United States Nuclear Regulatory Commission - Protecting People and the Environment
Home > NRC Library > Document Collections > Reports Associated With Events > Event Notification Reports > 2003 > July 31

Event Notification Report for July 31, 2003








                    U.S. Nuclear Regulatory Commission

                              Operations Center



                              Event Reports For

                           07/30/2003 - 07/31/2003



                              ** EVENT NUMBERS **



39941  40013  40017  40019  40020  40026  40027  40034  40036  40037  40038  



+------------------------------------------------------------------------------+

|Hospital                                         |Event Number:   39941       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  GUTHRIE HEALTH CARE                  |NOTIFICATION DATE: 06/16/2003|

|LICENSEE:  GUTHRIE HEALTH CARE                  |NOTIFICATION TIME: 09:20[EDT]|

|    CITY:  SAYRE                    REGION:  1  |EVENT DATE:        06/12/2003|

|  COUNTY:                            STATE:  PA |EVENT TIME:             [EDT]|

|LICENSE#:  37-01893-01           AGREEMENT:  N  |LAST UPDATE DATE:  07/30/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |RAYMOND LORSON       R1      |

|                                                |DOUG BROADDUS        NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  JOON PARK                    |                             |

|  HQ OPS OFFICER:  FANGIE JONES                 |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|LDIF 35.3045(a)(1)       DOSE <> PRESCRIBED DOSA|                             |

|LOTH 35.3045(a)(3)       DOSE TO OTHER SITE > SP|                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| DISCOVERY THAT PART OF THE IMPLANTED SEEDS WERE NOT IN THE PROPER SITE       |

|                                                                              |

| A patient was referred for treatment, due to reoccurring prostate cancer, to |

| the hospital where he had previously had treatment. Seeds were implanted     |

| around May 2001.  A scan of the previous treatment of implanted seeds        |

| determined that many of the seeds were not located in the prostate, but in   |

| adjacent tissue where they would have been ineffective in treatment.  Also,  |

| a review of the records indicated a scan was performed in early 2002, but    |

| was not followed up on. The patient and referring physician have been        |

| informed.  The hospital is conducting an investigation into the event and    |

| also developing a plan to provide appropriate treatment for the patient.     |

|                                                                              |

| * * * UPDATE ON 07/18/03 AT 1638 FROM JOON PARK TO ARLON COSTA * * *         |

|                                                                              |

| Post-op dosimetry on one patient was determined to be a misadministration.   |

| The dose that covered  the prostate was more than 20 percent different  from |

| the prescription as well as the penile bulb dose being close to 50 percent   |

| of the prescription dose.  Efforts are being made to contact the affected    |

| patient.  The licensee will continue efforts to obtain post-op dosimetry on  |

| the rest of the patients related to this incident so that  evaluations for   |

| misadministration can be performed.                                          |

|                                                                              |

| Notified R1DO (Della Greca) and NMSS EO (Pierson).                           |

|                                                                              |

| * * * UPDATE ON 07/25/03 AT 0921 EDT FROM JOON PARK TO JOHN MACKINNON * * *  |

|                                                                              |

| Post-op dosimetry for two patients were determined to be a                   |

| misadministration.  The patients had their prostates treated some time in    |

| the year 2001.  The iodine-125 seeds were placed  2 to 3 centimeters below   |

| the area where they were supposed to be located.  The improper location of   |

| the iodine-125 seeds caused more than 50% of the prescribed dose to be       |

| delivered to an un-intended organ.  The patients will be notified.           |

|                                                                              |

| Notified R1DO (Dan Holody) and NMSS EO (Trish Holahan).                      |

|                                                                              |

| * * * UPDATE ON 07/30/03 AT 0911 EDT FROM JOON PARK TO ARLON COSTA * * *     |

|                                                                              |

| Two additional patients of a group of seven were identified as having        |

| received a misadministration of iodine-125 to an unintended organ. The       |

| patients will be notified of this misadministration.  The licensee is in the |

| process of clarifying and document the issues related to this incident.      |

|                                                                              |

| Notified R1DO (James Moorman) and NMSS EO (Tom Essig).                       |

+------------------------------------------------------------------------------+



!!!!!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED  !!!!!!!

