Event Notification Report for January 14, 2009
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
01/13/2009 - 01/14/2009
EVENT NUMBERS
44773447744477544776
Power Reactor
Event Number: 44773
Facility: PRAIRIE ISLAND
Region: 3 State: MN
Unit: [1] [2] []
RX Type: [1] W-2-LP,[2] W-2-LP
NRC Notified By: BOB CARLSON
HQ OPS Officer: PETE SNYDER
Region: 3 State: MN
Unit: [1] [2] []
RX Type: [1] W-2-LP,[2] W-2-LP
NRC Notified By: BOB CARLSON
HQ OPS Officer: PETE SNYDER
Notification Date: 01/14/2009
Notification Time: 15:17 [ET]
Event Date: 01/14/2009
Event Time: 11:30 [CST]
Last Update Date: 01/14/2009
Notification Time: 15:17 [ET]
Event Date: 01/14/2009
Event Time: 11:30 [CST]
Last Update Date: 01/14/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
Person (Organization):
DAVE PASSEHL (R3)
DAVE PASSEHL (R3)
| 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 |
MANUAL ACTIONS FOR FIRE NOT IN COMPLIANCE
"During review of the 10 CFR 50 Appendix R safe shutdown compliance assessment, it was discovered that a fire in either fire area 31 or 32, the Aux Feedwater Pump and Instrument Air Compressor Room, could cause the loss of the instrument air system which is credited to supply compressed air for the control room chillers. The effect of the loss of compressed air supply to the control room chillers was not fully analyzed in the Appendix R compliance assessment.
"The chillers have compressed air cylinders to provide at least an 8 hour backup supply of compressed air and operators routinely validate that there is at least a 12 hour supply of compressed air and have a procedure to replace the compressed air cylinders if needed. The control room chillers are required to cool the control room to achieve and maintain hot shutdown and per the guidance in RIS 2006-10, 'Regulatory Expectations with Appendix R Paragraph III.G.2 Operator Manual Actions,' operator manual actions to replace compressed air cylinders for the loss of the instrument air compressors are not in compliance with 10 CFR 50 Appendix R.
"The discovery of this non-compliance is being reported as an unanalyzed condition as defined by 10 CFR 50.72(b)(3)(ii). An hourly fire patrol has already been in place for fire area 31 and 32 as a compensatory measure for other issues identified in these fire areas.
"The 60-day licensee event report, submitted to the Commission in accordance with 10 CFR 50.73(a)(2)(ii), will provide the results of the manual action compliance review and follow-up corrective actions."
The licensee has informed the NRC Resident Inspector.
"During review of the 10 CFR 50 Appendix R safe shutdown compliance assessment, it was discovered that a fire in either fire area 31 or 32, the Aux Feedwater Pump and Instrument Air Compressor Room, could cause the loss of the instrument air system which is credited to supply compressed air for the control room chillers. The effect of the loss of compressed air supply to the control room chillers was not fully analyzed in the Appendix R compliance assessment.
"The chillers have compressed air cylinders to provide at least an 8 hour backup supply of compressed air and operators routinely validate that there is at least a 12 hour supply of compressed air and have a procedure to replace the compressed air cylinders if needed. The control room chillers are required to cool the control room to achieve and maintain hot shutdown and per the guidance in RIS 2006-10, 'Regulatory Expectations with Appendix R Paragraph III.G.2 Operator Manual Actions,' operator manual actions to replace compressed air cylinders for the loss of the instrument air compressors are not in compliance with 10 CFR 50 Appendix R.
"The discovery of this non-compliance is being reported as an unanalyzed condition as defined by 10 CFR 50.72(b)(3)(ii). An hourly fire patrol has already been in place for fire area 31 and 32 as a compensatory measure for other issues identified in these fire areas.
"The 60-day licensee event report, submitted to the Commission in accordance with 10 CFR 50.73(a)(2)(ii), will provide the results of the manual action compliance review and follow-up corrective actions."
The licensee has informed the NRC Resident Inspector.
Hospital
Event Number: 44774
Rep Org: VARIAN MEDICAL SYSTEMS
Licensee: VARIAN MEDICAL SYSTEMS
Region: 1
City: CHARLOTTESVILLE State: VA
County:
License #:
Agreement: N
Docket:
NRC Notified By: RICHARD G. PICCOLO
HQ OPS Officer: JASON KOZAL
Licensee: VARIAN MEDICAL SYSTEMS
Region: 1
City: CHARLOTTESVILLE State: VA
County:
License #:
Agreement: N
Docket:
NRC Notified By: RICHARD G. PICCOLO
HQ OPS Officer: JASON KOZAL
Notification Date: 01/14/2009
Notification Time: 16:38 [ET]
Event Date: 01/14/2009
Event Time: 00:00 [EST]
Last Update Date: 01/15/2009
Notification Time: 16:38 [ET]
Event Date: 01/14/2009
Event Time: 00:00 [EST]
Last Update Date: 01/15/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21 - UNSPECIFIED PARAGRAPH 30.50(b)(2) - SAFETY EQUIPMENT FAILURE
10 CFR Section:
21.21 - UNSPECIFIED PARAGRAPH 30.50(b)(2) - SAFETY EQUIPMENT FAILURE
Person (Organization):
ART BURRITT (R1)
STEVEN RUDISAIL (R2)
DAVE PASSEHL (R3)
RYAN LANTZ (R4)
ANDREA KOCK (FSME)
ART BURRITT (R1)
STEVEN RUDISAIL (R2)
DAVE PASSEHL (R3)
RYAN LANTZ (R4)
ANDREA KOCK (FSME)
PART 21 REPORT DUE POTENTIAL ISSUE OF AFTERLOADER SOURCE STICKING
"The active source may have movement difficulties and become stuck during source extension or retraction. The problem may occur with the source outside of the HDR unit's tungsten shield.
