Event Notification Report for May 24, 2011

FITNESS FOR DUTY REPORT INVOLVING A MAINTENANCE SUPERVISOR

A maintenance supervisor had a confirmed positive for alcohol during a for cause fitness-for-duty test. The employee's access has been revoked. Contact the Headquarters Operations Officer for additional details.

The licensee has notified the NRC Resident Inspector.

AGREEMENT STATE REPORT - STUCK RADIOGRAPHY CAMERA SOURCE

The following information was received via email:

"Event Location: Flint Hills Resources LP, 2825 Suntide Road, Corpus Christi, Texas 78403.

"On May 24, 2011, the agency [State of Texas] was notified by a licensee that they were unable to retract a 27.7 Curie iridium (Ir) - 192 radiography source into a QSA Delta 880 camera at a field site. The licensee stated that when setting up for a shot, the radiographer ran the crank cables for the camera over a hot pipe. The licensee stated that while conducting a shot, the plastic on the crank cable shield melted. The licensee believes that this may have prevented the radiographer from retracting the source to the fully shielded position. The licensee's source recovery team went to the location and was able to return the source to the fully shielded position. The camera was taken to the licensee's facility for inspection. No one involved in the source recover exceeded any regulatory limits. The investigation into this event is on going. Additional information will be provided as it is received."

Texas Incident number: I - 8856

AGREEMENT STATE REPORT - STUCK RADIOGRAPHY CAMERA SOURCE

The following information was received via email:

"While using a QSA Global 880D radiographic exposure device, the licensee's crew was unable to move the drive cable forward or backward. It appeared that the source was moved slightly out of the fully shielded position when the device was unlocked prior to the attempt to crank out the source. The crew was unable to retract the source and lock the device. A licensee employee trained in source retrieval was sent to the site. The employee disassembled a portion of the drive cable which gave him access to manually pull the drive cable in the direction that would retract the source. The cable was moved approximately 1/4 inch. This placed the source in the fully shielded position and the source was locked in the shielded position.

"Only licensee personnel were potentially exposed to radiation from the device during the incident. Licensee personnel stated that they did not step in front of the camera at any point during the incident. The radiographer used the survey meter to determine where to stand to receive the least exposure while checking the camera. At one point he reached forward with the survey meter and measured 200 mR/hr at the front port of the device. Dose estimates for licensee personnel associated in the incident were well below the limits for occupationally exposed individuals."

Utah Event Report ID Number: UT - 110004

TROXLER MOISTURE DENSITY GAUGE STOLEN

At approximately 1230 EDT on 5/24/11, a Troxler Moisture Density Gauge, Model #3440, S/N 20641, with 8 mCi Cs-137 and 40 mCi Am-241/Be was stolen from a truck at Camp Lejeune Marine Corps Base. The RSO reported the theft to the Base Safety Officer.

* * * UPDATE FROM HARRY SLATER TO HOWIE CROUCH ON 5/24/11 @ 1431 EDT * * *

The Troxler Moisture Density Gauge was located on the job site off the side of the road in a ditch. There was no damage to the gauge, and the gauge was placed back into service.

* * * UPDATE FROM HARRY SLATER TO CHARLES TEAL ON 5/25/11 @ 0732 EDT * * *

The following was excerpted from an email:

"Initial investigation indicated that the [technician] did not have the gauge locked in the case while not in use. The gauge was also placed out of [the technician's] sight more than 10 feet from him. The case and the locking equipment were in the truck and are in working condition. The gauge did still have the lock trigger in place. The lack of securing the gauge when not in use is in direct violation of the company policies as indicated on the license and on the document signed by [the technician]."

Notified R1DO (Dentel), FSME EO (McIntosh), and ILTAB (Pearson).

