Event Notification Report for July 24, 2012
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
07/23/2012 - 07/24/2012
EVENT NUMBERS
4813548131481274812848273
Agreement State
Event Number: 48135
Rep Org: MA RADIATION CONTROL PROGRAM
Licensee: WALTHAM WATCH COMPANY
Region: 1
City: WALTHAM State: MA
County:
License #: none
Agreement: Y
Docket:
NRC Notified By: JOSH DAEHLER
HQ OPS Officer: PETE SNYDER
Licensee: WALTHAM WATCH COMPANY
Region: 1
City: WALTHAM State: MA
County:
License #: none
Agreement: Y
Docket:
NRC Notified By: JOSH DAEHLER
HQ OPS Officer: PETE SNYDER
Notification Date: 07/26/2012
Notification Time: 13:20 [ET]
Event Date: 07/24/2012
Event Time: 00:00 [EDT]
Last Update Date: 07/26/2012
Notification Time: 13:20 [ET]
Event Date: 07/24/2012
Event Time: 00:00 [EDT]
Last Update Date: 07/26/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
MEL GRAY (R1DO)
FSME EVENT RESOURCE (EMAI)
MEL GRAY (R1DO)
FSME EVENT RESOURCE (EMAI)
AGREEMENT STATE REPORT - MISSING OR ABANDONED AND FOUND RADIOACTIVE MATERIALS
"During conversion of the former Waltham Watch Co. property to offices and apartments the property owner discovered sub-floor areas to be contaminated with radium-226 and americium-241.
"The consultant submitted that the property had functioned as a watch factory; that during World War II the site was used to support the war effort; and that radium was used in self-luminous paints for watches, nuclear panels, aircraft switches, clocks, and instrument dials starting in the early 1900s and was still used as late as the 1960s. The americium was likely not part of the dial painting process and may have been associated with a former tenant.
"The consultant reported on radioactive waste manifest dated July 24, 2012 that a total of 890 microCuries (approximately 727 microCuries of americium-241 and approximately 163 microCuries of radium-226) was removed from the property. These materials are in addition to 10 microCuries of radium-226 that was removed from the property on May 23, 2012. In aggregate, the activities of materials meet the reporting requirements of 105 CMR 120.281(A)(1). Radioactive materials discovered and removed were mostly found under layers of flooring in areas of original wood subflooring materials in apartments not yet inhabited. The americium-241 was confined to two areas whereas the radium-226 was discovered in many areas. Final status surveys performed by the consultant indicate that no radioactivity is present above natural background levels in post-remediation areas.
"The Agency [Massachusetts Radiation Control Program] continues to investigate this incident and has performed on-site inspection of the specifically licensed person providing decontamination and decommissioning services to the property owner of the site."
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
This source is not amongst those sources or devices identified by the IAEA Code of Conduct for the Safety & Security of Radioactive Sources to be of concern from a radiological standpoint. Therefore is it being categorized as a less than Category 3 source
"During conversion of the former Waltham Watch Co. property to offices and apartments the property owner discovered sub-floor areas to be contaminated with radium-226 and americium-241.
"The consultant submitted that the property had functioned as a watch factory; that during World War II the site was used to support the war effort; and that radium was used in self-luminous paints for watches, nuclear panels, aircraft switches, clocks, and instrument dials starting in the early 1900s and was still used as late as the 1960s. The americium was likely not part of the dial painting process and may have been associated with a former tenant.
"The consultant reported on radioactive waste manifest dated July 24, 2012 that a total of 890 microCuries (approximately 727 microCuries of americium-241 and approximately 163 microCuries of radium-226) was removed from the property. These materials are in addition to 10 microCuries of radium-226 that was removed from the property on May 23, 2012. In aggregate, the activities of materials meet the reporting requirements of 105 CMR 120.281(A)(1). Radioactive materials discovered and removed were mostly found under layers of flooring in areas of original wood subflooring materials in apartments not yet inhabited. The americium-241 was confined to two areas whereas the radium-226 was discovered in many areas. Final status surveys performed by the consultant indicate that no radioactivity is present above natural background levels in post-remediation areas.
"The Agency [Massachusetts Radiation Control Program] continues to investigate this incident and has performed on-site inspection of the specifically licensed person providing decontamination and decommissioning services to the property owner of the site."
