Event Notification Report for February 28, 2018
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
02/27/2018 - 02/28/2018
EVENT NUMBERS
53237532385323353234
Agreement State
Event Number: 53237
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: AMARILLO TESTING & ENGINEERING INC.
Region: 4
City: AMARILLO State: TX
County:
License #: 02658
Agreement: Y
Docket:
NRC Notified By: ART TUCKER
HQ OPS Officer: OSSY FONT
Licensee: AMARILLO TESTING & ENGINEERING INC.
Region: 4
City: AMARILLO State: TX
County:
License #: 02658
Agreement: Y
Docket:
NRC Notified By: ART TUCKER
HQ OPS Officer: OSSY FONT
Notification Date: 03/01/2018
Notification Time: 15:51 [ET]
Event Date: 02/28/2018
Event Time: 16:30 [CST]
Last Update Date: 03/01/2018
Notification Time: 15:51 [ET]
Event Date: 02/28/2018
Event Time: 16:30 [CST]
Last Update Date: 03/01/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
THOMAS FARNHOLTZ (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
THOMAS FARNHOLTZ (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
AGREEMENT STATE REPORT - DAMAGED MOISTURE-DENSITY GAUGE
The following report was received from the Texas Department of State Health Services via email:
"On March 1, 2018, the Agency [Texas Department of State Health Services] was notified by the licensee that at approximately 1630 CST on February 28, 2018, one of its technicians was performing a density test at a job site when an equipment operator veered off of his path and over into the path where the technician was testing. The technician was barely able to get out of the way of the heavy equipment, but was unable to move a Troxler Model 3440 Plus gauge and it was run over.
"The gauge contains a 40 milliCurie Americium-241 source and an 8 milliCurie Cesium-137 source. The casing on the gauge was damaged and the Cesium source rod was bent. The technician straightened the rod and secured the gauge in its transport case.
"The licensee's radiation safety officer (RSO) responded to the site and performed a radiation survey of the ground where no elevated levels were identified. The RSO surveyed the device and radiation levels were between five and eight millirem/hour, which the RSO stated is higher than normal. The RSO has contacted the manufacturer for guidance. The gauge is in storage area at the licensee's facility. The gauge is not an exposure risk to any individual. The Agency will respond to the licensee's location to perform additional surveys. Additional information will be provided as it is received in accordance with SA-300."
Texas Incident #: I-9548
The following report was received from the Texas Department of State Health Services via email:
"On March 1, 2018, the Agency [Texas Department of State Health Services] was notified by the licensee that at approximately 1630 CST on February 28, 2018, one of its technicians was performing a density test at a job site when an equipment operator veered off of his path and over into the path where the technician was testing. The technician was barely able to get out of the way of the heavy equipment, but was unable to move a Troxler Model 3440 Plus gauge and it was run over.
"The gauge contains a 40 milliCurie Americium-241 source and an 8 milliCurie Cesium-137 source. The casing on the gauge was damaged and the Cesium source rod was bent. The technician straightened the rod and secured the gauge in its transport case.
"The licensee's radiation safety officer (RSO) responded to the site and performed a radiation survey of the ground where no elevated levels were identified. The RSO surveyed the device and radiation levels were between five and eight millirem/hour, which the RSO stated is higher than normal. The RSO has contacted the manufacturer for guidance. The gauge is in storage area at the licensee's facility. The gauge is not an exposure risk to any individual. The Agency will respond to the licensee's location to perform additional surveys. Additional information will be provided as it is received in accordance with SA-300."
