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Event Notification Report for May 14, 2001

                    U.S. Nuclear Regulatory Commission
                              Operations Center

                              Event Reports For
                           05/11/2001 - 05/14/2001

                              ** EVENT NUMBERS **

37802  37834  37985  37986  37987  

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|General Information or Other                     |Event Number:   37802       |
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| REP ORG:  KANSAS DEPT OF HEALTH & ENVIRONMENT  |NOTIFICATION DATE: 03/02/2001|
|LICENSEE:  HUTCHINSON HOSPITAL CORPORATION      |NOTIFICATION TIME: 17:45[EST]|
|    CITY:  HUTCHINSON               REGION:  4  |EVENT DATE:        03/02/2001|
|  COUNTY:                            STATE:  KS |EVENT TIME:             [CST]|
|LICENSE#:  19-B081-01            AGREEMENT:  Y  |LAST UPDATE DATE:  05/11/2001|
|  DOCKET:                                       |+----------------------------+
|                                                |PERSON          ORGANIZATION |
|                                                |LINDA HOWELL         R4      |
|                                                |JOSEPH HOLONICH      NMSS    |
+------------------------------------------------+                             |
| NRC NOTIFIED BY:  JAMES HARRIS                 |                             |
|  HQ OPS OFFICER:  STEVE SANDIN                 |                             |
+------------------------------------------------+                             |
|EMERGENCY CLASS:          N/A                   |                             |
|10 CFR SECTION:                                 |                             |
|NAGR                     AGREEMENT STATE        |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
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                                   EVENT TEXT                                   
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| AGREEMENT STATE REPORT INVOLVING POTENTIAL OVEREXPOSURE                      |
|                                                                              |
| The Kansas Department of Health and Environment was notified by Hutchinson   |
| Hospital Corporation that a Cardiologist may have received an overexposure.  |
| The source and extent of the potential overexposure are under investigation. |
| This is Kansas Case Number KS010006.  This report will be updated when more  |
| details are available.                                                       |
|                                                                              |
| * * * UPDATE AT 1230 EDT ON 5/11/01 BY JAMES HARRIS TO FANGIE JONES * * *    |
|                                                                              |
| "The event report by the licensee shows an interventional cardiologist       |
| received 10,115 mrem for the year 2000. The exposure was due to x-ray and    |
| not the radioactive material program at the hospital. The is the only        |
| physician in the area who performs these procedures and he performs more     |
| than 600 procedures in a year. Observations of the physician show the        |
| portable shielding, because of its design or limitations in placement, may   |
| have been a detriment to the procedure and therefore was not used or         |
| improperly used in many cases.                                               |
|                                                                              |
| "Corrective actions: New shielding with a better design has been purchased.  |
| A new shield curtain has been purchased to better control the side scatter   |
| from the x-ray tube. New lead equivalent glasses have been purchased.        |
| Shielding has been added to the x-ray head to harden the beam and reduce low |
| energy scatter. The safety staff is providing increased oversight."          |
|                                                                              |
| The R4DO (Jeff Shackelford) and NMSS (John Hickey) have been notified.       |
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!!!!!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED  !!!!!!!
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|Power Reactor                                    |Event Number:   37834       |
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| FACILITY: FITZPATRICK              REGION:  1  |NOTIFICATION DATE: 03/13/2001|
|    UNIT:  [1] [] []                 STATE:  NY |NOTIFICATION TIME: 18:07[EST]|
|   RXTYPE: [1] GE-4                             |EVENT DATE:        03/13/2001|
+------------------------------------------------+EVENT TIME:        14:45[EST]|
| NRC NOTIFIED BY:  JOHN HODDY                   |LAST UPDATE DATE:  05/11/2001|
|  HQ OPS OFFICER:  STEVE SANDIN                 +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          N/A                   |PETE ESELGROTH       R1      |
|10 CFR SECTION:                                 |                             |
|*IND 50.72(b)(3)(v)(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  |
|                                                   |                          |
|                                                   |                          |
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                                   EVENT TEXT                                   
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| HIGH PRESSURE COOLANT INJECTION (HPCI) DECLARED INOPERABLE DUE EXCESSIVE     |
| MOISTURE IN LUBE OIL                                                         |
|                                                                              |