+------------------------------------------------------------------------------+

|Power Reactor                                    |Event Number:   40013       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| FACILITY: HADDAM NECK              REGION:  1  |NOTIFICATION DATE: 07/23/2003|

|    UNIT:  [1] [] []                 STATE:  CT |NOTIFICATION TIME: 11:45[EDT]|

|   RXTYPE: [1] W-4-LP                           |EVENT DATE:        07/23/2003|

+------------------------------------------------+EVENT TIME:        10:52[EDT]|

| NRC NOTIFIED BY:  MICHAEL HEYL                 |LAST UPDATE DATE:  07/30/2003|

|  HQ OPS OFFICER:  NATHAN SANFILIPPO            +-----------------------------+

+------------------------------------------------+PERSON          ORGANIZATION |

|EMERGENCY CLASS:          NON EMERGENCY         |DANIEL HOLODY        R1      |

|10 CFR SECTION:                                 |                             |

|DDDD 73.71(b)(1)         SAFEGUARDS REPORTS     |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE   |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|1     N          N       0        Decommissioned   |0        Decommissioned   |

|                                                   |                          |

|                                                   |                          |

+------------------------------------------------------------------------------+

                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| LOSS OF CONTROL OF SAFEGUARDS MATERIAL                                       |

|                                                                              |

| Discovered vulnerability in control of safeguards material for which         |

| compensatory measures had not been employed.  Immediate compensatory         |

| measures taken upon discovery.  Licensee contacted NRC Region I (Bellamy)    |

| and the State of Connecticut.                                                |

|                                                                              |

| Contact the Headquarters Operations Officer for additional details.          |

|                                                                              |

| * * * RETRACTION ON 7/30/03 AT 1641 FROM JON BOWER TO BILL GOTT * * *        |

|                                                                              |

| "On July 23, 2003, Haddam Neck reported a loss of control of safeguards      |

| material in accordance with 10 CFR 73.71(b)(1).  After further review, this  |

| event was determined to be not reportable.  This determination is consistent |

| with Generic Letter 91-03, "Reporting of Safeguards Events."  The event did  |

| not involve: the loss of safeguards information that could significantly     |

| assist an individual in gaining unauthorized or undetected access to a       |

| facility; or that would significantly assist an individual in an act of      |

| radiological sabotage or theft of special nuclear material.  Thus, Haddam    |

| Neck retracts Event Number 40013."                                           |

|                                                                              |

| Notified R4DO (Noggle)                                                       |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|General Information or Other                     |Event Number:   40017       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  TEXAS DEPARTMENT OF HEALTH           |NOTIFICATION DATE: 07/25/2003|

|LICENSEE:  MEMORIAL HERMANN HOSPITAL            |NOTIFICATION TIME: 11:03[EDT]|

|    CITY:  The Woodlands            REGION:  4  |EVENT DATE:        06/25/2003|

|  COUNTY:                            STATE:  TX |EVENT TIME:        12:00[CDT]|

|LICENSE#:  L03772                AGREEMENT:  Y  |LAST UPDATE DATE:  07/25/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |TROY PRUETT          R4      |

|                                                |TRISH HOLAHAN        NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  HELEN WATKINS                |                             |

|  HQ OPS OFFICER:  JOHN MacKINNON               |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|NAGR                     AGREEMENT STATE        |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| INCORRECT PATIENT GIVEN A DOSE                                               |

|                                                                              |

| "On June 25, 2003, a nuclear medicine technologist gave a 243 microcurie     |

| iodine-123 capsule to the wrong patient.  There were two patients with the   |

| same last name and middle initial but different first names in the           |

| outpatient waiting room.  The wrong patient responded when the technologist  |

| took the patient into the nuclear medicine department, explained the         |

| procedure, and had him fill out a thyroid questionnaire.  After the patient  |

| swallowed the capsule, he informed the technologist that he was not at the   |

| hospital for a thyroid study.  The patient was informed of the               |

| misadministration.  The licensee did not report whether the referring        |

| physician was informed.                                                      |

|                                                                              |

| "Cause: The technologist failed to fully identify the patient.               |

|                                                                              |

| "Corrective Action: The technologist was counseled. To prevent a recurrence, |

| the technologists will question the patient's full name and match their date |

| of birth in the future.  The technologist will also ask the patient what     |

| examination or procedure they are scheduled for before initiating any        |

| test."                                                                       |

|                                                                              |

| Texas Incident No.:  I-8042.                                                 |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|General Information or Other                     |Event Number:   40019       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  CALIFORNIA RADIATION CONTROL PRGM    |NOTIFICATION DATE: 07/25/2003|

