Event Notification Report for April 05, 2017
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
04/04/2017 - 04/05/2017
Power Reactor
Event Number: 52670
Facility: PALO VERDE
Region: 4 State: AZ
Unit: [1] [2] [3]
RX Type: [1] CE,[2] CE,[3] CE
NRC Notified By: DAVID HECKMAN
HQ OPS Officer: JEFF ROTTON
Region: 4 State: AZ
Unit: [1] [2] [3]
RX Type: [1] CE,[2] CE,[3] CE
NRC Notified By: DAVID HECKMAN
HQ OPS Officer: JEFF ROTTON
Notification Date: 04/07/2017
Notification Time: 14:49 [ET]
Event Date: 04/05/2017
Event Time: 00:00 [MST]
Last Update Date: 04/07/2017
Notification Time: 14:49 [ET]
Event Date: 04/05/2017
Event Time: 00:00 [MST]
Last Update Date: 04/07/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21(d)(3)(i) - DEFECTS AND NONCOMPLIANCE
10 CFR Section:
21.21(d)(3)(i) - DEFECTS AND NONCOMPLIANCE
Person (Organization):
MICHAEL VASQUEZ (R4DO)
PART 21/50.55 REACTO (EMAI)
MICHAEL VASQUEZ (R4DO)
PART 21/50.55 REACTO (EMAI)
| 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 |
| 3 | N | Y | 100 | Power Operation | 100 | Power Operation |
PART 21 - CIRCUIT BREAKER DEFECT DISCOVERED DURING CURRENT INJECTION TESTING
"On April 5, 2017, Arizona Public Service Company (APS) completed an evaluation of a deviation, and concluded the condition represented a defect under 10 CFR 21. APS previously submitted an interim report (ADAMS Accession Number ML 16344A118) for this condition pursuant to 10 CFR 21.21(a)(2).
"A GE-Hitachi Type AKR-2BE-50, 2000 Amp circuit breaker (used to connect Class 1E batteries to the related Class 1E 125 VDC busses) exhibited arcing and smoking during current injection testing performed to test the overcurrent trip setpoint prior to installation. Arcing occurred at one of two hex bolts anchoring the protective trip device to the line side bus. The electrical arcing resulted from inadequate tightening of both hex bolts which caused a loose electrical connection on the bus within the breaker.
"APS concluded this condition could result in the breaker failing to perform its safety function and thus could create a substantial safety hazard. The breaker had been refurbished by GE-Hitachi and was received by APS and tested on October 13, 2016. Following the test failure, the damaged bolt was replaced, both bolts were tightened, and the breaker was retested and installed.
"Pre-installation inspection and testing that includes current injection testing, recommended in GEH document GEK-64459, should, and did, detect faults such as the condition identified in this notification. GE-Hitachi entered this failure into their corrective action program.
"Vendor: GE HITACHI NUCLEAR ENERGY, 3901 CASTLE HAYNE RD., WILMINGTON, NC 28402-2819
"Device: Breaker Model AKR-2BE-50, 2000 Amp, Serial No. N8682600001
"The NRC Resident Inspector has been informed."
"On April 5, 2017, Arizona Public Service Company (APS) completed an evaluation of a deviation, and concluded the condition represented a defect under 10 CFR 21. APS previously submitted an interim report (ADAMS Accession Number ML 16344A118) for this condition pursuant to 10 CFR 21.21(a)(2).
"A GE-Hitachi Type AKR-2BE-50, 2000 Amp circuit breaker (used to connect Class 1E batteries to the related Class 1E 125 VDC busses) exhibited arcing and smoking during current injection testing performed to test the overcurrent trip setpoint prior to installation. Arcing occurred at one of two hex bolts anchoring the protective trip device to the line side bus. The electrical arcing resulted from inadequate tightening of both hex bolts which caused a loose electrical connection on the bus within the breaker.
"APS concluded this condition could result in the breaker failing to perform its safety function and thus could create a substantial safety hazard. The breaker had been refurbished by GE-Hitachi and was received by APS and tested on October 13, 2016. Following the test failure, the damaged bolt was replaced, both bolts were tightened, and the breaker was retested and installed.
"Pre-installation inspection and testing that includes current injection testing, recommended in GEH document GEK-64459, should, and did, detect faults such as the condition identified in this notification. GE-Hitachi entered this failure into their corrective action program.
"Vendor: GE HITACHI NUCLEAR ENERGY, 3901 CASTLE HAYNE RD., WILMINGTON, NC 28402-2819
"Device: Breaker Model AKR-2BE-50, 2000 Amp, Serial No. N8682600001
"The NRC Resident Inspector has been informed."
Power Reactor
Event Number: 52666
Facility: WOLF CREEK
Region: 4 State: KS
Unit: [1] [] []
RX Type: [1] W-4-LP
NRC Notified By: DAVID GHOLSON
HQ OPS Officer: STEVE SANDIN
Region: 4 State: KS
Unit: [1] [] []
RX Type: [1] W-4-LP
NRC Notified By: DAVID GHOLSON
HQ OPS Officer: STEVE SANDIN
Notification Date: 04/05/2017
Notification Time: 16:32 [ET]
Event Date: 04/05/2017
Event Time: 14:00 [CDT]
Last Update Date: 04/06/2017
Notification Time: 16:32 [ET]
Event Date: 04/05/2017
Event Time: 14:00 [CDT]
Last Update Date: 04/06/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION 50.72(b)(3)(v)(A) - POT UNABLE TO SAFE SD 50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION 50.72(b)(3)(v)(A) - POT UNABLE TO SAFE SD 50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
MICHAEL VASQUEZ (R4DO)
MICHAEL VASQUEZ (R4DO)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 100 | Power Operation |
UNANALYZED CONDITION FOR BOTH EDG TRANSFER LINE CONNECTIONS
"Both Emergency Diesel Generators [EDGs] have truck connections connected to transfer lines that are potentially not compliant with general design criteria. A potentially unanalyzed condition exists due to threat of tornado generated missiles.