Texas Incident #: I-9548
Agreement State
Event Number: 53238
Rep Org: CALIFORNIA RADIATION CONTROL PRGM
Licensee: ENGEO INCORPORATED
Region: 4
City: SAN RAMON State: CA
County:
License #: 3016-07
Agreement: Y
Docket:
NRC Notified By: KAMANI HEWADIKARAM
HQ OPS Officer: HOWIE CROUCH
Licensee: ENGEO INCORPORATED
Region: 4
City: SAN RAMON State: CA
County:
License #: 3016-07
Agreement: Y
Docket:
NRC Notified By: KAMANI HEWADIKARAM
HQ OPS Officer: HOWIE CROUCH
Notification Date: 03/01/2018
Notification Time: 15:34 [ET]
Event Date: 02/28/2018
Event Time: 00:00 [PST]
Last Update Date: 03/01/2018
Notification Time: 15:34 [ET]
Event Date: 02/28/2018
Event Time: 00:00 [PST]
Last Update Date: 03/01/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
THOMAS FARNHOLTZ (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
THOMAS FARNHOLTZ (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
AGREEMENT STATE REPORT - STOLEN AND RECOVERED MOISTURE-DENSITY GAUGE
The following information was obtained from the State of Texas via email:
"On February 28, 2018, the radiation safety officer from ENGEO Incorporated, contacted RHB [California Radiologic Health Branch] to report a stolen moisture-density gauge. This is a Troxler moisture-density gauge, Model 3440, Serial Number 23533 containing 9 mCi of Cs-137 and 44 mCi of Am-241. According to the licensee, the operator left the gauge secured to the open bed truck at a job site, and upon his return noticed the gauge had been stolen. The gauge was stolen without the Type A container. The licensee immediately notified San Ramon Police Department (SRPD) of the incident.
"Note: On 03/01/18, at approximately 1100 PST, SRPD notified the licensee that they had recovered the gauge near the job site. The licensee is enroute to recover the gauge from SRPD. RHB will be following up on this incident."
California Report No.: 5010-022818
The following information was obtained from the State of Texas via email:
"On February 28, 2018, the radiation safety officer from ENGEO Incorporated, contacted RHB [California Radiologic Health Branch] to report a stolen moisture-density gauge. This is a Troxler moisture-density gauge, Model 3440, Serial Number 23533 containing 9 mCi of Cs-137 and 44 mCi of Am-241. According to the licensee, the operator left the gauge secured to the open bed truck at a job site, and upon his return noticed the gauge had been stolen. The gauge was stolen without the Type A container. The licensee immediately notified San Ramon Police Department (SRPD) of the incident.
"Note: On 03/01/18, at approximately 1100 PST, SRPD notified the licensee that they had recovered the gauge near the job site. The licensee is enroute to recover the gauge from SRPD. RHB will be following up on this incident."
California Report No.: 5010-022818
Agreement State
Event Number: 53233
Rep Org: MA RADIATION CONTROL PROGRAM
Licensee: QSA GLOBAL, INC.
Region: 1
City: BURLINGTON State: MA
County:
License #: 12-8361
Agreement: Y
Docket:
NRC Notified By: TONY CARPENITO
HQ OPS Officer: DAVID AIRD
Licensee: QSA GLOBAL, INC.
Region: 1
City: BURLINGTON State: MA
County:
License #: 12-8361
Agreement: Y
Docket:
NRC Notified By: TONY CARPENITO
HQ OPS Officer: DAVID AIRD
Notification Date: 02/28/2018
Notification Time: 14:33 [ET]
Event Date: 02/28/2018
Event Time: 10:30 [EST]
Last Update Date: 04/11/2018
Notification Time: 14:33 [ET]
Event Date: 02/28/2018
Event Time: 10:30 [EST]
Last Update Date: 04/11/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
10 CFR Section:
AGREEMENT STATE
Person (Organization):
BRICE BICKETT (R1DO)
GRETCHEN RIVERA-CAPELLA (NMSS DAY)
DESIREE DAVIS (ILTAB)
JEFFERY GRANT (IRD)
NMSS_EVENTS_NOTIFICATION (EMAIL)
BRICE BICKETT (R1DO)
GRETCHEN RIVERA-CAPELLA (NMSS DAY)
DESIREE DAVIS (ILTAB)
JEFFERY GRANT (IRD)
NMSS_EVENTS_NOTIFICATION (EMAIL)
AGREEMENT STATE REPORT - PACKAGE CONTAINING CATEGORY 2 SEALED SOURCES MISSING IN TRANSIT
The following information was received via E-mail:
"QSA Global reported via telephone on 2/28/2018 that a package shipped via [a common carrier] on 2/19/2018 (shipping documents prepared on 2/16/2018), containing two Model A424-9 Ir-192 industrial radiography sealed sources within a Model 650L source changer, was reported as missing via telephone by [the common carrier] at 1030 EST on 2/28/2018. [The common carrier] trace was already initiated and in progress, and tracking indicates last known package location was [the common carrier] hub in Memphis, TN. This was a RQ UN2916, Yellow-III, Type B package with a Transport Index of 1.9 at time of shipment. Package dimensions were 26x22x34 cm. Source changer SN 263. Sources - SN 63782G (111.6 Ci on 2/14/2018) and 73783G (108.0 Ci on 2/14/2018).