|LICENSEE:  DELLAVALLEY LABORATORIES             |NOTIFICATION TIME: 13:00[EDT]|

|    CITY:  SACRAMENTO               REGION:  4  |EVENT DATE:        07/25/2003|

|  COUNTY:                            STATE:  CA |EVENT TIME:        09:00[PDT]|

|LICENSE#:  3194-10               AGREEMENT:  Y  |LAST UPDATE DATE:  07/25/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |TROY PRUETT          R4      |

|                                                |FRED BROWN           NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  KENT PREDERGAST              |                             |

|  HQ OPS OFFICER:  STEVE SANDIN                 |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|NAGR                     AGREEMENT STATE        |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| AGREEMENT STATE REPORT INVOLVING A STOLEN TROXLER GAUGE                      |

|                                                                              |

| "[The licensee] got in late from work, and failed to take the gauge to       |

| storage location but instead left the gauge in the back of his pickup and    |

| covered it.  The gauge was covered inside the camper shell.  Sometime        |

| between 11 PM on 7/24/03 and 1:00 AM on 7/25/03, the pickup was stolen from  |

| it's parking location.  The Sacramento Police were notified on 7/25/03 and   |

| the licensee will be placing an advertisement in the Sacramento Bee          |

| [newspaper], offering a reward for the stolen gauge.                         |

|                                                                              |

| "The Stolen gauge was a CPN 131, Model 503 DR, serial number H35126508       |

| containing 50 millicuries of Americium  241 Beryllium."                      |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|General Information or Other                     |Event Number:   40020       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  NC DIV OF RADIATION PROTECTION       |NOTIFICATION DATE: 07/25/2003|

|LICENSEE:  REX HEALTHCARE                       |NOTIFICATION TIME: 13:09[EDT]|

|    CITY:  RALEIGH                  REGION:  2  |EVENT DATE:        07/14/2003|

|  COUNTY:                            STATE:  NC |EVENT TIME:             [EDT]|

|LICENSE#:  092-0160-1            AGREEMENT:  Y  |LAST UPDATE DATE:  07/25/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |ANNE BOLAND          R2      |

|                                                |FRED BROWN           NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  SHARN M. JEFFRIES            |                             |

|  HQ OPS OFFICER:  STEVE SANDIN                 |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|NAGR                     AGREEMENT STATE        |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| AGREEMENT STATE REPORT INVOLVING MISSING IODINE-125 SEEDS                    |

|                                                                              |

| On 7/22/03 Rex Healthcare personnel discovered that five (5) I-125 seeds     |

| (activity 0.384 milliCuries/ea for a total of 1.9 milliCuries) were missing. |

| The licensee conducted a search of the area between 7/22 and 7/24/03 with    |

| negative results.                                                            |

|                                                                              |

| NC Incident No.:  03-32                                                      |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|General Information or Other                     |Event Number:   40026       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  OK DEQ RAD MANAGEMENT                |NOTIFICATION DATE: 07/28/2003|

|LICENSEE:  CONOCOPHILLIPS COMPANY               |NOTIFICATION TIME: 15:45[EDT]|

|    CITY:  PONCA CITY               REGION:  4  |EVENT DATE:        07/21/2003|

|  COUNTY:                            STATE:  OK |EVENT TIME:        11:00[CDT]|

|LICENSE#:                        AGREEMENT:  Y  |LAST UPDATE DATE:  07/28/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |MARK SHAFFER         R4      |

|                                                |TOM ESSIG            NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  MIKE BRODERICK               |                             |

|  HQ OPS OFFICER:  STEVE SANDIN                 |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|NAGR                     AGREEMENT STATE        |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| FIRE DAMAGE TO NUCLEAR DENSITY GAUGE                                         |