"While in Mode 1 at 100% power, the Control Room was notified that the outdoor portion of the line upstream of JEV0001, EMERG FUEL OIL STORAGE TK A TRUCK CONN ISO, and the outdoor portion of the line upstream of JEV0002, EMERG FUEL OIL STORAGE TK B TRUCK CONN ISO, potentially have not been reviewed to meet general design criteria.
"No major equipment was out of service. No systems were required to respond to this event. The unit remains in Mode 1 at 100% power.
"The NRC Senior Resident Inspector has been notified.
"Compensatory measures have been established IAW [in accordance with] EGM 15-002."
The Unit entered Tech Spec 3.8.1 Condition B and D for approximately 45 minutes until compensatory measures were put into effect. The licensee identified this condition during a design review and is currently identifying long-term corrective actions.
* * * UPDATE ON 4/6/17 AT 0938 EDT FROM DAVID GHOLSON TO DONG PARK * * *
The Unit entered Tech Spec 3.8.1 Condition B and F, not Tech Spec 3.8.1 Condition B and D mentioned earlier.
Notified R4DO (Vasquez).
"Both Emergency Diesel Generators [EDGs] have truck connections connected to transfer lines that are potentially not compliant with general design criteria. A potentially unanalyzed condition exists due to threat of tornado generated missiles.
"While in Mode 1 at 100% power, the Control Room was notified that the outdoor portion of the line upstream of JEV0001, EMERG FUEL OIL STORAGE TK A TRUCK CONN ISO, and the outdoor portion of the line upstream of JEV0002, EMERG FUEL OIL STORAGE TK B TRUCK CONN ISO, potentially have not been reviewed to meet general design criteria.
"No major equipment was out of service. No systems were required to respond to this event. The unit remains in Mode 1 at 100% power.
"The NRC Senior Resident Inspector has been notified.
"Compensatory measures have been established IAW [in accordance with] EGM 15-002."
The Unit entered Tech Spec 3.8.1 Condition B and D for approximately 45 minutes until compensatory measures were put into effect. The licensee identified this condition during a design review and is currently identifying long-term corrective actions.
* * * UPDATE ON 4/6/17 AT 0938 EDT FROM DAVID GHOLSON TO DONG PARK * * *
The Unit entered Tech Spec 3.8.1 Condition B and F, not Tech Spec 3.8.1 Condition B and D mentioned earlier.
Notified R4DO (Vasquez).
Agreement State
Event Number: 52667
Rep Org: NEW YORK STATE DEPT. OF HEALTH
Licensee: NOT PROVIDED
Region: 1
City: NOT PROVIDED State: NY
County:
License #: NOT PROVIDED
Agreement: Y
Docket:
NRC Notified By: JANAKI KRISHNOMOORTHY
HQ OPS Officer: JEFF ROTTON
Licensee: NOT PROVIDED
Region: 1
City: NOT PROVIDED State: NY
County:
License #: NOT PROVIDED
Agreement: Y
Docket:
NRC Notified By: JANAKI KRISHNOMOORTHY
HQ OPS Officer: JEFF ROTTON
Notification Date: 04/06/2017
Notification Time: 12:11 [ET]
Event Date: 04/05/2017
Event Time: 00:00 [EDT]
Last Update Date: 04/06/2017
Notification Time: 12:11 [ET]
Event Date: 04/05/2017
Event Time: 00:00 [EDT]
Last Update Date: 04/06/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
CHRISTOPHER CAHILL (R1DO)
NMSS_EVENTS_NOTIFIC (EMAI)
CHRISTOPHER CAHILL (R1DO)
NMSS_EVENTS_NOTIFIC (EMAI)
AGREEMENT STATE REPORT - LESS THAN PRESCRIBED DOSE ADMINISTERED TO PATIENT
The following information was provided by the State of New York via facsimile:
"On 04/05/2017, a patient with metastatic esophageal cancer received right hepatic lobar treatment [to the liver] with Y90 from SIRTEX microspheres.
"The intended activity was 32.9 mCi. Drawn activity was 32.7 mCi. The administered activity measured at the end of the procedure was 8.2 mCi [25 percent of intended activity].
"Probable cause stated by the licensee: 'clumping' of microspheres resulting in occlusion of vial 'delivery C' needle provided by the vendor. The licensee plans to (1) request review from the manufacturer of the preparation and handling of the microspheres prior to arrival to the IR suite, (2) Since the patient is already planned for a left lobar treatment, a whole liver treatment will be planned to deliver the deficit dose to the right lobe."
NY Event Report ID No. NYDOH-NY-17-06
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 provided by the State of New York via facsimile:
"On 04/05/2017, a patient with metastatic esophageal cancer received right hepatic lobar treatment [to the liver] with Y90 from SIRTEX microspheres.
"The intended activity was 32.9 mCi. Drawn activity was 32.7 mCi. The administered activity measured at the end of the procedure was 8.2 mCi [25 percent of intended activity].
"Probable cause stated by the licensee: 'clumping' of microspheres resulting in occlusion of vial 'delivery C' needle provided by the vendor. The licensee plans to (1) request review from the manufacturer of the preparation and handling of the microspheres prior to arrival to the IR suite, (2) Since the patient is already planned for a left lobar treatment, a whole liver treatment will be planned to deliver the deficit dose to the right lobe."
NY Event Report ID No. NYDOH-NY-17-06
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.