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Event Notification Report for May 20, 1999

                    U.S. Nuclear Regulatory Commission
                              Operations Center

                              Event Reports For
                           05/19/1999 - 05/20/1999

                              ** EVENT NUMBERS **

35325  35726  35734  35737  35738  35739  35740  35741  35742  35743  

!!!!!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED  !!!!!!!
+------------------------------------------------------------------------------+
|Hospital                                         |Event Number:   35325       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| REP ORG:  DETROIT MACOMB HOSPITAL              |NOTIFICATION DATE: 01/29/1999|
|LICENSEE:  DETROIT MACOMB HOSPITAL              |NOTIFICATION TIME: 11:28[EST]|
|    CITY:  DETROIT                  REGION:  3  |EVENT DATE:        01/28/1999|
|  COUNTY:                            STATE:  MI |EVENT TIME:        16:10[EST]|
|LICENSE#:  21-01190-05           AGREEMENT:  N  |LAST UPDATE DATE:  05/19/1999|
|  DOCKET:                                       |+----------------------------+
|                                                |PERSON          ORGANIZATION |
|                                                |TONY VEGEL           R3      |
|                                                |DONALD COOL          NMSS    |
+------------------------------------------------+                             |
| NRC NOTIFIED BY:  ARTHUR EWALD                 |                             |
|  HQ OPS OFFICER:  BOB STRANSKY                 |                             |
+------------------------------------------------+                             |
|EMERGENCY CLASS:          N/A                   |                             |
|10 CFR SECTION:                                 |                             |
|LADM 35.33(a)            MED MISADMINISTRATION  |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+------------------------------------------------------------------------------+

                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| MEDICAL MISADMINISTRATION DUE TO PATIENT INTERVENTION                        |
|                                                                              |
| During brachytherapy treatment of a patient's endobronchial area, the        |
| patient dislodged the catheter approximately 25 cm, causing the treatment    |
| site to receive only 3.8% of the prescribed dose. Additionally, the          |
| patient's nasal area received approximately 13 rads (13 cGy) due to the      |
| displacement. The licensee estimates that the catheter was dislodged for     |
| approximately 10 minutes before being discovered.                            |
|                                                                              |
| The patient's referring physician has been informed of this event.           |
|                                                                              |
| * * * RETRACTED AT 1356 EDT ON 5/19/99 BY ART EWALD TO STEVE SANDIN * * *    |
|                                                                              |
| The licensee is retracting this report based on review and consultation with |
| the NRC.   Notified R3DO(Clayton) and NMSS(Camper).                          |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|Other Nuclear Material                           |Event Number:   35726       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| REP ORG:  U.S. ARMY                            |NOTIFICATION DATE: 05/17/1999|
|LICENSEE:  U.S. ARMY                            |NOTIFICATION TIME: 12:03[EDT]|
|    CITY:  ROCK ISLAND              REGION:  3  |EVENT DATE:        05/16/1999|
|  COUNTY:                            STATE:  IL |EVENT TIME:             [CDT]|
|LICENSE#:  12-00722-13           AGREEMENT:  Y  |LAST UPDATE DATE:  05/19/1999|
|  DOCKET:                                       |+----------------------------+
|                                                |PERSON          ORGANIZATION |
|                                                |BRENT CLAYTON        R3      |
|                                                |PETER ESELGROTH      R1      |
+------------------------------------------------+JOE HOLONICH         NMSS    |
| NRC NOTIFIED BY:  JEFF HAVENER                 |FEMA, DOE, USDA, HHS FAX     |
|  HQ OPS OFFICER:  FANGIE JONES                 |EPA, DOT (VIA NRC)   FAX     |
+------------------------------------------------+                             |
|EMERGENCY CLASS:          N/A                   |                             |
|10 CFR SECTION:                                 |                             |