|                                                                              |

| At approximately 1100 CDT on 7/21/03, a fire at the Conoco Phillips Ponca    |

| City facility  damaged the shielding on a Kay-Ray Model 7063P, Serial No.    |

| 24829, Density Meter containing a 200 millicurie Cs-137 sealed source.  A    |

| preliminary survey of the device found a slight increase in rad levels near  |

| the top of the source holder indicating that the lead shield had melted and  |

| shifted slightly.  Wipe tests found no evidence of source leakage.  The      |

| manufacturer, Thermo Measure Tech, was contacted to make arrangements to     |

| remove the damaged gauge from the site on 7/30 and return it to their Round  |

| Rock, Texas facility for examination/repair.  There was no radiation         |

| exposure associated with this incident to any plant personnel or emergency   |

| responders.                                                                  |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|General Information or Other                     |Event Number:   40027       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  OK DEQ RAD MANAGEMENT                |NOTIFICATION DATE: 07/28/2003|

|LICENSEE:  TUBE BODY INSPECTION, INC.           |NOTIFICATION TIME: 15:45[EDT]|

|    CITY:  ARDMORE                  REGION:  4  |EVENT DATE:        07/23/2003|

|  COUNTY:                            STATE:  OK |EVENT TIME:             [CDT]|

|LICENSE#:                        AGREEMENT:  Y  |LAST UPDATE DATE:  07/28/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |MARK SHAFFER         R4      |

|                                                |TOM ESSIG            NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  MIKE BRODERICK               |                             |

|  HQ OPS OFFICER:  STEVE SANDIN                 |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|NAGR                     AGREEMENT STATE        |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| INAPPROPRIATE TRANSFER OF LICENSED MATERIAL  DURING REPAIR                   |

|                                                                              |

| On 7/23/03, Oklahoma Department of Environmental Quality was informed by a   |

| representative of the Colorado Department of Health, a Mr. James Jarvis,     |

| that a Ludlum TWC 3250, Serial No. 6201,  device containing a 1.5 curie      |

| Cs-137 source had been delivered to Stewart Instruments in Ardmore, Oklahoma |

| for refurbishing of the electronics package.  Normally, the electronic       |

| package is disconnected from the source for maintenance.  However, the       |

| Colorado licensee, i.e.,  Tube Body Inspection located in Ft. Morgan,        |

| Colorado, [Colorado licensee No. 76201], had delivered the device intact.    |

| The Stewart Instruments principal [owner] recognized that he did not have a  |

| licensee to possess the material but, due to extensive past experience       |

| working with these devices, took appropriate steps to ensure proper          |

| handling.  Oklahoma inspectors visited the storage location and were         |

| satisfied with the existing arrangements for temporary storage, i.e., locked |

| public storage location.  The Colorado licensee has been contacted and       |

| requested to remove the device from Oklahoma.                                |

|                                                                              |

| Tube Body Inspection is in the process of terminating their Colorado license |

| and is making arrangements to transfer this device to a California firm.     |

| However, according to the Oklahoma State representative, the California      |

| company is not licensed to possess this material.                            |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|Power Reactor                                    |Event Number:   40034       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| FACILITY: PALO VERDE               REGION:  4  |NOTIFICATION DATE: 07/30/2003|

|    UNIT:  [1] [] []                 STATE:  AZ |NOTIFICATION TIME: 07:45[EDT]|

|   RXTYPE: [1] CE,[2] CE,[3] CE                 |EVENT DATE:        07/29/2003|

+------------------------------------------------+EVENT TIME:        23:44[MST]|

| NRC NOTIFIED BY:  DANN DAILEY                  |LAST UPDATE DATE:  07/30/2003|

|  HQ OPS OFFICER:  JOHN MacKINNON               +-----------------------------+

+------------------------------------------------+PERSON          ORGANIZATION |

|EMERGENCY CLASS:          NON EMERGENCY         |CHUCK CAIN           R4      |

|10 CFR SECTION:                                 |                             |

|ACOM 50.72(b)(3)(xiii)   LOSS COMM/ASMT/RESPONSE|                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE   |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|1     N          Y       98       Power Operation  |98       Power Operation  |