"This situation is an immediately reportable event per regulation.
"The search for the missing package is ongoing.
"Agency [Massachusetts Radiation Control Program] currently considers this docket to still be OPEN."
Package Origin: Burlington, MA, USA
Intended Destination: Bogota, Columbia
Notified External: DHS SWO, FEMA Ops Center, USDA Ops Center, HHS Ops Center, DOE Ops Center, DHS NICC Watch Officer, and EPA EOC.
Notified External via E-mail: FDA EOC, NuclearSSA, FEMA NRCC SASC, FEMA National Watch Center, DNDO-JAC.
* * * UPDATE FROM ANTHONY CARPENITO (VIA EMAIL) TO HOWIE CROUCH AT 1119 EST ON 3/1/2018 * * *
QSA Global reported to the Agency that the package was received at its intended destination on 2/26/2018. Agency considers this event to still be OPEN.
Massachusetts Radiation Control Program updated Tennessee Division of Radiological Health.
Notified R1DO (Bickett), NMSS EO (Rivera-Capella), ILTAB (English), IRD MOC (Pham), and NMSS Events (email).
Notified External: DHS SWO, FEMA Ops Center, USDA Ops Center, HHS Ops Center, DOE Ops Center, DHS NICC Watch Officer, and EPA EOC.
Notified External via E-mail: FDA EOC, NuclearSSA, FEMA NRCC SASC, FEMA National Watch Center, DNDO-JAC.
* * * UPDATE FROM ANTHONY CARPENITO TO ANDREW WAUGH AT 1406 EDT ON 4/11/2018 * * *
The following was received from the Commonwealth of Massachusetts via email:
"QSA Global provided a 30-day written report received by the Agency on 3/9/18. Agency telephone discussions with QSA Global and [the common carrier] were held on 3/12/18. The following information is provided in order to report previously unreported details: (1) QSA Global confirmed that the 650-L Source Changer is itself a Type B package and was not shipped in an overpack container and therefore was the shipping container, (2) [the common carrier] indicated, as a corrective action, this situation would be included in the lessons learned portion of annual refresher training presented to [the common carrier] employees. In this case, although QSA Global had contact with the international customer on 2/21/18 and 2/23/18, the customer did not follow-up to inform QSA Global when the item actually arrived on 2/26/18 (two days before it was reported to Agency as missing by QSA Global on 2/28/18).
"Agency considers this event to be CLOSED."
Massachusetts Radiation Control Program updated Tennessee Division of Radiological Health.
NMED number: 180099
Massachusetts Event: 15-3140
Notified R1DO (Jackson), NMSS EO (Rivera-Capella), ILTAB (Ahern), IRD MOC (Pham), and NMSS Events (email).
THIS MATERIAL EVENT CONTAINS A "CATEGORY 2" LEVEL OF RADIOACTIVE MATERIAL
Category 2 sources, if not safely managed or securely protected, could cause permanent injury to a person who handled them, or were otherwise in contact with them, for a short time (minutes to hours). It could possibly be fatal to be close to this amount of unshielded radioactive material for a period of hours to days. These sources are typically used in practices such as industrial gamma radiography, high dose rate brachytherapy and medium dose rate brachytherapy. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.
The following information was received via E-mail:
"QSA Global reported via telephone on 2/28/2018 that a package shipped via [a common carrier] on 2/19/2018 (shipping documents prepared on 2/16/2018), containing two Model A424-9 Ir-192 industrial radiography sealed sources within a Model 650L source changer, was reported as missing via telephone by [the common carrier] at 1030 EST on 2/28/2018. [The common carrier] trace was already initiated and in progress, and tracking indicates last known package location was [the common carrier] hub in Memphis, TN. This was a RQ UN2916, Yellow-III, Type B package with a Transport Index of 1.9 at time of shipment. Package dimensions were 26x22x34 cm. Source changer SN 263. Sources - SN 63782G (111.6 Ci on 2/14/2018) and 73783G (108.0 Ci on 2/14/2018).