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
This source is not amongst those sources or devices identified by the IAEA Code of Conduct for the Safety & Security of Radioactive Sources to be of concern from a radiological standpoint. Therefore is it being categorized as a less than Category 3 source
Power Reactor
Event Number: 48131
Facility: COLUMBIA GENERATING STATION
Region: 4 State: WA
Unit: [2] [] []
RX Type: [2] GE-5
NRC Notified By: RYAN OAKES
HQ OPS Officer: DONALD NORWOOD
Region: 4 State: WA
Unit: [2] [] []
RX Type: [2] GE-5
NRC Notified By: RYAN OAKES
HQ OPS Officer: DONALD NORWOOD
Notification Date: 07/24/2012
Notification Time: 19:29 [ET]
Event Date: 07/24/2012
Event Time: 11:22 [PDT]
Last Update Date: 07/24/2012
Notification Time: 19:29 [ET]
Event Date: 07/24/2012
Event Time: 11:22 [PDT]
Last Update Date: 07/24/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(C) - POT UNCNTRL RAD REL 50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
10 CFR Section:
50.72(b)(3)(v)(C) - POT UNCNTRL RAD REL 50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
JAMES DRAKE (R4DO)
JAMES DRAKE (R4DO)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 2 | N | Y | 100 | Power Operation | 100 | Power Operation |
LOSS OF SECONDARY CONTAINMENT DIFFERENTIAL PRESSURE DUE TO THE TRIP OF SECONDARY CONTAINMENT SUPPLY AND EXHAUST FANS
"Reactor Building (Secondary Containment) Supply Fan 1B (ROA-FN-1B) and Reactor Building Exhaust Fan 1B (REA-FN-1B) inadvertently tripped. Secondary containment pressure exceeded atmospheric pressure which does not meet the surveillance requirement to have secondary containment vacuum greater than or equal to 0.25 inches of water vacuum. This event is reportable as an event that could have prevented fulfillment of a safety function needed to control the release of radiation and mitigate the consequences of an accident. Alternate supply and exhaust fans were manually started within 4 minutes and Secondary Containment pressure was restored to normal (greater than 0.25 inches water vacuum) within 5 minutes, returning Secondary Containment to operable status.
"Event investigation is on-going to determine exact cause of the fans tripping; however, electrical maintenance activities were in progress at the time.
"There were no radiological releases associated with the event.
"No safety system actuations or isolations occurred."
The licensee notified the NRC Resident Inspector.
"Reactor Building (Secondary Containment) Supply Fan 1B (ROA-FN-1B) and Reactor Building Exhaust Fan 1B (REA-FN-1B) inadvertently tripped. Secondary containment pressure exceeded atmospheric pressure which does not meet the surveillance requirement to have secondary containment vacuum greater than or equal to 0.25 inches of water vacuum. This event is reportable as an event that could have prevented fulfillment of a safety function needed to control the release of radiation and mitigate the consequences of an accident. Alternate supply and exhaust fans were manually started within 4 minutes and Secondary Containment pressure was restored to normal (greater than 0.25 inches water vacuum) within 5 minutes, returning Secondary Containment to operable status.
"Event investigation is on-going to determine exact cause of the fans tripping; however, electrical maintenance activities were in progress at the time.
"There were no radiological releases associated with the event.
"No safety system actuations or isolations occurred."
The licensee notified the NRC Resident Inspector.
Power Reactor
Event Number: 48127
Facility: HARRIS
Region: 2 State: NC
Unit: [1] [] []
RX Type: [1] W-3-LP
NRC Notified By: JUSTIN KELLY
HQ OPS Officer: VINCE KLCO
Region: 2 State: NC
Unit: [1] [] []
RX Type: [1] W-3-LP
NRC Notified By: JUSTIN KELLY
HQ OPS Officer: VINCE KLCO
Notification Date: 07/24/2012
Notification Time: 13:43 [ET]
Event Date: 07/24/2012
Event Time: 05:55 [EDT]
Last Update Date: 07/25/2012
Notification Time: 13:43 [ET]
Event Date: 07/24/2012
Event Time: 05:55 [EDT]
Last Update Date: 07/25/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
BINOY DESAI (R2DO)
BINOY DESAI (R2DO)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 100 | Power Operation |
TECHNICAL SUPPORT CENTER OUT OF SERVICE
"At approximately 0555 [EDT] on 07/24/2012, the AH-17 TSC Cooling Fan was found with the cooling system not fully working. The fan is running, but the condensing compressor is not. Repairs are being planned and will be worked immediately. This event is reportable per 10 CFR 50.72(b)(3)(xiii) as described in NUREG-1022, Revision 2. The on call Site Emergency Coordinator and Emergency Response Manager have been notified. The Alternate TSC is available per plant procedure, if required."