|                                                   |                          |

|                                                   |                          |

+------------------------------------------------------------------------------+

                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| LOSS OF 9 OF THE 42 EMERGENCY EVACUATIONS SIRENS DUE TO STORM                |

|                                                                              |

| "On July 29, 2003 at approximately 23:44 Mountain Standard Time, the Palo    |

| Verde Unit 1 control room was notified of a power failure, probably due to a |

| storm that recently passed through the area of Buckeye, AZ, causing the loss |

| of 9 of the 42 emergency evacuation sirens.  The 9 affected sirens are       |

| estimated to impact approximately 26% of the population in the emergency     |

| planning zone (EPZ).  This call is being placed due to the relatively large  |

| segment of the population affected, and the uncertainty of the length of     |

| time that will be needed to restore electrical power to the affected areas.  |

| The Palo Verde Emergency Plan (section 6.6.2.1) has a contingency for        |

| dispatching Maricopa County Sheriff's Office (MCSO) vehicles with loud       |

| speakers to alert persons within the affected area (s) when sirens are       |

| inoperable.                                                                  |

|                                                                              |

| "There are no events in progress that require siren operation.               |

|                                                                              |

| "The NRC Resident Inspector has been notified of the siren failure and this  |

| ENS call."                                                                   |

|                                                                              |

| * * * UPDATE ON 7/30/03 AT 1200 EDT FROM DAN MARKS TO S. SANDIN * * *        |

|                                                                              |

| "On July 30, 2003, at approximately 08:15 AM (MST), the Palo Verde Unit 1    |

| control room was notified that power had been restored to the 9 emergency    |

| evacuation sirens. The NRC Resident Inspector has been notified."            |

|                                                                              |

| Notified R4DO (Cain)                                                         |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|Other Nuclear Material                           |Event Number:   40036       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| REP ORG:  METAL MANAGEMENT AEROSPACE           |NOTIFICATION DATE: 07/30/2003|

|LICENSEE:  METAL MANAGEMENT AEROSPACE           |NOTIFICATION TIME: 16:52[EDT]|

|    CITY:  HARTFORD                 REGION:  1  |EVENT DATE:        07/30/2003|

|  COUNTY:                            STATE:  CT |EVENT TIME:        15:00[EDT]|

|LICENSE#:  06-30670-01           AGREEMENT:  N  |LAST UPDATE DATE:  07/30/2003|

|  DOCKET:                                       |+----------------------------+

|                                                |PERSON          ORGANIZATION |

|                                                |JAMES NOGGLE         R1      |

|                                                |DANIEL GILLEN        NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  DAN MULLEN                   |                             |

|  HQ OPS OFFICER:  STEVE SANDIN                 |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|NONR                     OTHER UNSPEC REQMNT    |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| LEAK TEST RESULTS OF SEALED SOURCE EXCEED ALLOWABLE LIMITS                   |

|                                                                              |

| On 6/11/03 Metal Management Aerospace arranged for leak testing of a  20     |

| millicurie Cd-109 sealed source, S/N 942-24, by RSA Laboratories in Hebron,  |

| CT.  The results were received at 1500 EDT today, 7/30.  The activity was    |

| measured at 0.437 microcuries which exceeds the limit of 0.005 microcuries   |

| as specified in the license.  This source is used in a Kevex Spectrometer    |

| model 6700 for alloy identification.  The licensee has discontinued use of   |

| the spectrometer until it's decontaminated and will contact the source       |

| manufacturer, Isotope Products located in Burbank, CA, for return.           |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|Fuel Cycle Facility                              |Event Number:   40037       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| FACILITY: PORTSMOUTH GASEOUS DIFFUSION PLANT   |NOTIFICATION DATE: 07/30/2003|