|BAB1 20.2201(a)(1)(i)    LOST/STOLEN LNM>1000X  |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+------------------------------------------------------------------------------+

                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| LOST OR STOLEN 3-CURIE TRITIUM SOURCE FROM AN M140 ALIGNMENT DEVICE          |
|                                                                              |
| Sometime on 5/16/99 near Watervliet Arsenal (about 35 miles from Albany, NY) |
| at a contractor's facility (Wright Malta Corporation at Wright Malta         |
| Station), a break-in occurred.  In the facility was a howitzer with an M1A1  |
| collimator (10 curies tritium) and an M140 alignment device (3 curies        |
| tritium).  The two devices were taken but were recovered on site when the    |
| thieves were interrupted on the way out and dropped them.  However, the      |
| source was missing from the M140 alignment device, and it is unknown whether |
| the source was missing previously or removed and taken by the thieves.  The  |
| local police are following up on the break-in and theft.  The Watervliet     |
| Arsenal contacted the State of New York, who in turn notified NRC Region 1.  |
|                                                                              |
| (Call the NRC operations officer for additional information.)                |
|                                                                              |
| * * * UPDATE 1730EDT ON 5/19/99 FROM JEFF HAVENNER TO S.SANDIN * * *         |
|                                                                              |
| Additional information received by the licensee on 5/19/99 indicates that an |
| M58 and an M59 aiming post light may also be missing.  These are 5 and 4     |
| Curies of tritium for a total of 9 Curies.  Notified R1DO(Eselgroth),        |
| R3DO(Clayton), NMSS(Haughney) and FEMA, DOE, USDA, HHS, EPA, and DOT (via    |
| NRC) by fax.                                                                 |
+------------------------------------------------------------------------------+

!!!!!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED  !!!!!!!
+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   35734       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: SEABROOK                 REGION:  1  |NOTIFICATION DATE: 05/18/1999|
|    UNIT:  [1] [] []                 STATE:  NH |NOTIFICATION TIME: 15:52[EDT]|
|   RXTYPE: [1] W-4-LP                           |EVENT DATE:        05/18/1999|
+------------------------------------------------+EVENT TIME:        15:00[EDT]|
| NRC NOTIFIED BY:  RON STRICKLAND               |LAST UPDATE DATE:  05/19/1999|
|  HQ OPS OFFICER:  STEVE SANDIN                 +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          N/A                   |PETER ESELGROTH      R1      |
|10 CFR SECTION:                                 |                             |
|DDDD 73.71               UNSPECIFIED PARAGRAPH  |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE   |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|1     N          Y       85       Power Operation  |85       Power Operation  |
|                                                   |                          |
|                                                   |                          |
+------------------------------------------------------------------------------+
                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| 1-HOUR SECURITY REPORT                                                       |
|                                                                              |
| SAFEGUARDS SYSTEM DEGRADATION RELATED TO DETECTION/MONITORING/ALARM OF VITAL |
| AREA ACCESS DOORS.  IMMEDIATE COMPENSATORY ACTIONS TAKEN UPON DISCOVERY.     |
| THE LICENSEE WILL INFORM THE NRC RESIDENT INSPECTOR.  CONTACT THE            |
| HEADQUARTERS OPERATIONS CENTER FOR ADDITIONAL DETAILS.                       |
|                                                                              |
| * * * RETRACTED AT 1300 EDT ON 5/19/99 BY MIKE KILEY TO FANGIE JONES * * *   |
|                                                                              |
| THIS NOTIFICATION WAS RETRACTED AS IT WAS ONLY REQUIRED TO BE LOGGED DUE TO  |
| COMPENSATORY MEASURES TAKEN UPON DISCOVERY ON THE DEGRADATION.  THE LICENSEE |
| NOTIFIED THE NRC RESIDENT INSPECTOR AND THE HEADQUARTERS OPERATIONS OFFICER  |
| NOTIFIED THE R1DO (PETER ESELGROTH)                                          |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   35737       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: POINT BEACH              REGION:  3  |NOTIFICATION DATE: 05/19/1999|