| "At approximately 1100 hours, operators observed oil puddled around the HPCI |
| lube oil sump vents and observed a slightly higher than normal sump level.   |
| The system engineer was consulted and recommended lowering sump level and    |
| sampling for moisture.                                                       |
|                                                                              |
| "At 1445, water was observed in the sample taken from the HPCI lube oil      |
| sump.  The amount of water observed (approximately 1/2 gallon) was such that |
| compliance with a maximum recommended lube oil moisture content of 5% could  |
| not be assured.  A conservative decision was made to declare HPCI            |
| inoperable.  The system is inoperable but available.  The plant is in a      |
| 7-day LCO per T.S. 3.5.C."                                                   |
|                                                                              |
| The licensee informed the NRC resident inspector.                            |
|                                                                              |
| ***** RETRACTION RECEIVED AT 0933 ON 05/11/01 FROM ART ZAREMBA TO LEIGH      |
| TROCINE *****                                                                |
|                                                                              |
| The initial notification regarded the HPCI system being declared inoperable  |
| because of an unknown quantity of water in the lube oil sump.  The licensee  |
| subsequently drained, cleaned, and refilled the lube oil sump and determined |
| exactly how much water intrusion had occurred.  The licensee's engineering   |
| evaluation determined that the technical requirements were not exceeded      |
| (based on the acceptance criteria for the percentage of water in the system) |
| and that the HPCI system was in fact operable.  Therefore, the licensee is   |
| retracting this event notification.                                          |
|                                                                              |
| The licensee notified the NRC resident inspector.  The NRC operations        |
| officer notified the R1DO (Cook).                                            |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|General Information or Other                     |Event Number:   37985       |
+------------------------------------------------------------------------------+
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| REP ORG:  INOVISION                            |NOTIFICATION DATE: 05/11/2001|
|LICENSEE:  INOVISION                            |NOTIFICATION TIME: 15:05[EDT]|
|    CITY:  CLEVELAND                REGION:  3  |EVENT DATE:        05/10/2001|
|  COUNTY:                            STATE:  OH |EVENT TIME:             [EDT]|
|LICENSE#:                        AGREEMENT:  Y  |LAST UPDATE DATE:  05/11/2001|
|  DOCKET:                                       |+----------------------------+
|                                                |PERSON          ORGANIZATION |
|                                                |VERN HODGE (FAX)     NRR     |
|                                                |                             |
+------------------------------------------------+                             |
| NRC NOTIFIED BY:  JANICE BROWNLEE              |                             |
|  HQ OPS OFFICER:  FANGIE JONES                 |                             |
+------------------------------------------------+                             |
|EMERGENCY CLASS:          N/A                   |                             |
|10 CFR SECTION:                                 |                             |
|CCCC 21.21               UNSPECIFIED PARAGRAPH  |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
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                                   EVENT TEXT                                   
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| 10 CFR 21 REPORT - INTERIM REPORT ABOUT R-11 MONITOR PROBLEM                 |
|                                                                              |
| The following is taken from a faxed report:                                  |
|                                                                              |
| Deviation being evaluated:  An R-11 Monitor installed in Korea has been      |
| reported as having a rapid increase in displayed concentration and analog    |
| output values. Initial evaluation of the problem indicates the cause may be  |
| in one of the base 960 firmware modules, which are also installed in some US |
| nuclear power plants. The significance of the problem is still under         |
| evaluation to determine if it could create a substantial safety hazard. The  |
| initial report was received on March 15, 2001.                               |
|                                                                              |
| Evaluation information to date: The problem is a rapid increase in displayed |
| concentration and analog output values. The problem is not apparent at low   |
| levels of activity where low count rates and statistical variation mask the  |
| increase. When activity is near the upper range of the monitor, this spike   |
| in calculated activity has triggered radiation alarms and could place the    |
| channel into over range. The spiking in activity is believed to be due to    |
| the microprocessor being unable to read and clear a register within the      |
| allotted time. This results in a higher accumulated count value when the     |
| register is finally read. Since the problem is directly related to processor |
| workload, the problem is most likely to occur in a complex channel           |
