Event Notification Report for September 24, 2004
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
09/23/2004 - 09/24/2004
EVENT NUMBERS
410664106741068410694107843691
Power Reactor
Event Number: 41066
Facility: INDIAN POINT
Region: 1 State: NY
Unit: [2] [] []
RX Type: [2] W-4-LP,[3] W-4-LP
NRC Notified By: DAN LYON
HQ OPS Officer: JOHN MacKINNON
Region: 1 State: NY
Unit: [2] [] []
RX Type: [2] W-4-LP,[3] W-4-LP
NRC Notified By: DAN LYON
HQ OPS Officer: JOHN MacKINNON
Notification Date: 09/24/2004
Notification Time: 13:29 [ET]
Event Date: 09/24/2004
Event Time: 11:55 [EDT]
Last Update Date: 09/24/2004
Notification Time: 13:29 [ET]
Event Date: 09/24/2004
Event Time: 11:55 [EDT]
Last Update Date: 09/24/2004
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL 50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL 50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
JOHN CARUSO (R1)
STUART RICHARDS (NRR)
JOHN CARUSO (R1)
STUART RICHARDS (NRR)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 2 | M/R | Y | 100 | Power Operation | 0 | Hot Standby |
MANUAL REACTOR TRIP WITH NO COMPLICATIONS DUE TO LOWERING STEAM GENERATOR WATER LEVEL
"On September 24, 2004, at 11:53 hours, operations noticed the 23 Main Feedwater (FW) regulating valve operating erratically and FW flow and 23 Steam Generator (SG) level decreasing. At 11:55 hours operations initiated a manual trip of the reactor based on the degrading condition with FW flow and SG level. All control rods fully inserted and safety equipment operated as expected. Auxiliary Feedwater started as expected, the Emergency Diesel Generators did not start as offsite power remained available. The plant is in Hot (Standby) at Normal Temperature and Pressure and there was no radiation releases. The condition is under investigation and a post trip review is being conducted." State was notified of this event by the licensee.
The NRC Resident Inspector was notified of this event by the licensee.
"On September 24, 2004, at 11:53 hours, operations noticed the 23 Main Feedwater (FW) regulating valve operating erratically and FW flow and 23 Steam Generator (SG) level decreasing. At 11:55 hours operations initiated a manual trip of the reactor based on the degrading condition with FW flow and SG level. All control rods fully inserted and safety equipment operated as expected. Auxiliary Feedwater started as expected, the Emergency Diesel Generators did not start as offsite power remained available. The plant is in Hot (Standby) at Normal Temperature and Pressure and there was no radiation releases. The condition is under investigation and a post trip review is being conducted." State was notified of this event by the licensee.
The NRC Resident Inspector was notified of this event by the licensee.
Power Reactor
Event Number: 41067
Facility: SAINT LUCIE
Region: 2 State: FL
Unit: [1] [2] []
RX Type: [1] CE,[2] CE
NRC Notified By: JOE HESSLING
HQ OPS Officer: JOHN MacKINNON
Region: 2 State: FL
Unit: [1] [2] []
RX Type: [1] CE,[2] CE
NRC Notified By: JOE HESSLING
HQ OPS Officer: JOHN MacKINNON
Notification Date: 09/24/2004
Notification Time: 17:23 [ET]
Event Date: 09/24/2004
Event Time: 17:00 [EDT]
Last Update Date: 09/26/2004
Notification Time: 17:23 [ET]
Event Date: 09/24/2004
Event Time: 17:00 [EDT]
Last Update Date: 09/26/2004
Emergency Class: UNUSUAL EVENT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED 50.72(b)(2)(xi) - OFFSITE NOTIFICATION
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED 50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
ROBERT HAAG (R2)
STUART RICHARDS (NRR)
HO NIEH (IRD)
AUSTIN (FEMA)
McKENTRY (DHS)
ROBERT HAAG (R2)
STUART RICHARDS (NRR)
HO NIEH (IRD)
AUSTIN (FEMA)
McKENTRY (DHS)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 100 | Power Operation |
| 2 | N | Y | 100 | Power Operation | 100 | Power Operation |
ENTERED UNUSUAL EVENT CLASSIFICATION DUE TO HURRICANE WARNING IN EFFECT
Hurricane warning in effect for St. Lucie County including Plant Site. Hurricane warning was issued by the National Weather Service. St. Lucie Nuclear Power Plant entered an Unusual Event Classification per Emergency Action Level 5B (Hurricane Warning). State and Local Officials notified by the licensee.