"This type of event was first seen in December 2008.
"This event has occurred three times:
"a) Southwest Regional Cancer Center, Austin TX - December 2, 2008 [see EN #44697]
"b) Hershey Medical Center, Hershey PA - December 11, 2008
"c) Stanford University Medical Center, Stanford, CA - December 30, 2008
"In each case the problem occurred during a routine source exchange and patients were not involved. The emergency retract handle was used in each occurrence to retract the source and park it safely in the HDR unit's tungsten shield. The relationship between the source exchange and the problem is unknown."
"The affected sites in the United States are as follows:"
St. Joseph's - Mercy Hospital of Macomb - Clinton Twp., MI
Cancer Healthcare Associates Cedars Med Ctr - Miami, FL
Providence Hospital - Anchorage, AK
Coborn Cancer Center - St. Cloud, MN
Stanford University Medical Center - Palo Alto, CA
Barnes Jewish #2 - Washington University - St. Louis, MO
Mayo Clinic - Rochester, MN
DeKalb Medical Center - Decatur, GA
Cy-Fair Cancer Center - Houston, TX
Billings Clinic - Billings, MT
Palm Beach Cancer Institute - West Palm Beach, FL
St. Lukes - Bethlehem, PA
University of Nebraska Medical Center - Omaha, NE
Geisinger Health System - Wilkes-Barre, PA
Southwest Regional Cancer Center - Austin, TX
Hershey Medical Center - Hershey, PA
Carolinas Medical Center - Charlotte, NC
Cheyenne Regional Medical Center - Cheyenne, WY
Mary Washington Hospital - Fredericksburg, VA
Treasure Coast Radiation Oncology - Stuart, FL
Mayhill Denton Cancer Center - Denton, TX
Hamilton Medical Center - Dalton, GA
Providence Hospital - Everett, WA
Good Samaritan Hospital - Downers Grove, IL
Seattle Cancer Care Alliance - Seattle, WA
* * * UPDATE FROM RICHARD PICCOLO TO JASON KOZAL AT 1240 ON 01/15/09 * * *
After conferring with Region 1 (Gabriel) and NRC HQ (Flannery) the licensee is also reporting this under 10 CFR 30.50(b)(2).
Notified R1DO (Burritt) and FSME (Flannery).
"The active source may have movement difficulties and become stuck during source extension or retraction. The problem may occur with the source outside of the HDR unit's tungsten shield.
"This type of event was first seen in December 2008.
"This event has occurred three times:
"a) Southwest Regional Cancer Center, Austin TX - December 2, 2008 [see EN #44697]
"b) Hershey Medical Center, Hershey PA - December 11, 2008
"c) Stanford University Medical Center, Stanford, CA - December 30, 2008
"In each case the problem occurred during a routine source exchange and patients were not involved. The emergency retract handle was used in each occurrence to retract the source and park it safely in the HDR unit's tungsten shield. The relationship between the source exchange and the problem is unknown."
"The affected sites in the United States are as follows:"
St. Joseph's - Mercy Hospital of Macomb - Clinton Twp., MI
Cancer Healthcare Associates Cedars Med Ctr - Miami, FL
Providence Hospital - Anchorage, AK
Coborn Cancer Center - St. Cloud, MN
Stanford University Medical Center - Palo Alto, CA
Barnes Jewish #2 - Washington University - St. Louis, MO
Mayo Clinic - Rochester, MN
DeKalb Medical Center - Decatur, GA
Cy-Fair Cancer Center - Houston, TX
Billings Clinic - Billings, MT
Palm Beach Cancer Institute - West Palm Beach, FL
St. Lukes - Bethlehem, PA
University of Nebraska Medical Center - Omaha, NE
Geisinger Health System - Wilkes-Barre, PA
Southwest Regional Cancer Center - Austin, TX
Hershey Medical Center - Hershey, PA
Carolinas Medical Center - Charlotte, NC
Cheyenne Regional Medical Center - Cheyenne, WY
Mary Washington Hospital - Fredericksburg, VA
Treasure Coast Radiation Oncology - Stuart, FL
Mayhill Denton Cancer Center - Denton, TX
Hamilton Medical Center - Dalton, GA
Providence Hospital - Everett, WA
Good Samaritan Hospital - Downers Grove, IL
Seattle Cancer Care Alliance - Seattle, WA
* * * UPDATE FROM RICHARD PICCOLO TO JASON KOZAL AT 1240 ON 01/15/09 * * *
After conferring with Region 1 (Gabriel) and NRC HQ (Flannery) the licensee is also reporting this under 10 CFR 30.50(b)(2).