"This situation is an immediately reportable event per regulation.
"The search for the missing package is ongoing.
"Agency [Massachusetts Radiation Control Program] currently considers this docket to still be OPEN."
Package Origin: Burlington, MA, USA
Intended Destination: Bogota, Columbia
Notified External: DHS SWO, FEMA Ops Center, USDA Ops Center, HHS Ops Center, DOE Ops Center, DHS NICC Watch Officer, and EPA EOC.
Notified External via E-mail: FDA EOC, NuclearSSA, FEMA NRCC SASC, FEMA National Watch Center, DNDO-JAC.
* * * UPDATE FROM ANTHONY CARPENITO (VIA EMAIL) TO HOWIE CROUCH AT 1119 EST ON 3/1/2018 * * *
QSA Global reported to the Agency that the package was received at its intended destination on 2/26/2018. Agency considers this event to still be OPEN.
Massachusetts Radiation Control Program updated Tennessee Division of Radiological Health.
Notified R1DO (Bickett), NMSS EO (Rivera-Capella), ILTAB (English), IRD MOC (Pham), and NMSS Events (email).
Notified External: DHS SWO, FEMA Ops Center, USDA Ops Center, HHS Ops Center, DOE Ops Center, DHS NICC Watch Officer, and EPA EOC.
Notified External via E-mail: FDA EOC, NuclearSSA, FEMA NRCC SASC, FEMA National Watch Center, DNDO-JAC.
* * * UPDATE FROM ANTHONY CARPENITO TO ANDREW WAUGH AT 1406 EDT ON 4/11/2018 * * *
The following was received from the Commonwealth of Massachusetts via email:
"QSA Global provided a 30-day written report received by the Agency on 3/9/18. Agency telephone discussions with QSA Global and [the common carrier] were held on 3/12/18. The following information is provided in order to report previously unreported details: (1) QSA Global confirmed that the 650-L Source Changer is itself a Type B package and was not shipped in an overpack container and therefore was the shipping container, (2) [the common carrier] indicated, as a corrective action, this situation would be included in the lessons learned portion of annual refresher training presented to [the common carrier] employees. In this case, although QSA Global had contact with the international customer on 2/21/18 and 2/23/18, the customer did not follow-up to inform QSA Global when the item actually arrived on 2/26/18 (two days before it was reported to Agency as missing by QSA Global on 2/28/18).
"Agency considers this event to be CLOSED."
Massachusetts Radiation Control Program updated Tennessee Division of Radiological Health.
NMED number: 180099
Massachusetts Event: 15-3140
Notified R1DO (Jackson), NMSS EO (Rivera-Capella), ILTAB (Ahern), IRD MOC (Pham), and NMSS Events (email).
THIS MATERIAL EVENT CONTAINS A "CATEGORY 2" LEVEL OF RADIOACTIVE MATERIAL
Category 2 sources, if not safely managed or securely protected, could cause permanent injury to a person who handled them, or were otherwise in contact with them, for a short time (minutes to hours). It could possibly be fatal to be close to this amount of unshielded radioactive material for a period of hours to days. These sources are typically used in practices such as industrial gamma radiography, high dose rate brachytherapy and medium dose rate brachytherapy. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.
