples taken the day before did not indicate a problem with TSS prior to discharge. Typical averages for TSS in 2008 are 12.3 pounds per day, which is well below the permit daily average limit of 32 pounds per day. The dredging campaign has since been completed, and the following weekly sample analysis (dated October 8, 2008), indicates that TSS values are back to normal, around 15 pounds.
"Liquid discharges from the Columbia Plant are regulated with regard to chemical pollutants through the SC-DHEC/EPA administered NPDES permit SC#0001848. WEC is required to notify SC-DHEC of non-compliance conditions which exceed any daily maximum effluent limitation. ' Any event or situation, related to the health and safety of the public or onsite personnel, or protection of the environment, for which a news release is planned or notification to other government agencies has been or will be made shall be reported to the NRC Operations Center concurrent to the news release or other notification.'
"Liquid discharges from the Columbia Plant are regulated with regard to chemical parameters through the SC-DHEC/EPA NPDES Permit #SC0001848.
"Liquid effluent discharges are being temporarily halted while reviews are being conducted to verify no potential for recurrence of the event. The event will be entered into the plant's Corrective Action Process and a thorough review will be performed to identify the cause of the event. The problem was identified by Westinghouse EH&S personnel. At no time was the health or safety to any employee or member of the public in jeopardy.
SC-DHEC has been notified."
Hospital
Event Number: 44589
Rep Org: SAINT MARY'S MEDICAL CENTER
Licensee: SAINT MARY'S MEDICAL CENTER
Region: 1
City: HUNTINGTON State: WV
County:
License #: 47-09576-01
Agreement: N
Docket:
NRC Notified By: JAMES NORWECK
HQ OPS Officer: JASON KOZAL
Licensee: SAINT MARY'S MEDICAL CENTER
Region: 1
City: HUNTINGTON State: WV
County:
License #: 47-09576-01
Agreement: N
Docket:
NRC Notified By: JAMES NORWECK
HQ OPS Officer: JASON KOZAL
Notification Date: 10/22/2008
Notification Time: 10:15 [ET]
Event Date: 10/15/2008
Event Time: 14:00 [EDT]
Last Update Date: 10/22/2008
Notification Time: 10:15 [ET]
Event Date: 10/15/2008
Event Time: 14:00 [EDT]
Last Update Date: 10/22/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(3) - DOSE TO OTHER SITE > SPECIFIED LIMITS
10 CFR Section:
35.3045(a)(3) - DOSE TO OTHER SITE > SPECIFIED LIMITS
Person (Organization):
CHRISTOPHER CAHILL (R1)
MICHELE BURGESS (FSME)
CHRISTOPHER CAHILL (R1)
MICHELE BURGESS (FSME)
OVEREXPOSURE TO ESOPHAGUS DURING MEDICAL PROCEDURE
The patient was being treated for a thyroid condition with a capsule of I-131 (150 milliCi). The procedure involved the patient swallowing the capsule to position it near the thyroid. During the procedure the capsule became lodged in the patient's throat due to an esophageal obstruction. The staff attempted to aid in passing the capsule by having the patient drink soda and eat applesauce. The capsule eventually passed the obstruction after approximately 2 1/2 hours.
The estimated dose to the esophagus was 1000 Rads. The calculated dose to the esophagus is 1786 Rads. The patient is following-up with a physician today and at that time will be notified of the overexposure. The potential adverse effects of this dose are esophagitis (inflammation of the lining of the esophagus) and radiation fibrosis.
The licensee initially investigated this event shortly after it occurred and at the time contacted NRC R2 (Gabriel). At that time, based on the information that was available (mainly time the device was lodged in the patients esophagus), this event was deemed not reportable. When new information became available to the licensee the event was determined to be reportable.
A Medical Event may indicate potential problems in a medical facilities use of radioactive materials. It does not necessarily result in harm to the patient.
The patient was being treated for a thyroid condition with a capsule of I-131 (150 milliCi). The procedure involved the patient swallowing the capsule to position it near the thyroid. During the procedure the capsule became lodged in the patient's throat due to an esophageal obstruction. The staff attempted to aid in passing the capsule by having the patient drink soda and eat applesauce. The capsule eventually passed the obstruction after approximately 2 1/2 hours.
