Event Notification Report for January 8, 1999
U.S. Nuclear Regulatory Commission Operations Center Event Reports For 01/07/1999 - 01/08/1999 ** EVENT NUMBERS ** 35126 35218 35224 35225 35226 35227 35228 !!!!!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!!! +------------------------------------------------------------------------------+ |Power Reactor |Event Number: 35126 | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ | FACILITY: VERMONT YANKEE REGION: 1 |NOTIFICATION DATE: 12/08/1998| | UNIT: [1] [] [] STATE: VT |NOTIFICATION TIME: 21:09[EST]| | RXTYPE: [1] GE-4 |EVENT DATE: 12/08/1998| +------------------------------------------------+EVENT TIME: 20:55[EST]| | NRC NOTIFIED BY: MCCLUSKIE |LAST UPDATE DATE: 01/07/1999| | HQ OPS OFFICER: JOHN MacKINNON +-----------------------------+ +------------------------------------------------+PERSON ORGANIZATION | |EMERGENCY CLASS: N/A |JOHN ROGGE R1 | |10 CFR SECTION: | | |AOUT 50.72(b)(1)(ii)(B) OUTSIDE DESIGN BASIS | | |AINC 50.72(b)(2)(iii)(C) POT UNCNTRL RAD REL | | | | | | | | +-----+----------+-------+--------+-----------------+--------+-----------------+ |UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE | +-----+----------+-------+--------+-----------------+--------+-----------------+ |1 N Y 100 Power Operation |100 Power Operation | | | | | | | +------------------------------------------------------------------------------+ EVENT TEXT +------------------------------------------------------------------------------+ | BOTH TRAINS OF STANDBY GAS TREATMENT DECLARED INOPERABLE. | | | | DURING PREPARATION OF DESIGN BASIS DOCUMENTATION (DBD) FOR THE STANDBY GAS | | TREATMENT SYSTEM (SBGTS), A CONDITION WAS DISCOVERED WHICH COULD LEAD TO | | DEGRADATION OF BOTH SBGTS TRAINS. | | | | A REVIEW OF THE SIZING OF THE SBGTS LOOP SEAL LINES INDICATED THAT, DURING | | THE INITIAL STAGES OF A DESIGN BASIS ACCIDENT (DBA) WITH THE SBGTS INLET | | NORMALLY ALIGNED TO THE TORUS TO MAINTAIN DRYWELL TO TORUS DIFFERENTIAL | | PRESSURE, THE RESULTING TORUS PRESSURE INCREASE WOULD CAUSE AN OVERPRESSURE | | CONDITION WHICH WOULD RESULT IN A PRESSURE, WITHIN THE UNITS, OF 1.8 PSIG. | | ALTHOUGH, THIS PRESSURE IS WITHIN THE INTERNAL ALLOWABLE PRESSURE OF THE | | UNITS THE EFFECT WOULD BE TO CAUSE A CLEARING OF THE EACH UNIT LOOP SEAL. | | THE RESULTING FLOW THROUGH THE LOOP SEAL INTO THE UNIT WOULD BYPASS THE | | MOISTURE SEPARATOR AND WOULD BE OF SUFFICIENT VELOCITY TO PREVENT | | RE-ESTABLISHMENT OF THE LOOP SEAL BY DRAINS FROM THE MOISTURE SEPARATOR. | | WITHOUT REFILL OF THE LOOP SEALS, THE WATER COLLECTED BY THE DEMISTER WILL | | ACCUMULATE IN THE UNITS POTENTIALLY REDUCING THE EFFECTIVENESS OR FAILING | | THE HEATER, THE HEPA FILTERS, AND THE CHARCOAL ADSORBERS. | | | | THIS CONDITION HAS BEEN EVALUATED AND A MODIFICATION TO THE LOOP SEAL VALVE | | LINEUP WILL BE PERFORMED TO THROTTLE THE LOOP SEAL DRAIN VALVE TO ENSURE | | THAT FLOW INTO THE UNIT, THROUGH THE LOOP SEAL DRAIN LINE, IS NOT OF | | SUFFICIENT VELOCITY TO PREVENT REFILLING OF THE LOOP SEALS. THE EFFECT OF | | THE BYPASS FLOW ON THE OPERATION OF THE UNITS HAS ALSO BEEN EVALUATED AND | | FOUND TO BE OF INSUFFICIENT VOLUME TO EFFECT THE PROPER OPERATION OF THE | | SBGTS HEATER, HEPA FILTERS, OR CHARCOAL ADSORBERS. | | | | THE LICENSEE IS IN TECHNICAL SPECIFICATION 3.7.C.2 (FOUR HOURS TO RESTORE | | SECONDARY CONTAINMENT) AND TECHNICAL SPECIFICATION 3.7.B.4 (24 HOURS TO | | RESTORE BOTH TRAINS OF SBGT WHICH ARE NOW INOPERABLE). THE LICENSEE WILL | | NOTIFY THE STATE OF THIS EVENT. | | | | | | THE NRC RESIDENT INSPECTOR WAS NOTIFIED OF THIS EVENT BY THE LICENSEE. | | | | * * * RETRACTION 1046 1/7/99 FROM M. MAGNUSON TAKEN BY STRANSKY * * * | | | | The licensee is retracting this