| configuration with multiple detectors (such as a PIG or Extended Range) and  |
| where the microprocessor is highly tasked with RMS computer or isolator      |
| communications.                                                              |
|                                                                              |
| For single range channels, the result of the spike would be a false          |
| radiation alarm and possibly an over range condition as well, although this  |
| has not been reported to the best of our knowledge. The other possibility is |
| that this situation could occur on an Extended Range monitor thereby placing |
| the channel in 'accident' or high range mode. If this occurs, the normal     |
| range is shut down and/or by-passed. If the accident range detector is       |
| brought online below its minimum operating range and the normal range        |
| detector is shut down, an unmonitored release might be possible.             |
|                                                                              |
| A more detailed analysis of the firmware in specific channels is needed to   |
| determine if this last condition is possible.                                |
|                                                                              |
| The possible defect is believed at this time to only affect Model 960        |
| firmware modules upgraded or purchased since 1992.                           |
|                                                                              |
| Evaluation completion date: July 10. 2001                                    |
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|Fuel Cycle Facility                              |Event Number:   37986       |
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| FACILITY: FRAMATOME ANP RICHLAND               |NOTIFICATION DATE: 05/12/2001|
|   RXTYPE: URANIUM FUEL FABRICATION             |NOTIFICATION TIME: 09:55[EDT]|
| COMMENTS: LEU CONVERSION                       |EVENT DATE:        05/12/2001|
|           FABRICATION & SCRAP RECOVERY         |EVENT TIME:        05:29[PDT]|
|           COMMERCIAL LWR FUEL                  |LAST UPDATE DATE:  05/12/2001|
|    CITY:  RICHLAND                 REGION:  4  +-----------------------------+
|  COUNTY:  BENTON                    STATE:  WA |PERSON          ORGANIZATION |
|LICENSE#:  SNM-1227              AGREEMENT:  Y  |JEFF SHACKELFORD     R4      |
|  DOCKET:  07001257                             |C.W. (BILL) REAMER   NMSS    |
+------------------------------------------------+JOSEPH HOLONICH      IRO     |
| NRC NOTIFIED BY:  LOREN MAAS                   |JASINSKI             OPA     |
|  HQ OPS OFFICER:  BOB STRANSKY                 |HEYMAN               FEMA    |
+------------------------------------------------+WIEGEL               EPA     |
|EMERGENCY CLASS:          ALE                   |                             |
|10 CFR SECTION:                                 |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
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                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| ALERT DECLARED AND TERMINATED DUE TO INADVERTENT CRITICALITY ALARM           |
| ACTIVATION                                                                   |
|                                                                              |
| "Maintenance personnel were changing out nuclear criticality detectors       |
| (NCDs) as part of an annual PM. Maintenance personnel in central guard       |
| station inadvertently turned the alarm key in an out-of-order sequence,      |
| causing the criticality alarm system to sound. The error was corrected       |
| immediately. The alarm system is fully in service."                          |
|                                                                              |
| The licensee stated that no actual criticality occurred.                     |
+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   37987       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: MAINE YANKEE             REGION:  1  |NOTIFICATION DATE: 05/14/2001|
|    UNIT:  [1] [] []                 STATE:  ME |NOTIFICATION TIME: 02:21[EDT]|
|   RXTYPE: [1] CE                               |EVENT DATE:        05/14/2001|
+------------------------------------------------+EVENT TIME:        00:20[EDT]|
| NRC NOTIFIED BY:  TERRY WHITE                  |LAST UPDATE DATE:  05/14/2001|
|  HQ OPS OFFICER:  BOB STRANSKY                 +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          N/A                   |WILLIAM COOK         R1      |
|10 CFR SECTION:                                 |                             |
|*PRE 50.72(b)(2)(xi)     OFFSITE NOTIFICATION   |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE   |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|1     N          N       0        Decommissioned   |0        Decommissioned   |
|                                                   |                          |
|                                                   |                          |
+------------------------------------------------------------------------------+
                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| OFFSITE NOTIFICATION DUE TO DIESEL FUEL SPILL ONSITE                         |
|                                                                              |
| The licensee notified the Maine Department of Environmental Protection       |
| regarding the spillage of approximately 25 gallons of diesel fuel.  The fuel |
| oil was spilled when the fuel tank of a truck was punctured as it was        |
| driving over a temporary ramp.  The spill has been contained.                |
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