Notified R1DO (Burritt) and FSME (Flannery).
Power Reactor
Event Number: 44775
Facility: ARKANSAS NUCLEAR
Region: 4 State: AR
Unit: [] [2] []
RX Type: [1] B&W-L-LP,[2] CE
NRC Notified By: JAMES CRABILL
HQ OPS Officer: PETE SNYDER
Region: 4 State: AR
Unit: [] [2] []
RX Type: [1] B&W-L-LP,[2] CE
NRC Notified By: JAMES CRABILL
HQ OPS Officer: PETE SNYDER
Notification Date: 01/14/2009
Notification Time: 16:46 [ET]
Event Date: 01/14/2009
Event Time: 14:30 [CST]
Last Update Date: 01/14/2009
Notification Time: 16:46 [ET]
Event Date: 01/14/2009
Event Time: 14:30 [CST]
Last Update Date: 01/14/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
RYAN LANTZ (R4)
RYAN LANTZ (R4)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 2 | M/R | Y | 60 | Power Operation | 0 | Hot Standby |
CONTROLLED SHUTDOWN FOR FEEDWATER HEATER REPAIRS
"Unit 2 performed a controlled shutdown from 60% power to make repairs to a low pressure feedwater heater. The unit was taken off line at 1148 today. The unit is stable in Mode 3, Hot Standby. A press release was made at 1430 today."
The licensee notified the NRC Resident Inspector.
"Unit 2 performed a controlled shutdown from 60% power to make repairs to a low pressure feedwater heater. The unit was taken off line at 1148 today. The unit is stable in Mode 3, Hot Standby. A press release was made at 1430 today."
The licensee notified the NRC Resident Inspector.
Fuel Cycle Facility
Event Number: 44776
Facility: PADUCAH GASEOUS DIFFUSION PLANT
Region: 2 State: KY
Unit: [] [] []
RX Type: URANIUM ENRICHMENT FACILITY
Comments: 2 DEMOCRACY CENTER
6903 ROCKLEDGE DRIVE
BETHESDA, MD 20817 (301)564-3200
NRC Notified By: MIKE BOREN
HQ OPS Officer: PETE SNYDER
Region: 2 State: KY
Unit: [] [] []
RX Type: URANIUM ENRICHMENT FACILITY
Comments: 2 DEMOCRACY CENTER
6903 ROCKLEDGE DRIVE
BETHESDA, MD 20817 (301)564-3200
NRC Notified By: MIKE BOREN
HQ OPS Officer: PETE SNYDER
Notification Date: 01/14/2009
Notification Time: 22:53 [ET]
Event Date: 01/14/2009
Event Time: 20:39 [CST]
Last Update Date: 01/15/2009
Notification Time: 22:53 [ET]
Event Date: 01/14/2009
Event Time: 20:39 [CST]
Last Update Date: 01/15/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
STEVEN RUDISAIL (R2)
JACK DAVIS (NMSS)
BRIAN McDERMOTT (IRD)
STEVEN RUDISAIL (R2)
JACK DAVIS (NMSS)
BRIAN McDERMOTT (IRD)
ONGOING RECIRCULATING COOLING WATER LEAK AT C337A FACILITY
The site staffed their Emergency Operations Center to troubleshoot an ongoing recirculating cooling water leak under the concrete floor of the C337A autoclave facility. The process in that facility automatically shutdown and is in a stable condition.
Overall impact to the plant is minimal and processes continue to operate in the cascade facility. Offsite assistance has been requested. DOE, Massac County, Illinois and McCracken and Ballard Counties in Kentucky have been notified.
The licensee notified the NRC Resident Inspector.
* * * UPDATE AT 0220 ON 1/15/2009 FROM MIKE BOREN TO MARK ABRAMOVITZ * * *
The event was terminated at 0220. The leak is not isolated but has been localized.
Notified the R2DO (Rudisail) and NMSS (Davis).
The site staffed their Emergency Operations Center to troubleshoot an ongoing recirculating cooling water leak under the concrete floor of the C337A autoclave facility. The process in that facility automatically shutdown and is in a stable condition.
Overall impact to the plant is minimal and processes continue to operate in the cascade facility. Offsite assistance has been requested. DOE, Massac County, Illinois and McCracken and Ballard Counties in Kentucky have been notified.
The licensee notified the NRC Resident Inspector.
* * * UPDATE AT 0220 ON 1/15/2009 FROM MIKE BOREN TO MARK ABRAMOVITZ * * *
The event was terminated at 0220. The leak is not isolated but has been localized.
Notified the R2DO (Rudisail) and NMSS (Davis).