|    UNIT:  [1] [2] []                STATE:  WI |NOTIFICATION TIME: 10:19[EDT]|
|   RXTYPE: [1] W-2-LP,[2] W-2-LP                |EVENT DATE:        05/19/1999|
+------------------------------------------------+EVENT TIME:        08:35[CDT]|
| NRC NOTIFIED BY:  ADAMS                        |LAST UPDATE DATE:  05/19/1999|
|  HQ OPS OFFICER:  CHAUNCEY GOULD               +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          N/A                   |BRENT CLAYTON        R3      |
|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          N       0        Hot Shutdown     |0        Hot Shutdown     |
|2     N          Y       55       Power Operation  |55       Power Operation  |
|                                                   |                          |
+------------------------------------------------------------------------------+
                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| BOTH COMMERCIAL AND FTS PHONES OUT OF SERVICE.                               |
|                                                                              |
| THE PHONE SYSTEM FAILED WHEN AN INADVERTENT UNDERGROUND CABLE WAS CUT DURING |
| ROAD CONSTRUCTION ON A NEARBY ROAD,  AMERITECH IS WORKING ON THE CABLE       |
| REPAIR AND IT SHOULD BE FIXED BY 1130 EDT.                                   |
|                                                                              |
| THE RESIDENT INSPECTOR WAS NOTIFIED.                                         |
|                                                                              |
| * * * UPDATE AT 1224 EDT ON 5/19/99 BY PHILLIP SHORT TO FANGIE JONES * * *   |
|                                                                              |
| ALL PHONE LINES HAVE BEEN RESTORED TO SERVICE.  THE NRC RESIDENT INSPECTOR   |
| WAS NOTIFIED BY THE LICENSEE AND THE R3DO (BRENT CLAYTON) WAS NOTIFIED BY    |
| THE HEADQUARTERS OPERATION OFFICER.                                          |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   35738       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: WOLF CREEK               REGION:  4  |NOTIFICATION DATE: 05/19/1999|
|    UNIT:  [1] [] []                 STATE:  KS |NOTIFICATION TIME: 12:12[EDT]|
|   RXTYPE: [1] W-4-LP                           |EVENT DATE:        05/19/1999|
+------------------------------------------------+EVENT TIME:        11:00[CDT]|
| NRC NOTIFIED BY:  DAVID ERBE                   |LAST UPDATE DATE:  05/19/1999|
|  HQ OPS OFFICER:  STEVE SANDIN                 +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          N/A                   |GARY SANBORN         R4      |
|10 CFR SECTION:                                 |                             |
|DDDD 73.71               UNSPECIFIED PARAGRAPH  |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|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                                   
+------------------------------------------------------------------------------+
| PHYSICAL SECURITY REPORT                                                     |
|                                                                              |
| Unescorted access granted inappropriately, immediate compensatory measures   |
| taken upon discovery.  The licensee notified the NRC Resident Inspector.     |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   35739       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: MCGUIRE                  REGION:  2  |NOTIFICATION DATE: 05/19/1999|
|    UNIT:  [1] [2] []                STATE:  NC |NOTIFICATION TIME: 13:38[EDT]|
|   RXTYPE: [1] W-4-LP,[2] W-4-LP                |EVENT DATE:        05/19/1999|
+------------------------------------------------+EVENT TIME:        10:30[EDT]|
| NRC NOTIFIED BY:  TIM HEAFNER                  |LAST UPDATE DATE:  05/19/1999|
|  HQ OPS OFFICER:  STEVE SANDIN                 +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          N/A                   |ANN BOLAND           R2      |
|10 CFR SECTION:                                 |                             |
|NLTR                     LICENSEE 24 HR REPORT  |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|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                                   
+------------------------------------------------------------------------------+
| 24-hour Condition of License report involving fire protection barriers.      |
|                                                                              |
| "On May 19,1999 at 1030 hours. McGuire Nuclear Station determined that       |
| provisions of the McGuire fire protection program had not been maintained as |
| required by conditions C.(4) (Unit I) and C.(7) (Unit 2) of the McGuire      |