The NRC Resident Inspector was notified of this by the licensee.
* * * UPDATE AT 0838 EDT ON 9/25/04 FROM JOE HESSLING TO S. SANDIN * * *
"St. Lucie Unit 1 commenced a plant shutdown at 0820 in preparation for Hurricane. St. Lucie Unit 2 will commence plant shutdown at 0900 in preparation for Hurricane. St. Lucie still in Unusual Event due to Hurricane warning."
Unit 1 expects to enter mode 3 at approximately 1230 hours with Unit 2 entering mode 3 between 1300-1330 hours. Both Units will remain in mode 3 with restart dates to be determined. Highest sustained winds on-site are projected at 120 mph. Current wind speed on-site is between 14-15 mph sustained from a northerly direction.
The licensee notified both state and local agencies and will inform the NRC Resident Inspector. Notified R2DO (Robert Haag), NRR (Stu Richards), IRD (Susan Frant), R4DO (William Johnson), FEMA (Erwin) and DHS-DOE Desk (left message).
* * * UPDATE AT 1313 EDT ON 09/25/04 FROM DAN WEST TO JOHN MACKINNON * * *
St. Lucie Units 1 & 2 have shutdown and have been removed from service. R2DO (Haag) , NRR EO (Stu Richards), FEMA (Erwin), DHS (Algen), R4DO (William Johnson), NRC Region 2 (Hufham) & IRD (S. Frant) notified.
The NRC Resident Inspector will be notified of this by the licensee.
* * * UPDATE AT 1413 EDT ON 09/26/04 FROM M. GRAY TO MACKINNON * * *
Hurricane warning has been discontinued. Unusual Event exited at 1412 EDT. R2DO (Haag), NRR EO (Richards), IRD Manager (S. Frant), R4DO (Bill Johnson), FEMA (Austin), DHS (Travis Johnson) , DOE (Robert Turner), NRC/DOT (Crews), USDA (Lori Thomas) & DHS-DOE Desk (message left) notified.
The NRC Resident Inspector was notified of this update by the licensee.
HOO Note: See related ENs # 41071, 41072 and 41073.
Hurricane warning in effect for St. Lucie County including Plant Site. Hurricane warning was issued by the National Weather Service. St. Lucie Nuclear Power Plant entered an Unusual Event Classification per Emergency Action Level 5B (Hurricane Warning). State and Local Officials notified by the licensee.
The NRC Resident Inspector was notified of this by the licensee.
* * * UPDATE AT 0838 EDT ON 9/25/04 FROM JOE HESSLING TO S. SANDIN * * *
"St. Lucie Unit 1 commenced a plant shutdown at 0820 in preparation for Hurricane. St. Lucie Unit 2 will commence plant shutdown at 0900 in preparation for Hurricane. St. Lucie still in Unusual Event due to Hurricane warning."
Unit 1 expects to enter mode 3 at approximately 1230 hours with Unit 2 entering mode 3 between 1300-1330 hours. Both Units will remain in mode 3 with restart dates to be determined. Highest sustained winds on-site are projected at 120 mph. Current wind speed on-site is between 14-15 mph sustained from a northerly direction.
The licensee notified both state and local agencies and will inform the NRC Resident Inspector. Notified R2DO (Robert Haag), NRR (Stu Richards), IRD (Susan Frant), R4DO (William Johnson), FEMA (Erwin) and DHS-DOE Desk (left message).
* * * UPDATE AT 1313 EDT ON 09/25/04 FROM DAN WEST TO JOHN MACKINNON * * *
St. Lucie Units 1 & 2 have shutdown and have been removed from service. R2DO (Haag) , NRR EO (Stu Richards), FEMA (Erwin), DHS (Algen), R4DO (William Johnson), NRC Region 2 (Hufham) & IRD (S. Frant) notified.
The NRC Resident Inspector will be notified of this by the licensee.
* * * UPDATE AT 1413 EDT ON 09/26/04 FROM M. GRAY TO MACKINNON * * *
Hurricane warning has been discontinued. Unusual Event exited at 1412 EDT. R2DO (Haag), NRR EO (Richards), IRD Manager (S. Frant), R4DO (Bill Johnson), FEMA (Austin), DHS (Travis Johnson) , DOE (Robert Turner), NRC/DOT (Crews), USDA (Lori Thomas) & DHS-DOE Desk (message left) notified.