event notification. The following text was | | submitted in support of the retraction: | | | | "Vermont Yankee Engineering has analyzed the particulars of this cited | | condition. Vermont Yankee's conclusion is that the as-built seal | | configuration will not preclude proper operation of the unit. | | | | "The demister-loop seal does not bypass the radioactive filtration elements | | of the unit. Additional essential observations / conclusions include: | | | | "a) Contrary to the preliminary assessment, further evaluations, including | | a preliminary calculation concluded that if there is significant moisture in | | the process stream it will rapidly refill the loop seal (were it to be | | voided by the pressure pulse described in the original report), and | | | | "b) If there is insufficient moisture available for a rapid refill, then | | there is not sufficient moisture to challenge the charcoal filter element. | | | | "c) Therefore, the system safety function would have been achieved." | | | | The NRC resident inspector has been informed of this retraction by the | | licensee. Notified R1DO (Cook). | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ |Power Reactor |Event Number: 35218 | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ | FACILITY: NORTH ANNA REGION: 2 |NOTIFICATION DATE: 01/05/1999| | UNIT: [1] [2] [] STATE: VA |NOTIFICATION TIME: 15:18[EST]| | RXTYPE: [1] W-3-LP,[2] W-3-LP |EVENT DATE: 01/05/1999| +------------------------------------------------+EVENT TIME: 13:56[EST]| | NRC NOTIFIED BY: JEFF MOSHER |LAST UPDATE DATE: 01/07/1999| | HQ OPS OFFICER: LEIGH TROCINE +-----------------------------+ +------------------------------------------------+PERSON ORGANIZATION | |EMERGENCY CLASS: N/A |LEN WERT R2 | |10 CFR SECTION: | | |APRE 50.72(b)(2)(vi) OFFSITE NOTIFICATION | | | | | | | | | | | +-----+----------+-------+--------+-----------------+--------+-----------------+ |UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE | +-----+----------+-------+--------+-----------------+--------+-----------------+ |1 N Y 100 Power Operation |100 Power Operation | |2 N Y 100 Power Operation |100 Power Operation | | | | +------------------------------------------------------------------------------+ EVENT TEXT +------------------------------------------------------------------------------+ | OFFSITE NOTIFICATION REGARDING INOPERABILITY OF THE SPILLWAY EMERGENCY | | DIESEL GENERATOR | | | | The following text is a portion of a facsimile received from the licensee: | | | | "At 1356 hours on 01/05/99, the Federal Emergency Regulatory Commission | | (FERC) was notified of the inoperability of the North Anna spillway | | emergency diesel generator in accordance with the requirements of | | 18CFR12.10(a). The diesel generator failed its operability test due to the | | engine water temperature being below the acceptable range of 165 - 195�F. | | Water temperature during the test was 155�F. A work request has been | | initiated to identify and correct the cause of this problem in a timely | | manner. The diesel generator remains available." | | | | The licensee stated that the spillway emergency diesel generator is not | | safety related and that the units are not in any limiting conditions for | | operation as a result of this issue. | | | | In addition to the FERC, the licensee notified the NRC resident inspector. | | | | * * * UPDATE 1036 1/7/98 FROM M. WHALEN TAKEN BY STRANSKY * * * | | | | "At 0820 hours on 1/7/99, the Federal Energy Regulatory Commission (FERC) | | was notified to retract a previous notification made at 1356 hours on | | 1/5/99. The previous notification was made as a result of declaring the | | North Anna spillway diesel generator inoperable due to engine