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

LO-LO LEVEL IN STEAM GENERATOR RESULTS IN SPECIFIED SYSTEM ACTUATIONS

"At 11:20 [CDT] on 5/24/11, the unit, while in Mode 4, had a reactor trip and Aux Feedwater actuation/Feedwater Isolation Signal due to lo-lo level on 'B' Steam Generator. Reactor Trip breakers were closed to support DRPI [Digital Rod Position Indication] testing. Steam Generator levels were being maintained approximately 30% to support Aux Feedwater pump full flow testing."

The trip occurred at 23.5% level in the steam generator. Reactor trip breakers opened and the motor-driven auxiliary feedwater pump fed the steam generators. The feedwater isolation valves fully closed. No other actuations occurred. Operators are in the process of resetting plant conditions to support completion of the testing in progress at the time of the trip.

The licensee has notified the NRC Resident Inspector.

LOSS OF POWER TO THIRTY-TWO EMERGENCY SIRENS

"This 8-hour notification is being made per the reporting requirements specified by 10 CFR 50.72(b)(3)xiii.

"At 0946 CDT on May 24, 2011, the TVA Corporate Operations Duty Specialist notified the Nuclear Power Group Emergency Duty Officer that the fifteen minute communication test for Lawrence County indicated a loss of communications with the Lawrence County siren activation system.

"At 0958 CDT, Lawrence County Alabama Emergency Management Agency (EMA) staff reported that a transformer had de-energized at 0918 CDT and that both the primary siren activation point (Lawrence County EMA office) and the backup activation point (Moulton, Alabama Fire Department) were without power. The EMA offices normally have backup power supplied by a diesel generator. However, the generator had failed during EMA operations associated with the April 27, 2011 tornadoes. The State of Alabama had supplied a generator for temporary use but this generator required manual actions for making connections in order for it to be placed into service.

"At 1003 CDT, electrical power was restored and the primary and backup siren activation points were returned to service.

"Browns Ferry has 100 ANS sirens and 32 are located in Lawrence County. All of the 32 Lawrence County sirens were affected. The duration of the condition was estimated to be approximately 45 minutes (0918 CDT through 1003 CDT). (Note that the polling system that provides the out of service times polls the system every 15 minutes so the timeframe by necessity is an approximation.)

"Both primary and backup activation systems were operable at 1003 CDT. A silent test was performed from the Lawrence County EMA office at 1159 CDT with all 32 Lawrence County sirens satisfactorily responding."

The licensee has notified the State of Alabama, the Lawrence County EMA and the NRC Resident Inspector of this report.

AGREEMENT STATE REPORT - Y-90 THERASPHERE SPILL

The following information was obtained from the State of Georgia via facsimile:

"Description of Event: A spill involving Y-90 microspheres (SIR-Spheres) that occurred on May 24, 2011 at Emory University Hospital [and] was reported by the Deputy Radiation Safety Officer. During an embolization treatment using Y-90 microspheres, resistance was encountered when flushing the catheter following the initial successful microsphere administration. The authorized user examined the catheter which was found to be occluded. Preparations were made to continue the administration with a second measured dose, but this was halted when further examination showed evidence of a leak between the Y-90 vial and the catheter. The procedure was postponed until contamination controls were complete. The patient received the completion of the prescribed dose pursuant to the Authorized User's written directives when the Interventional Suite was available for use on the following day.

"Describe clean-up actions taken by RCP [Georgia Radiation Control Program]: No action performed by RCP but the licensee sealed the Y-90 shielding and cart and removed [them] for decay and evaluation. The floor and equipment were decontaminated by licensee radiation safety staff.

"List radiation measurements taken by RCP: No measurements performed by the RCP but the licensee initiated spill containment procedures [and surveyed] the staff before allowing anyone to exit the room. Some minor contamination was discovered on staff clothing and shoes, but no contamination was detected on the skin of staff after removal of affected items. The deputy RSO surveyed the patient and had a bremsstrahlung scan of patient. No contamination was found on the patient during the scan.

"List any other actions required of RCP: The licensee is storing all waste from this event for decay and subsequent investigation."

Georgia Incident Summary number GA-2011-61i.