| Facility Operating License.                                                  |
|                                                                              |
| "Selected Licensee Commitment 16.9-5 requires that all fire rated assemblies |
| and sealing devices separating                                               |
|                                                                              |
| 1. Safety from non-safety related areas or,                                  |
| 2. Redundant analyzed post fire safe shutdown equipment or,                  |
| 3. The Control Complex (Control Room, Cable Rooms, and Battery Rooms) from   |
| the remainder of the plant or,                                               |
| 4. Containment from Non-containment areas shall be operable.                 |
|                                                                              |
| "Contrary to this, numerous fire barrier penetrations designed to satisfy    |
| the above separation criteria for certain containment to non-containment     |
| penetrations have been determined to be inoperable. This discovery was made  |
| as part of routine surveillance testing.  A particular penetration design    |
| has been identified to have been installed in non-conformance with the       |
| design. The design specifies the incorporation of a fire resistive block     |
| material surrounded by a metal frame as the physical penetration which is    |
| installed in the wall as a unit. Necessary cables then penetrate through the |
| fire resistive block.  Physical penetrations were installed in excess of     |
| those actually necessary for transporting cables to accommodate future       |
| modifications or other contingencies. Penetrations in these 'blank           |
| locations' incorporated a welded steel plate as opposed to the design        |
| described above. This configuration has not been qualified as a 3 hour fire  |
| rated assembly.                                                              |
|                                                                              |
| "Remedial actions required by Selected Licensee Commitment 16.9-5 have been  |
| implemented (fire watches). The ability of the facility to achieve safe      |
| shutdown conditions under a postulated design bases fire has not been        |
| compromised by the discovered condition. Therefore, McGuire did not operate  |
| outside the design basis of the plant.                                       |
|                                                                              |
| "The resident Inspector has been notified.  A follow-up written report will  |
| be issued within 14 days. Note that this event is not reportable under the   |
| requirements of 10CFR50.72 or 10CFR50.73."                                   |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|Other Nuclear Material                           |Event Number:   35740       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| REP ORG:  U.S. ARMY                            |NOTIFICATION DATE: 05/19/1999|
|LICENSEE:  U.S. ARMY                            |NOTIFICATION TIME: 15:18[EDT]|
|    CITY:  ROCK ISLAND              REGION:  3  |EVENT DATE:        05/19/1999|
|  COUNTY:                            STATE:  IL |EVENT TIME:             [CDT]|
|LICENSE#:  12-00722-06           AGREEMENT:  Y  |LAST UPDATE DATE:  05/19/1999|
|  DOCKET:                                       |+----------------------------+
|                                                |PERSON          ORGANIZATION |
|                                                |BRENT CLAYTON        R3      |
|                                                |ANN BOLAND           R2      |
+------------------------------------------------+LARRY CAMPER         NMSS    |
| NRC NOTIFIED BY:  JEFF HAVENNER                |FEMA, DOE, USDA, HHS FAX     |
|  HQ OPS OFFICER:  STEVE SANDIN                 |EPA, DOT(VIA NRC)    FAX     |
+------------------------------------------------+                             |
|EMERGENCY CLASS:          N/A                   |                             |
|10 CFR SECTION:                                 |                             |
|BAB1 20.2201(a)(1)(i)    LOST/STOLEN LNM>1000X  |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+------------------------------------------------------------------------------+

                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| MISSING MUZZLE REFERENCE SENSOR CONTAINING 10 CURIE TRITIUM SOURCE.          |
|                                                                              |
| ON 5/19/99 WHILE TRAINING AT FT. PICKETT, VA,  A TANK UNIT OF THE            |
| PENNSYLVANIA ARMY NATIONAL GUARD NOTED THAT A MUZZLE REFERENCE SENSOR        |