water | | temperature being below the acceptance range. Further evaluation and | | consultation with the diesel vendor determined the spillway diesel generator | | was in fact operable and able to perform its design function." | | | | The NRC resident inspector has been informed of this update by the licensee. | | Notified R2DO (Wert). | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ |Power Reactor |Event Number: 35224 | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ | FACILITY: CLINTON REGION: 3 |NOTIFICATION DATE: 01/06/1999| | UNIT: [1] [] [] STATE: IL |NOTIFICATION TIME: 15:26[EST]| | RXTYPE: [1] GE-6 |EVENT DATE: 01/06/1999| +------------------------------------------------+EVENT TIME: 13:45[CST]| | NRC NOTIFIED BY: DAVID WARD |LAST UPDATE DATE: 01/07/1999| | HQ OPS OFFICER: LEIGH TROCINE +-----------------------------+ +------------------------------------------------+PERSON ORGANIZATION | |EMERGENCY CLASS: UNU |BRENT CLAYTON R3 | |10 CFR SECTION: |JOHN STOLZ, NRR EO | |AAEC 50.72(a)(1)(i) EMERGENCY DECLARED |JOSEPH GIITTER, AEOD IRD | |AESF 50.72(b)(2)(ii) ESF ACTUATION |GENE CANUPP FEMA | | | | | | | +-----+----------+-------+--------+-----------------+--------+-----------------+ |UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE | +-----+----------+-------+--------+-----------------+--------+-----------------+ |1 N N 0 Cold Shutdown |0 Cold Shutdown | | | | | | | +------------------------------------------------------------------------------+ EVENT TEXT +------------------------------------------------------------------------------+ | UNUSUAL EVENT DUE TO A LOSS OF OFFSITE POWER TO THE EMERGENCY BUSES WHILE IN | | COLD SHUTDOWN | | | | At 1319 CST on 01/06/98, there was a loss of the 138-kV line supplying power | | to the emergency reserve auxiliary transformer (ERAT) while the reserve | | auxiliary transformer (RAT) was tagged/switched out of service due to | | ongoing plant modifications. All three emergency diesel generators | | automatically started and loaded properly, and they are currently supplying | | power to the emergency buses. The non-vital buses are being energized via | | the main power transformer back-feed lineup from the 345-kV source (normal | | grid). Shutdown cooling is being maintained via the use of reactor water | | cleanup, and vessel feed is from the control rod drive system. Residual | | heat removal (RHR) train 'B' was in shutdown cooling prior to this event, | | and the 'B' RHR pump tripped off when its emergency bus was initially | | de-energized. The licensee stated that there were no reports of abnormal | | functions other than the loss of the 138-kV line. | | | | A Notification of Unusual Event was declared at 1345 CST due to the loss of | | the ERAT and RAT (when no sources of offsite power are available). The | | licensee's procedures do not specifically address credit for having a | | back-feed capability. The licensee plans to terminate the Unusual Event | | when either the ERAT or RAT are returned to service and offsite power is | | restored to safety systems. | | | | The cause of the loss of the 138-kV line is being investigated, but it is | | currently believed to be from insulator damage to the 138-kV line near the | | town of Clinton, Illinois. | | | | The unit has been in an extended shutdown since 09/06/96. | | | | The licensee notified the NRC resident inspector, the State of Illinois, and | | DeWitt County Sheriff. | | | | ******************** UPDATE AT 1626 EST ON 01/06/99 FROM DAVID WARD TO | | TROCINE ******************** | | | | The licensee reported that the automatic start of the emergency diesel | | generators was an engineered safety feature actuation and that the cause of | | the loss of the 138-kV line had