Agreement State
Event Number: 53234
Rep Org: ARKANSAS DEPARTMENT OF HEALTH
Licensee: GEORGIA-PACIFIC CONSUMER OPERATIONS
Region: 4
City: CROSSETT State: AR
County:
License #: ARK-0321-03120
Agreement: Y
Docket:
NRC Notified By: DAVID STEPHENS
HQ OPS Officer: DAVID AIRD
Licensee: GEORGIA-PACIFIC CONSUMER OPERATIONS
Region: 4
City: CROSSETT State: AR
County:
License #: ARK-0321-03120
Agreement: Y
Docket:
NRC Notified By: DAVID STEPHENS
HQ OPS Officer: DAVID AIRD
Notification Date: 02/28/2018
Notification Time: 14:45 [ET]
Event Date: 02/28/2018
Event Time: 11:27 [CST]
Last Update Date: 07/24/2018
Notification Time: 14:45 [ET]
Event Date: 02/28/2018
Event Time: 11:27 [CST]
Last Update Date: 07/24/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
10 CFR Section:
AGREEMENT STATE
Person (Organization):
THOMAS FARNHOLTZ (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
THOMAS FARNHOLTZ (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
AGREEMENT STATE REPORT - GAUGE SHUTTER STUCK OPEN
The following report was received from the State of Arkansas via e-mail:
"At approximately 1127 CST on 2/28/2018, the Arkansas Department of Health [ADH] Radioactive Materials Program received a phone call from the licensee stating that during routine shutter tests the gauge shutter handle fell off and the shutter is stuck open. The gauge is a Vega America Corporation (Ohmart) Model A-2102, serial number 6997, originally containing 1.5 Curies [Cesium-137] on 4/30/1968 (calculated current activity approximately 475 milliCuries).
"Discussion with the licensee indicates that the gauge is mounted on a digester, outside of normal employee traffic. It is normally open during operations and is only closed during maintenance of the digester, which is not planned. Cautionary signage is already present. The licensee representative stated that the staff will be made aware of the situation. Licensee maintenance is assessing the situation and will advise the ADH Radioactive Materials program of the plan for handling this situation.
"The State of Arkansas is awaiting a written report from the licensee and final disposition information for the gauge. The State's event number is AR-2018-003."
* * * UPDATE FROM DAVID STEPHENS TO VINCE KLCO ON 7/24/2018 AT 1043 EDT * * *
The following information was received from the State of Arkansas via email:
"Communication with the licensee on March 28, 2018 indicated the licensee was working with the manufacturer to effect replacement of the gauge, and on April 26, 2018 the licensee communicated that a replacement quote from the vendor had been obtained and logistics were being arranged. On May 30, 2018, the licensee amended their license to obtain the replacement, and on June 15, 2018, a contractor replaced the gauge, placing the old gauge in storage. On June 19, 2018, possession of the old gauge was assumed by QSA Global.
"The licensee attributes the failure of the shutter handle to the age of the gauge and the environmental conditions (heat, humidity) it was exposed to in the paper plant.
"The State of Arkansas considers this incident closed."
Notified the R4DO (Gepford) and the NMSS Events Group via email.
The following report was received from the State of Arkansas via e-mail:
"At approximately 1127 CST on 2/28/2018, the Arkansas Department of Health [ADH] Radioactive Materials Program received a phone call from the licensee stating that during routine shutter tests the gauge shutter handle fell off and the shutter is stuck open. The gauge is a Vega America Corporation (Ohmart) Model A-2102, serial number 6997, originally containing 1.5 Curies [Cesium-137] on 4/30/1968 (calculated current activity approximately 475 milliCuries).
"Discussion with the licensee indicates that the gauge is mounted on a digester, outside of normal employee traffic. It is normally open during operations and is only closed during maintenance of the digester, which is not planned. Cautionary signage is already present. The licensee representative stated that the staff will be made aware of the situation. Licensee maintenance is assessing the situation and will advise the ADH Radioactive Materials program of the plan for handling this situation.
"The State of Arkansas is awaiting a written report from the licensee and final disposition information for the gauge. The State's event number is AR-2018-003."
* * * UPDATE FROM DAVID STEPHENS TO VINCE KLCO ON 7/24/2018 AT 1043 EDT * * *
The following information was received from the State of Arkansas via email:
"Communication with the licensee on March 28, 2018 indicated the licensee was working with the manufacturer to effect replacement of the gauge, and on April 26, 2018 the licensee communicated that a replacement quote from the vendor had been obtained and logistics were being arranged. On May 30, 2018, the licensee amended their license to obtain the replacement, and on June 15, 2018, a contractor replaced the gauge, placing the old gauge in storage. On June 19, 2018, possession of the old gauge was assumed by QSA Global.
"The licensee attributes the failure of the shutter handle to the age of the gauge and the environmental conditions (heat, humidity) it was exposed to in the paper plant.
"The State of Arkansas considers this incident closed."
Notified the R4DO (Gepford) and the NMSS Events Group via email.