| MOUNTED ON THE END OF THE TANK GUN BARREL WAS MISSING.  THE DEVICE CONTAINS  |
| 10 CURIES TRITIUM GAS.  A SEARCH IS UNDERWAY TO LOCATE THE MISSING SOURCE.   |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|General Information or Other                     |Event Number:   35741       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| REP ORG:  NC BUREAU OF RAD PROTECTION          |NOTIFICATION DATE: 05/19/1999|
|LICENSEE:  STERIGENICS INTERNATIONAL CORP       |NOTIFICATION TIME: 15:53[EDT]|
|    CITY:  CHARLOTTE                REGION:  2  |EVENT DATE:        05/13/1999|
|  COUNTY:                            STATE:  NC |EVENT TIME:        21:30[EDT]|
|LICENSE#:  NC 060-0974-1         AGREEMENT:  Y  |LAST UPDATE DATE:  05/19/1999|
|  DOCKET:                                       |+----------------------------+
|                                                |PERSON          ORGANIZATION |
|                                                |ANN BOLAND           R2      |
|                                                |LARRY CAMPER         NMSS    |
+------------------------------------------------+                             |
| NRC NOTIFIED BY:  J. MARION EADDY III          |                             |
|  HQ OPS OFFICER:  STEVE SANDIN                 |                             |
+------------------------------------------------+                             |
|EMERGENCY CLASS:          N/A                   |                             |
|10 CFR SECTION:                                 |                             |
|NAGR                     AGREEMENT STATE        |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+------------------------------------------------------------------------------+

                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| AGREEMENT STATE REPORT INVOLVING PANORAMIC IRRADIATOR SOURCE RACK FAILURE TO |
| RETRACT TO THE FULLY SHIELDED POSITION.                                      |
|                                                                              |
| The following information was provided by the NC Bureau of Radiation         |
| Protection via fax:                                                          |
|                                                                              |
| LICENSEE:                                                                    |
|                                                                              |
| SteriGenics International Corporation                                        |
| 10811 Withers Cove Park                                                      |
| Charlotte, NC 28278                                                          |
| N.C. Radioactive Materials License No. 060-0974-1                            |
|                                                                              |
| DESCRIPTION OF THE EVENT:                                                    |
|                                                                              |
| The N. C. Division of Radiation Protection (DRP) was notified by telephone   |
| on 14 May 1999 at 15:50 that a power failure had occurred at the above       |
| referenced facility on 13 May 1999 at approximately 21:30. The licensee has  |
| two (2) irradiator pools at the facility. One of the racks (the 'smaller'    |
| activity rack) did not return to its fully shielded position as required by  |
| 10 CFR 36.37 and had to be manually lowered into the pool. The Radiation     |
| Safety Officer at the facility stated that no cell entry occurred and that   |
| all interlocks were operational during the event.                            |
|                                                                              |
| SteriGenics is in the process of conducting tests of the uninterruptable     |
| power supply(ies) on site, as well as other systems. Their engineering staff |
| is currently analyzing the root cause of the failure. SteriGenics has been   |
| notified by DRP of the 30 day reporting requirement in 10 CFR 36.83.         |
|                                                                              |
| North Carolina has assigned Log No. 99-08 to this incident.                  |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   35742       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: SOUTH TEXAS              REGION:  4  |NOTIFICATION DATE: 05/19/1999|
|    UNIT:  [1] [] []                 STATE:  TX |NOTIFICATION TIME: 17:27[EDT]|
|   RXTYPE: [1] W-4-LP,[2] W-4-LP                |EVENT DATE:        05/19/1999|
+------------------------------------------------+EVENT TIME:        15:00[CDT]|
| NRC NOTIFIED BY:  GREG JANAK                   |LAST UPDATE DATE:  05/19/1999|