not yet been determined. | | | | Shutdown cooling is still being maintained via the use of reactor water | | cleanup, and vessel feed is from the control rod drive system. The licensee | | stated that it would take 72 hours for boiling to occur if shutdown cooling | | was not available. | | | | The NRC operations officer notified the R3DO (Clayton), NRR EO (Stolz), and | | AEOD IRD (Giitter). | | | | ******************** UPDATE AT 1717 EST ON 01/06/99 FROM DAVID WARD TO | | TROCINE ******************** | | | | The 'B' RHR pump was restored to service (in shutdown cooling) at 1600 CST. | | Reactor water cleanup was running prior to the event, and remained in | | service to provide an alternate means of shutdown cooling. | | | | The licensee plans to issue a press release and plans to notify the NRC | | resident inspector. The NRC operations officer notified the R3DO (Clayton), | | NRR EO (Zwolinski), and AEOD IRD (Giitter). | | | | ******************** UPDATE AT 1814 EST ON 01/06/99 FROM DAVID WARD TO | | TROCINE ******************** | | | | The estimated time for restoration of RAT power is approximately 1800 CST, | | and the estimated time for exiting the Unusual Event is approximately 2100 | | CST. | | | | The NRC operations officer notified the R3DO (Clayton), NRR EO (Zwolinski), | | and AEOD IRD (Giitter). | | | | ******************** UPDATE AT 1916 EST ON 01/06/99 FROM DAVID WARD TO | | TROCINE ******************** | | | | Offsite power was restored to the RAT at approximately 1750 CST, but it is | | not yet supplying vital loads. Vital loads are still being supplied via the | | emergency diesel generators. The estimated time for exiting the Unusual | | Event is still approximately 2100 CST. Spent fuel pool cooling was | | maintained throughout this event. | | | | The NRC operations officer notified the R3DO (Clayton), NRR EO (Zwolinski), | | and AEOD IRD (Giitter). | | | | ******************** UPDATE AT 2016 EST ON 01/06/99 FROM MAXWELL KIER TO | | TROCINE ******************** | | | | Vital loads are still being supplied via the emergency diesel generators. | | The licensee currently expects the RAT to supply vital loads at | | approximately 2100 CST. The estimated time for exiting the Unusual Event is | | still approximately 2100 CST. | | | | The NRC operations officer notified the R3DO (Clayton), NRR EO (Zwolinski), | | and AEOD IRD (Giitter). | | | | ******************** UPDATE AT 2116 EST ON 01/06/99 FROM MAXWELL KIER TO | | TROCINE ******************** | | | | The cause of the loss of the 138-kV line was determined to be a pole over | | north of Clinton that shorted a couple of phases. Repairs are in progress, | | and the estimated time of completion is unknown. The estimated time for | | exiting the Unusual Event is now approximately 2130 CST. | | | | The NRC operations officer notified the R3DO (Clayton), NRR EO (Zwolinski), | | and AEOD IRD (Giitter). | | | | ******************** UPDATE AT 2216 EST ON 01/06/99 FROM MAXWELL KIER TO | | TROCINE ******************** | | | | The licensee is currently swapping emergency buses from the emergency diesel | | generators to the RAT. The licensee is also in the process of restoring the | | ERAT to service. Repairs to the 138-kV line are complete. The estimated | | time for exiting the Unusual Event is still approximately 2130 CST. | | | | The NRC operations officer notified the R3DO (Clayton), NRR EO (Zwolinski), | | and AEOD IRD (Giitter). | | | | ******************** UPDATE AT 2314 EST ON 01/06/99 FROM MAXWELL KIER TO | | TROCINE ******************** | | | | The root cause of the 138-kV line going down was determined to be down guys | | on a corner pole where the line taps to Clinton. The guys were possibly | | severed by a snow