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Event Notification Report for January 22, 2001

                    U.S. Nuclear Regulatory Commission
                              Operations Center

                              Event Reports For
                           01/19/2001 - 01/22/2001

                              ** EVENT NUMBERS **

37671  37672  37673  

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|Power Reactor                                    |Event Number:   37671       |
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| FACILITY: NORTH ANNA               REGION:  2  |NOTIFICATION DATE: 01/19/2001|
|    UNIT:  [] [2] []                 STATE:  VA |NOTIFICATION TIME: 11:58[EST]|
|   RXTYPE: [1] W-3-LP,[2] W-3-LP                |EVENT DATE:        01/19/2001|
+------------------------------------------------+EVENT TIME:        11:45[EST]|
| NRC NOTIFIED BY:  ALEX BLANCHARD               |LAST UPDATE DATE:  01/19/2001|
|  HQ OPS OFFICER:  STEVE SANDIN                 +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          UNU                   |LOUIS REYES          R2      |
|10 CFR SECTION:                                 |BOB DENNIG           EO      |
|                                                |JOSEPH GIITTER       IRO     |
|                                                |SULLIVAN             FEMA    |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE   |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|                                                   |                          |
|2     N          Y       99       Power Operation  |99       Power Operation  |
|                                                   |                          |
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                                   EVENT TEXT                                   
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| UNIT 2 DECLARED AN UNUSUAL EVENT BASED ON IDENTIFIED REACTOR COOLANT SYSTEM  |
| (RCA) LEAKAGE > 10 GPM                                                       |
|                                                                              |
| At 1145EST on 1/19/01, Unit 2 declared an Unusual Event based on RCS leakage |
| of 10.0015 gpm.  The location of the leakage is the "C" loop unit bypass     |
| valve 2-RC-MOV-2587.  The leakage is through the packing leakoff line to the |
| primary drain tank.  There are minor elevated rad levels in the stripper     |
| cubicle where the drain tank is located.  HP personnel are monitoring this   |
| area.  The licensee expects to have Unit 2 offline by 1600EST today.  Tech   |
| Spec 3.4.6.2 requires that identified RCS leakage be less than 10 gpm or     |
| that the unit be placed in cold shutdown by 0300EST on 1/21/01.  The         |
| licensee anticipates completing repairs while in mode 3 at which time they   |
| will exit the Unusual Event.                                                 |
|                                                                              |
| The licensee informed both state/local agencies and the NRC resident         |
| inspector.                                                                   |
|                                                                              |
| * * * UPDATE AT 2314 on 1/19/01, BY BROWN, RECEIVED BY WEAVER * * *          |
|                                                                              |
| 2-RC-MOV-2587 was opened electrically and manually backseated.  This reduced |
| RCS leakage below 10 gpm and the unusual event was terminated at 2323EST.    |
| The plant is stable in mode 3 and the licensee is developing a plan to       |
| repair the valve.  Repairs may be done with the plant in mode 3.  The        |
| licensee will notify the NRC resident inspector.                             |
|                                                                              |
| The operations center notified the RDO (Rodgers); EO (Leeds); FEMA           |
| (Steindurf)                                                                  |
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|Hospital                                         |Event Number:   37672       |
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| REP ORG:  FROEDTERT MEMORIAL LUTHERAN HOSP     |NOTIFICATION DATE: 01/19/2001|
|LICENSEE:  FROEDTERT MEMORIAL LUTHERAN HOSP     |NOTIFICATION TIME: 16:59[EST]|
|    CITY:  MILWAUKEE                REGION:  3  |EVENT DATE:        01/17/2001|
|  COUNTY:                            STATE:  WI |EVENT TIME:        18:30[CST]|
|LICENSE#:  48-04193              AGREEMENT:  N  |LAST UPDATE DATE:  01/19/2001|
|  DOCKET:                                       |+----------------------------+
|                                                |PERSON          ORGANIZATION |
|                                                |ROGER LANKSBURY      R3      |
|                                                |ERIC LEEDS           NMSS    |
+------------------------------------------------+                             |
| NRC NOTIFIED BY:  MARCUM MARTZ                 |                             |
|  HQ OPS OFFICER:  DOUG WEAVER                  |                             |
+------------------------------------------------+                             |
|EMERGENCY CLASS:          N/A                   |                             |
|10 CFR SECTION:                                 |                             |
|LADM 35.33(a)            MED MISADMINISTRATION  |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
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                                   EVENT TEXT                                   
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| POTENTIAL MEDICAL MISADMINISTRATION                                          |
|                                                                              |
| A patient being treated with a Leksell gamma system model 23004 type B       |
| received a treatment to the wrong site.  The intended dose or dose delivered |
| were not available.  The dose was delivered to the wrong location because    |
| the head frame had been installed in the wrong position.  The correct site   |
| was subsequently treated.  The hospital is in the process of informing the   |
| patient and the referring physician.  The attending physician did not        |
| believe the mistake would pose a problem to the patient.                     |
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+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   37673       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: COOPER                   REGION:  4  |NOTIFICATION DATE: 01/21/2001|
|    UNIT:  [1] [] []                 STATE:  NE |NOTIFICATION TIME: 18:29[EST]|
|   RXTYPE: [1] GE-4                             |EVENT DATE:        01/21/2001|
+------------------------------------------------+EVENT TIME:        15:28[CST]|
| NRC NOTIFIED BY:  WILLIAM GREEN                |LAST UPDATE DATE:  01/21/2001|
|  HQ OPS OFFICER:  DOUG WEAVER                  +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          N/A                   |KRISS KENNEDY        R4      |
|10 CFR SECTION:                                 |                             |
|AIND 50.72(b)(2)(iii)(D) ACCIDENT MITIGATION    |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|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                                   
+------------------------------------------------------------------------------+
| CONTROL ROOM EMERGENCY FILTRATION SYSTEM INOPERABLE                          |
|                                                                              |
| At 1528 the Control Room Emergency Filtration System (CREFS) was declared    |
| inoperable when fire door H305 was noted to hang open instead of fully       |
| closing when personnel passed through the door.   BLDG-DOOR-H305 is a        |
| Control Room Envelope Door.  CREFS is a single train system.   When CREFS    |
| was determined to be inoperable Technical Specification LCO 3.7.4 condition  |
| A was entered.  This LCO requires the restoration of CREFS to OPERABLE       |
| status within 7 days or be in MODE 3 within 12 hours and MODE 4 within 36    |
| hours.                                                                       |
|                                                                              |
| Following the transfer of CREFS to DIV 1 power at 13:30, it was subsequently |
| noted that the control room blast doors seemed harder to open than normal.   |
| The ventilation lineup for the Control Building was verified to be correct.  |
| During this verification it was determined that BLDG-DOOR-H305 would not     |
| operate properly and the door and CREFS were declared inoperable.            |
|                                                                              |
| Ventilation flow through other Control Room Boundary Doors appears [to]be    |
| abnormal for the present ventilation lineup.  A Fire Watch has been          |
| stationed at BLDG-DOOR-H305.  A Problem Identification Report has been       |
| initiated to identify that BLDG-DOOR-H305 will not close by itself from the  |
| fully open position. The ventilation lineup has not been changed since the   |
| discovery of this condition for evidence preservation.  The Ventilation      |
| System Engineer is responding to the Site to assist with troubleshooting of  |
| the ventilation system.                                                      |
|                                                                              |
| The licensee notified the NRC resident inspector.                            |
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