|  HQ OPS OFFICER:  STEVE SANDIN                 +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          N/A                   |GARY SANBORN         R4      |
|10 CFR SECTION:                                 |                             |
|NLTR                     LICENSEE 24 HR REPORT  |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|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                                   
+------------------------------------------------------------------------------+
| 24-HOUR REPORT INVOLVING VIOLATION OF OPERATING LICENSE BASED ON INOPERABLE  |
| AUXILIARY FEEDWATER TRAIN.                                                   |
|                                                                              |
| "On May 13, 1999, it was discovered that Train 'D' Auxiliary Feedwater       |
| Regulating Valve FV-7526 would not open as required during surveillance      |
| testing.  Investigations revealed that at 05:00 on May 10, 1999, Train 'D'   |
| Auxiliary Feedwater was removed from service to perform a static diagnostic  |
| test on AF-FV-7526. This test was completed and Train 'D' Auxiliary          |
| Feedwater was declared operable at 09:20 on May 11, 1999.                    |
|                                                                              |
| "The failure of AF-FV-7526 was found to be caused by a misadjusted bracket   |
| for the limit switch which could have been caused during the static          |
| diagnostic test that was performed on May 10. 1999. This problem was         |
| corrected and Train 'D' Auxiliary Feedwater was declared operable at 00:10   |
| on May 14,1999. This rendered Train 'D' Auxiliary Feedwater inoperable for a |
| period of 91 hours and 10 minutes. This exceeded the time allowed under      |
| Technical Specification 3.7.1.2 action b., which states that the inoperable  |
| component must be restored to [an]operable[condition] within 72 hours.       |
|                                                                              |
| "This is a violation of Operating License NPF-076, Section 2G."              |
|                                                                              |
| The licensee informed the NRC Resident Inspector.                            |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   35743       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: BRAIDWOOD                REGION:  3  |NOTIFICATION DATE: 05/19/1999|
|    UNIT:  [] [2] []                 STATE:  IL |NOTIFICATION TIME: 20:53[EDT]|
|   RXTYPE: [1] W-4-LP,[2] W-4-LP                |EVENT DATE:        05/19/1999|
+------------------------------------------------+EVENT TIME:        19:17[CDT]|
| NRC NOTIFIED BY:  LARRY BROOKS                 |LAST UPDATE DATE:  05/19/1999|
|  HQ OPS OFFICER:  STEVE SANDIN                 +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          N/A                   |BRENT CLAYTON        R3      |
|10 CFR SECTION:                                 |                             |
|ARPS 50.72(b)(2)(ii)     RPS ACTUATION          |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE   |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|                                                   |                          |
|2     A/R        Y       4        Startup          |0        Hot Standby      |
|                                                   |                          |
+------------------------------------------------------------------------------+
                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| AUTOMATIC REACTOR TRIP DUE TO SPIKING ON INTERMEDIATE RANGE NUCLEAR          |
| INSTRUMENT  (IRNI)  "N-36" DUE TO AN APPARENT INSTRUMENTATION PROBLEM.       |
|                                                                              |
| DURING STARTUP OF UNIT 2 FOLLOWING A REFUELING OUTAGE, THE IRNI "N-36"       |
| UNEXPECTEDLY SPIKED CAUSING A "HIGH FLUX" TRIP (FIRST OUT).  IT APPEARS TO   |
| BE AN INSTRUMENTATION PROBLEM.  THERE WAS NO I&C MAINTENANCE IN PROGRESS AT  |
| THE TIME.  ALL CONTROL RODS FULLY INSERTED.  DECAY HEAT WHICH IS LOW IS      |
| BEING REJECTED TO THE MAIN CONDENSER VIA THE STEAM DUMPS.  THE STARTUP       |
| FEEDWATER PUMP IS IN SERVICE  SUPPLYING WATER TO THE STEAM GENERATORS.  ALL  |
| SYSTEM FUNCTIONED AS REQUIRED WITH ALL SAFETY-RELATED EQUIPMENT OPERATIONAL. |
| THE LICENSEE WILL MAINTAIN THE UNIT IN MODE 3 PENDING THE RESULTS OF THE     |
| INVESTIGATION.  THERE WAS NO RADIOACTIVE RELEASE.                            |
|                                                                              |
| THE LICENSEE INFORMED THE NRC RESIDENT INSPECTOR.                            |
+------------------------------------------------------------------------------+