plow. This allowed the pole to lean causing the static | | shield to contact one of the phases. | | | | The division 1 and 2 emergency buses are currently being supplied from the | | RAT, and the licensee is currently placing the division 3 emergency bus on | | the RAT. The new estimated time for exiting the Unusual Event is | | approximately 2245 CST. | | | | The NRC operations officer notified the R3DO (Clayton), NRR EO (Zwolinski), | | and AEOD IRD (Giitter). | | | | * * * UPDATE 0010 1/7/99 FROM M. KIER TAKEN BY STRANSKY * * * | | | | The UE was terminated at 2306 CST on 1/6/99. One offsite power source has | | been restored to the emergency busses, and the other offsite source is | | currently being restored. The NRC resident inspector has been informed of | | the termination. Notified R3DO (Clayton), EO (Zwolinski). | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ |Power Reactor |Event Number: 35225 | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ | FACILITY: HOPE CREEK REGION: 1 |NOTIFICATION DATE: 01/07/1999| | UNIT: [1] [] [] STATE: NJ |NOTIFICATION TIME: 12:16[EST]| | RXTYPE: [1] GE-4 |EVENT DATE: 01/07/1999| +------------------------------------------------+EVENT TIME: 10:30[EST]| | NRC NOTIFIED BY: HARLAN HANSON |LAST UPDATE DATE: 01/07/1999| | HQ OPS OFFICER: DOUG WEAVER +-----------------------------+ +------------------------------------------------+PERSON ORGANIZATION | |EMERGENCY CLASS: N/A |WILLIAM COOK R1 | |10 CFR SECTION: | | |AARC 50.72(b)(1)(v) OTHER ASMT/COMM INOP | | | | | | | | | | | +-----+----------+-------+--------+-----------------+--------+-----------------+ |UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE | +-----+----------+-------+--------+-----------------+--------+-----------------+ |1 N Y 100 Power Operation |100 Power Operation | | | | | | | +------------------------------------------------------------------------------+ EVENT TEXT +------------------------------------------------------------------------------+ | EMERGENCY RESPONSE DATA SYSTEM (ERDS) INOPERABLE | | | | The licensee reported that their ERDS system was discovered to be inoperable | | during quarterly system testing because of a bad phone line or modem at | | 1030am on 1/7/99. Efforts to restore the phone line/modem were not | | successful within the one hour allotted per the PSE&G Event Classification | | Guidance. These efforts will continue. | | | | The licensee will inform the NRC resident inspector. | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ |General Information or Other |Event Number: 35226 | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ | REP ORG: STATE OF CALIFORNIA |NOTIFICATION DATE: 01/07/1999| |LICENSEE: CEDARS-SINAI HOSPITAL |NOTIFICATION TIME: 16:23[EST]| | CITY: Los Angeles REGION: 4 |EVENT DATE: 01/06/1999| | COUNTY: Los Angeles STATE: CA |EVENT TIME: 12:00[PST]| |LICENSE#: AGREEMENT: Y |LAST UPDATE DATE: 01/07/1999| | DOCKET: |+----------------------------+ | |PERSON ORGANIZATION | | |JOSEPH TAPIA R4 | | | | +------------------------------------------------+ | | NRC NOTIFIED BY: DONALD BUNN | | | HQ OPS OFFICER: DOUG WEAVER | | +------------------------------------------------+ | |EMERGENCY CLASS: N/A | | |10 CFR SECTION: | | |NAGR AGREEMENT STATE | | | | | | | | | | | | | | +------------------------------------------------------------------------------+ EVENT TEXT +------------------------------------------------------------------------------+ | MEDICAL MISADMINISTRATION | | | | The licensee was using an investigative new drug (IND) Rhenium-188 when the | | isotope leaked out of its container and into the blood stream of the | | patient. Re-188 is used to prevent restenosis (the collapsing of the blood | | vessel) during angioplasty. The