The estimated dose to the esophagus was 1000 Rads. The calculated dose to the esophagus is 1786 Rads. The patient is following-up with a physician today and at that time will be notified of the overexposure. The potential adverse effects of this dose are esophagitis (inflammation of the lining of the esophagus) and radiation fibrosis.
The licensee initially investigated this event shortly after it occurred and at the time contacted NRC R2 (Gabriel). At that time, based on the information that was available (mainly time the device was lodged in the patients esophagus), this event was deemed not reportable. When new information became available to the licensee the event was determined to be reportable.
A Medical Event may indicate potential problems in a medical facilities use of radioactive materials. It does not necessarily result in harm to the patient.
General Information or Other
Event Number: 44592
Rep Org: SCIENTECH
Licensee: ENSIGN POWER SYSTEMS
Region: 4
City: IDAHO FALLS State: ID
County:
License #:
Agreement: N
Docket:
NRC Notified By: TONY GILL
HQ OPS Officer: JOE O'HARA
Licensee: ENSIGN POWER SYSTEMS
Region: 4
City: IDAHO FALLS State: ID
County:
License #:
Agreement: N
Docket:
NRC Notified By: TONY GILL
HQ OPS Officer: JOE O'HARA
Notification Date: 10/22/2008
Notification Time: 14:50 [ET]
Event Date: 10/15/2008
Event Time: 00:00 [MDT]
Last Update Date: 10/22/2008
Notification Time: 14:50 [ET]
Event Date: 10/15/2008
Event Time: 00:00 [MDT]
Last Update Date: 10/22/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21 - UNSPECIFIED PARAGRAPH
10 CFR Section:
21.21 - UNSPECIFIED PARAGRAPH
Person (Organization):
ALAN BLAMEY (R2)
VERN HODGE (NRR)
OMID TABATABAI (NRO)
JOHN THORP (NRR)
ALAN BLAMEY (R2)
VERN HODGE (NRR)
OMID TABATABAI (NRO)
JOHN THORP (NRR)
POWER SUPPLIES MANUFACTURED WITH UNAUTHORIZED CAPACITOR DELIVERED TO H.B. ROBINSON
"On October 15. 2008, Ensign Power Systems. Inc. of Loveland, Colorado informed Scientech of a defect. An internal audit had revealed that some Model 9061-01 power supplies provided to Scientech for use in their safety related line of NUSI modules had been inadvertently manufactured with an unauthorized part.
"The design required the use of two capacitors in the power line filter. When Ensign attempted to purchase the required parts, their supplier made an unauthorized substitution of capacitors. These capacitors are virtually identical, and the packaging was labeled with the correct Ensign Power Systems part number.
"Scientech immediately put a HOLD on all shipments of modules with Ensign power supplies until it could be verified that they were built using the correct parts. (Complete 10/15/08)
"Scientech located all Ensign power supplies in house and isolated them. (Complete 10/16/08)
"Scientech notified H. B. Robinson that some of the twelve modules contain power supplies with unauthorized parts. (Complete 10/16/08)
"Scientech is working with H. B. Robinson to replace the eight Ensign power supplies with [authorized] parts. (in progress)
"Scientech will return all affected power supplies to Ensign for installation of the approved components.
"Scientech will review the revised Ensign receipt inspection procedures to assure that they are robust enough to prevent reoccurrence.
"On October 15. 2008, Ensign Power Systems. Inc. of Loveland, Colorado informed Scientech of a defect. An internal audit had revealed that some Model 9061-01 power supplies provided to Scientech for use in their safety related line of NUSI modules had been inadvertently manufactured with an unauthorized part.
"The design required the use of two capacitors in the power line filter. When Ensign attempted to purchase the required parts, their supplier made an unauthorized substitution of capacitors. These capacitors are virtually identical, and the packaging was labeled with the correct Ensign Power Systems part number.
"Scientech immediately put a HOLD on all shipments of modules with Ensign power supplies until it could be verified that they were built using the correct parts. (Complete 10/15/08)
"Scientech located all Ensign power supplies in house and isolated them. (Complete 10/16/08)
"Scientech notified H. B. Robinson that some of the twelve modules contain power supplies with unauthorized parts. (Complete 10/16/08)
"Scientech is working with H. B. Robinson to replace the eight Ensign power supplies with [authorized] parts. (in progress)
"Scientech will return all affected power supplies to Ensign for installation of the approved components.
"Scientech will review the revised Ensign receipt inspection procedures to assure that they are robust enough to prevent reoccurrence.