The NRC Resident Inspector was notified of this update by the licensee.
HOO Note: See related ENs # 41071, 41072 and 41073.
Power Reactor
Event Number: 41068
Facility: TURKEY POINT
Region: 2 State: FL
Unit: [3] [4] []
RX Type: [3] W-3-LP,[4] W-3-LP
NRC Notified By: JIM SPEICHER
HQ OPS Officer: ARLON COSTA
Region: 2 State: FL
Unit: [3] [4] []
RX Type: [3] W-3-LP,[4] W-3-LP
NRC Notified By: JIM SPEICHER
HQ OPS Officer: ARLON COSTA
Notification Date: 09/24/2004
Notification Time: 17:23 [ET]
Event Date: 09/24/2004
Event Time: 17:00 [EDT]
Last Update Date: 09/26/2004
Notification Time: 17:23 [ET]
Event Date: 09/24/2004
Event Time: 17:00 [EDT]
Last Update Date: 09/26/2004
Emergency Class: UNUSUAL EVENT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED
Person (Organization):
ROBERT HAAG (R2)
STUART RICHARDS (NRR)
HO NIEH (IRD)
AUSTIN (FEMA)
MCKENTRY (DHS)
ROBERT HAAG (R2)
STUART RICHARDS (NRR)
HO NIEH (IRD)
AUSTIN (FEMA)
MCKENTRY (DHS)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 3 | N | Y | 100 | Power Operation | 100 | Power Operation |
| 4 | N | Y | 100 | Power Operation | 100 | Power Operation |
UNUSUAL EVENT DECLARED DUE TO HURRICANE WARNING
"Turkey Point Nuclear entered an Unusual Event due to Category 12 Natural Phenomena sub category A. Confirmed hurricane warning."
The licensee notified the NRC Resident Inspector, State and Local authorities.
* * * UPDATE 0723 EDT ON 9/26/04 FROM KEN HARRISON TO S. SANDIN * * *
The licensee is terminating their Unusual Event as of 0715 EDT after the Hurricane Warning was lifted for Miami-Dade. The licensee informed both state and local agencies and the NRC Resident Inspector.
Notified R2 Response Manager (Len Wert), NRR (Stu Richards), IRD (Susan Frant), FEMA (Austin) and DHS (SWO).
"Turkey Point Nuclear entered an Unusual Event due to Category 12 Natural Phenomena sub category A. Confirmed hurricane warning."
The licensee notified the NRC Resident Inspector, State and Local authorities.
* * * UPDATE 0723 EDT ON 9/26/04 FROM KEN HARRISON TO S. SANDIN * * *
The licensee is terminating their Unusual Event as of 0715 EDT after the Hurricane Warning was lifted for Miami-Dade. The licensee informed both state and local agencies and the NRC Resident Inspector.
Notified R2 Response Manager (Len Wert), NRR (Stu Richards), IRD (Susan Frant), FEMA (Austin) and DHS (SWO).
Power Reactor
Event Number: 41069
Facility: CRYSTAL RIVER
Region: 2 State: FL
Unit: [3] [] []
RX Type: [3] B&W-L-LP
NRC Notified By: BILL BANDHAUER
HQ OPS Officer: JOHN MacKINNON
Region: 2 State: FL
Unit: [3] [] []
RX Type: [3] B&W-L-LP
NRC Notified By: BILL BANDHAUER
HQ OPS Officer: JOHN MacKINNON
Notification Date: 09/24/2004
Notification Time: 17:53 [ET]
Event Date: 09/24/2004
Event Time: 14:00 [EDT]
Last Update Date: 09/24/2004
Notification Time: 17:53 [ET]
Event Date: 09/24/2004
Event Time: 14:00 [EDT]
Last Update Date: 09/24/2004
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(A) - DEGRADED CONDITION
10 CFR Section:
50.72(b)(3)(ii)(A) - DEGRADED CONDITION
Person (Organization):
ROBERT HAAG (R2)
ROBERT HAAG (R2)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 3 | N | Y | 100 | Power Operation | 100 | Power Operation |
NUREG-1022 CLARIFICATION REVISED RESULTS OF PAST STEAM GENERATOR TUBE INSEPCTIONS
"On September 24,2004, the NRC published a Notice of Clarification for NUREG-1022 Reporting Guidelines for 10 CFR 50.72 and 50.73. The Notice of Clarification revised the criterion used to determine if the results of steam generator tube inspections were reportable. In this Notice of Clarification, the NRC further directed the plants to consider the results of previous steam generator tube inspections against the new criterion.