licensee was authorized to use up to 200 | | mCi of material during this procedure, but the exact quantity used was not | | known at the time of this report. The licensee is in the process of | | developing a dose estimate, however negative health effects are not | | expected. | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ |Other Nuclear Material |Event Number: 35227 | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ | REP ORG: USAF RADIOISOTOPE COMMITTEE |NOTIFICATION DATE: 01/07/1999| |LICENSEE: USAF RADIOISOTOPE COMMITTEE |NOTIFICATION TIME: 16:29[EST]| | CITY: GLENDALE REGION: 4 |EVENT DATE: 01/07/1999| | COUNTY: STATE: AZ |EVENT TIME: 15:30[EST]| |LICENSE#: 42-23539-01AF AGREEMENT: Y |LAST UPDATE DATE: 01/07/1999| | DOCKET: |+----------------------------+ | |PERSON ORGANIZATION | | |JOSEPH TAPIA R4 | | | | +------------------------------------------------+ | | NRC NOTIFIED BY: MAJOR JIM HICKS | | | HQ OPS OFFICER: DOUG WEAVER | | +------------------------------------------------+ | |EMERGENCY CLASS: N/A | | |10 CFR SECTION: | | |BAB1 20.2201(a)(1)(i) LOST/STOLEN LNM>1000X | | | | | | | | | | | | | | +------------------------------------------------------------------------------+ EVENT TEXT +------------------------------------------------------------------------------+ | F-16 CRASHED CONTAINING 8�Ci OF AMERICIUM-241 | | | | An Air Force F-16 crashed near Luke Air Force base, Arizona. The plane | | contained an 8 �Ci Am-241 source. The pilot and navigator ejected safely. | | | | | | The Air Force is responding to the crash site and will perform a search for | | the source. | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ |Power Reactor |Event Number: 35228 | +------------------------------------------------------------------------------+ +------------------------------------------------------------------------------+ | FACILITY: VOGTLE REGION: 2 |NOTIFICATION DATE: 01/07/1999| | UNIT: [1] [2] [] STATE: GA |NOTIFICATION TIME: 16:44[EST]| | RXTYPE: [1] W-4-LP,[2] W-4-LP |EVENT DATE: 01/07/1999| +------------------------------------------------+EVENT TIME: 16:28[EST]| | NRC NOTIFIED BY: TOM TYNAN |LAST UPDATE DATE: 01/08/1999| | HQ OPS OFFICER: DOUG WEAVER +-----------------------------+ +------------------------------------------------+PERSON ORGANIZATION | |EMERGENCY CLASS: N/A |LEN WERT R2 | |10 CFR SECTION: | | |AENS 50.72(b)(1)(v) ENS INOPERABLE | | | | | | | | | | | +-----+----------+-------+--------+-----------------+--------+-----------------+ |UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE | +-----+----------+-------+--------+-----------------+--------+-----------------+ |1 N Y 100 Power Operation |100 Power Operation | |2 N Y 100 Power Operation |100 Power Operation | | | | +------------------------------------------------------------------------------+ EVENT TEXT +------------------------------------------------------------------------------+ | FTS AND COMMERCIAL PHONE LINES OUT OF SERVICE | | | | The licensee notified the NRC via cellular phone that both their FTS-2000 | | and their commercial lines were unavailable for dial out. However, the | | commercial lines could be accessed by dialing in from the Operations Center. | | The licensee is troubleshooting this problem and believes it may be related | | to some other work (digging) in progress. | | | | The licensee informed the NRC resident inspector. | | | | * * * UPDATE 0153 1/8/99 FROM SHFLIGER TAKEN BY STRANSKY * * * | | | | All telephones are now working properly. The NRC resident inspector will be | | informed by the licensee. Notified R2DO (Wert). | +------------------------------------------------------------------------------+
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