The licensee notified the NRC Resident Inspector.
* * * UPDATE FROM CASPER JERNIGAN TO JOHN SHOEMAKER AT 0929 EDT, ON 07/25/12 * * *
TSC cooling system repairs have been completed and the system has been returned to normal.
The licensee notified the NRC Resident Inspector.
Notified the R2DO (Franke).
"At approximately 0555 [EDT] on 07/24/2012, the AH-17 TSC Cooling Fan was found with the cooling system not fully working. The fan is running, but the condensing compressor is not. Repairs are being planned and will be worked immediately. This event is reportable per 10 CFR 50.72(b)(3)(xiii) as described in NUREG-1022, Revision 2. The on call Site Emergency Coordinator and Emergency Response Manager have been notified. The Alternate TSC is available per plant procedure, if required."
The licensee notified the NRC Resident Inspector.
* * * UPDATE FROM CASPER JERNIGAN TO JOHN SHOEMAKER AT 0929 EDT, ON 07/25/12 * * *
TSC cooling system repairs have been completed and the system has been returned to normal.
The licensee notified the NRC Resident Inspector.
Notified the R2DO (Franke).
Agreement State
Event Number: 48128
Rep Org: WISCONSIN RADIATION PROTECTION
Licensee: WATERTOWN MEMORIAL HOSPITAL
Region: 3
City: WATERTOWN State: WI
County:
License #: 055-1335-01
Agreement: Y
Docket:
NRC Notified By: ROYSTON NGWAYAH
HQ OPS Officer: VINCE KLCO
Licensee: WATERTOWN MEMORIAL HOSPITAL
Region: 3
City: WATERTOWN State: WI
County:
License #: 055-1335-01
Agreement: Y
Docket:
NRC Notified By: ROYSTON NGWAYAH
HQ OPS Officer: VINCE KLCO
Notification Date: 07/24/2012
Notification Time: 14:23 [ET]
Event Date: 07/24/2012
Event Time: 00:00 [CDT]
Last Update Date: 07/24/2012
Notification Time: 14:23 [ET]
Event Date: 07/24/2012
Event Time: 00:00 [CDT]
Last Update Date: 07/24/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
TAMARA BLOOMER (R3DO)
FSME via email
TAMARA BLOOMER (R3DO)
FSME via email
AGREEMENT STATE REPORT- UNDERDOSE DURING A BRACHYTHERAPY TREATMENT
The following information was received by email:
"Wisconsin Department of Health Services (DHS) received notification via voicemail from the licensee on July 23, 2012 regarding the discovery of a brachytherapy medical event that occurred on July 17, 2007. The medical event involved a procedure during which the administered dose differed from the prescribed dose by more than 20% (underdose) for permanent prostate implants using Cs-131 seeds. The prescribed dose was 115 Gy. The delivered dose was 60 Gy. The medical event was identified by DHS inspectors during a recent routine inspection, at which time the inspectors also determined that the licensee had not conducted adequate review of their prostate brachytherapy cases against their medical event criteria.
"Per the licensee's procedures, a post-implant CT is performed the same day as the procedure and analyzed within two working days after. If the post-implant analysis reveals an underdose, which occurred in this situation, additional seeds are implanted and another post-implant CT/analysis process follows. The licensee is currently reviewing additional cases dating back to 2003 for medical events against the revised medical event criteria submitted to DHS on June 22, 2012. DHS is investigating the event and is currently in the process of communicating with the licensee regarding decisions on patient notifications. A special inspection team will be sent following the licensee's review."
Wisconsin Event: WI 120009
A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.
The following information was received by email:
"Wisconsin Department of Health Services (DHS) received notification via voicemail from the licensee on July 23, 2012 regarding the discovery of a brachytherapy medical event that occurred on July 17, 2007. The medical event involved a procedure during which the administered dose differed from the prescribed dose by more than 20% (underdose) for permanent prostate implants using Cs-131 seeds. The prescribed dose was 115 Gy. The delivered dose was 60 Gy. The medical event was identified by DHS inspectors during a recent routine inspection, at which time the inspectors also determined that the licensee had not conducted adequate review of their prostate brachytherapy cases against their medical event criteria.