|   RXTYPE: URANIUM ENRICHMENT FACILITY          |NOTIFICATION TIME: 17:51[EDT]|

| COMMENTS: 2 DEMOCRACY CENTER                   |EVENT DATE:        07/30/2003|

|           6903 ROCKLEDGE DRIVE                 |EVENT TIME:        03:00[EDT]|

|           BETHESDA, MD 20817    (301)564-3200  |LAST UPDATE DATE:  07/30/2003|

|    CITY:  PIKETON                  REGION:  3  +-----------------------------+

|  COUNTY:  PIKE                      STATE:  OH |PERSON          ORGANIZATION |

|LICENSE#:  GDP-2                 AGREEMENT:  N  |BRUCE BURGESS        R3      |

|  DOCKET:  0707002                              |DANIEL GILLEN        NMSS    |

+------------------------------------------------+                             |

| NRC NOTIFIED BY:  KURK SISLER                  |                             |

|  HQ OPS OFFICER:  BILL GOTT                    |                             |

+------------------------------------------------+                             |

|EMERGENCY CLASS:          NON EMERGENCY         |                             |

|10 CFR SECTION:                                 |                             |

|OSAF 76.120(c)(2)        SAFETY EQUIPMENT FAILUR|                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+------------------------------------------------------------------------------+



                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| REMOTE OPERABILITY OF PIGTAIL LINE ISOLATION DISABLED                        |

|                                                                              |

| "On 07/30/03 at 0300 hrs [EDT] the Plant Shift Superintendent's (PSS) office |

| was notified by operations personnel at the X-344 facility, that the air     |

| supply line to the Parent Cylinder Safety Valve on Autoclave #3 (Q safety    |

| system component) appeared to be severely damaged.  The PSS on duty and the  |

| Shift Engineer (SE) responded to assess the condition, and determined that   |

| the Parent Cylinder Safety Valve air supply line was damaged and would not   |

| or could not have performed its intended safety function.  The PSS declared  |

| the Parent Cylinder Safety Valve inoperable and directed operations          |

| personnel at the X-344 facility to place autoclave #3 into mode VII          |

| (Shutdown).                                                                  |

|                                                                              |

| "The damaged air line had apparently been present during applicable TSR      |

| modes, II (Heating), III (Cylinder/Pigtail Operations) and IV (Feeding,      |

| Transfer or Sampling).  This condition is reportable under 76.120 (c)(2)(ii) |

| and 76.120 (d)(2). The equipment is required by Technical Safety             |

| Requirements (TSR)  to be available and operable and either should have been |

| operating or should have operated on demand."                                |

|                                                                              |

| The certificate holder notified the NRC Resident Inspector.                  |

+------------------------------------------------------------------------------+



+------------------------------------------------------------------------------+

|Power Reactor                                    |Event Number:   40038       |

+------------------------------------------------------------------------------+

+------------------------------------------------------------------------------+

| FACILITY: INDIAN POINT             REGION:  1  |NOTIFICATION DATE: 07/30/2003|

|    UNIT:  [2] [] []                 STATE:  NY |NOTIFICATION TIME: 18:15[EDT]|

|   RXTYPE: [2] W-4-LP,[3] W-4-LP                |EVENT DATE:        07/30/2003|

+------------------------------------------------+EVENT TIME:        12:10[EDT]|

| NRC NOTIFIED BY:  RICH ALEXANDER               |LAST UPDATE DATE:  07/30/2003|

|  HQ OPS OFFICER:  MIKE RIPLEY                  +-----------------------------+

+------------------------------------------------+PERSON          ORGANIZATION |

|EMERGENCY CLASS:          NON EMERGENCY         |JAMES NOGGLE         R1      |

|10 CFR SECTION:                                 |WILLIAM BECKNER      NRR     |

|NONR                     OTHER UNSPEC REQMNT    |                             |

|                                                |                             |

|                                                |                             |

|                                                |                             |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE   |

+-----+----------+-------+--------+-----------------+--------+-----------------+

|2     N          Y       100      Power Operation  |100      Power Operation  |

|                                                   |                          |

|                                                   |                          |

+------------------------------------------------------------------------------+

                                   EVENT TEXT                                   

+------------------------------------------------------------------------------+

| CHLORINATION SAMPLING NOT PERFORMED IN ACCORDANCE WITH DISCHARGE PERMIT      |

|                                                                              |

| "On 7/30/03 at 1210 [EDT], chlorination was started on 21 circulating water  |

| pump bay.  The first sample for chlorine concentration was not obtained      |

| until one hour after the start of chlorination.  The SPDES permit requires   |

| 30-minute samples."                                                          |

|                                                                              |

| The licensee will notify the NRC Resident Inspector.                         |

+------------------------------------------------------------------------------+