"Per the licensee's procedures, a post-implant CT is performed the same day as the procedure and analyzed within two working days after. If the post-implant analysis reveals an underdose, which occurred in this situation, additional seeds are implanted and another post-implant CT/analysis process follows. The licensee is currently reviewing additional cases dating back to 2003 for medical events against the revised medical event criteria submitted to DHS on June 22, 2012. DHS is investigating the event and is currently in the process of communicating with the licensee regarding decisions on patient notifications. A special inspection team will be sent following the licensee's review."
Wisconsin Event: WI 120009
A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.
Agreement State
Event Number: 48273
Rep Org: OHIO BUREAU OF RADIATION PROTECTION
Licensee: ACUREN INSPECTION, INC
Region: 3
City: DAYTON State: OH
County:
License #: 03320990006
Agreement: Y
Docket:
NRC Notified By: STEPHEN JAMES
HQ OPS Officer: BILL HUFFMAN
Licensee: ACUREN INSPECTION, INC
Region: 3
City: DAYTON State: OH
County:
License #: 03320990006
Agreement: Y
Docket:
NRC Notified By: STEPHEN JAMES
HQ OPS Officer: BILL HUFFMAN
Notification Date: 09/04/2012
Notification Time: 15:01 [ET]
Event Date: 07/24/2012
Event Time: 00:00 [EDT]
Last Update Date: 09/04/2012
Notification Time: 15:01 [ET]
Event Date: 07/24/2012
Event Time: 00:00 [EDT]
Last Update Date: 09/04/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
KENNETH RIEMER (R3DO)
FSME EVENT RESOURCE (EMAI)
KENNETH RIEMER (R3DO)
FSME EVENT RESOURCE (EMAI)
AGREEMENT STATE REPORT - RADIOGRAPHY CAMERA SOURCE DISCONNECT
The following information was provided by the Ohio Bureau of Radiation Protection via e-mail:
"Licensee experienced a source disconnect with an industrial radiography camera. The radiographers were working at a temporary job site and attempted to retrieve source after completing the first exposure of the workday. Source would not retrieve and a source disconnect was suspected, with the source remaining at the exposure end of the guide tube. The source position was verified by on-site radiation surveys. The guide tube (containing the source at the far end) was disconnected from the camera and moved to an isolated location at the client site. The radiographers established appropriate barriers and entry controls for the temporary area and maintained constant surveillance until licensee's source retrieval personnel arrived. Retrieval personnel were able to reconnect the source using a special tool and the source was able to be retracted back into the camera. The camera and all associated equipment were sent to the manufacturer for evaluation. Cause of the problem was determined to be a worn connecting collar around the plug assembly and failure to follow a source connect procedure recommended by the manufacturer. Ohio Bureau of Radiation Protection will visit site and conduct an investigation.
"The licensee's report was received at Ohio Bureau of Radiation Protection today, 9/4/12, at approximately 1240 EDT.
"Based on manufacturer's evaluation of the equipment used, Ohio Bureau of Radiation Protection will conduct an investigation of licensee's maintenance program and to determine reasons for failure by licensee to make initial notification and follow-up written report in a timely manner."
No significant personnel exposure was received during retrieval procedures.
Ohio Report OH 120003
The following information was provided by the Ohio Bureau of Radiation Protection via e-mail:
"Licensee experienced a source disconnect with an industrial radiography camera. The radiographers were working at a temporary job site and attempted to retrieve source after completing the first exposure of the workday. Source would not retrieve and a source disconnect was suspected, with the source remaining at the exposure end of the guide tube. The source position was verified by on-site radiation surveys. The guide tube (containing the source at the far end) was disconnected from the camera and moved to an isolated location at the client site. The radiographers established appropriate barriers and entry controls for the temporary area and maintained constant surveillance until licensee's source retrieval personnel arrived. Retrieval personnel were able to reconnect the source using a special tool and the source was able to be retracted back into the camera. The camera and all associated equipment were sent to the manufacturer for evaluation. Cause of the problem was determined to be a worn connecting collar around the plug assembly and failure to follow a source connect procedure recommended by the manufacturer. Ohio Bureau of Radiation Protection will visit site and conduct an investigation.
"The licensee's report was received at Ohio Bureau of Radiation Protection today, 9/4/12, at approximately 1240 EDT.
"Based on manufacturer's evaluation of the equipment used, Ohio Bureau of Radiation Protection will conduct an investigation of licensee's maintenance program and to determine reasons for failure by licensee to make initial notification and follow-up written report in a timely manner."
No significant personnel exposure was received during retrieval procedures.
Ohio Report OH 120003