"Crystal River Unit 3 (CR3) has reviewed the results of the steam generator tube inspection that occurred in the refueling outage of 2003. Specifically, the previously performed Condition Monitoring assessment of the CR3's steam generators concluded that the structural requirements were met and the as-found projected leakage values for a Main Steam Line Break were exceeded.
"Previously, NUREG-1022 required that both the structural and the leakage criteria must be exceeded for this condition to be reportable. The revision to NUREG-1022 will indicate that only one of the two criteria need be exceeded to be considered reportable per 10 CFR 50.72.
"Accordingly, CR3 reports per 10 CFR 50.72 (b) (3) (ii) (A) that steam generator projected leakage values for a Main Steam Line Break were exceeded.
"Immediate corrective actions to reduce the projected accident leakage were completed during the 2003 refueling outage prior to plant startup."
The NRC Resident Inspector was notified of this by the licensee.
"On September 24,2004, the NRC published a Notice of Clarification for NUREG-1022 Reporting Guidelines for 10 CFR 50.72 and 50.73. The Notice of Clarification revised the criterion used to determine if the results of steam generator tube inspections were reportable. In this Notice of Clarification, the NRC further directed the plants to consider the results of previous steam generator tube inspections against the new criterion.
"Crystal River Unit 3 (CR3) has reviewed the results of the steam generator tube inspection that occurred in the refueling outage of 2003. Specifically, the previously performed Condition Monitoring assessment of the CR3's steam generators concluded that the structural requirements were met and the as-found projected leakage values for a Main Steam Line Break were exceeded.
"Previously, NUREG-1022 required that both the structural and the leakage criteria must be exceeded for this condition to be reportable. The revision to NUREG-1022 will indicate that only one of the two criteria need be exceeded to be considered reportable per 10 CFR 50.72.
"Accordingly, CR3 reports per 10 CFR 50.72 (b) (3) (ii) (A) that steam generator projected leakage values for a Main Steam Line Break were exceeded.
"Immediate corrective actions to reduce the projected accident leakage were completed during the 2003 refueling outage prior to plant startup."
The NRC Resident Inspector was notified of this by the licensee.
General Information or Other
Event Number: 41078
Rep Org: WA DIVISION OF RADIATION PROTECTION
Licensee: SWEDISH MEDICAL CENTER
Region: 4
City: SEATTLE State: WA
County:
License #: WN-M008-1
Agreement: Y
Docket:
NRC Notified By: ARDEN SCROGGS
HQ OPS Officer: BILL GOTT
Licensee: SWEDISH MEDICAL CENTER
Region: 4
City: SEATTLE State: WA
County:
License #: WN-M008-1
Agreement: Y
Docket:
NRC Notified By: ARDEN SCROGGS
HQ OPS Officer: BILL GOTT
Notification Date: 09/28/2004
Notification Time: 15:08 [ET]
Event Date: 09/24/2004
Event Time: 00:00 [PDT]
Last Update Date: 09/28/2004
Notification Time: 15:08 [ET]
Event Date: 09/24/2004
Event Time: 00:00 [PDT]
Last Update Date: 09/28/2004
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
LINDA HOWELL (R4)
TOM ESSIG (NMSS)
LINDA HOWELL (R4)
TOM ESSIG (NMSS)
AGREEMENT STATE REPORT
"Per Swedish Medical Center policy, post thyroid treatment patients are prescribed 74 mBq (2mCi (milliCuries)) for the treatment follow-up scan, and 185 mBq (5 mCi) for subsequent treatment if necessary. On 24 September 2004 a patient was prescribed 74 mBq (2 mCi) of NaI (Iodine-131) for a post treatment scan. Instead, 191 mBq (5.16 mCi) of NaI (Iodine-131) were administered. The prescribing physician realized that a misadministration had occurred on 27 September 2004 when the patient underwent the scan. A viable follow-up scan was able to be performed even though the misadministration had occurred.
"There are multiple procedural checks in place to assure medical technicians administer the prescribed dose. Human error appears to have lead to checks not being performed prior to this event.
"The Radiation Safety Officer for Swedish Medical Center notified the State of Washington, of the misadministration, on 27 September 2004.
"The treating physician notified the patient on Monday, 27 September 2004, when the physician discovered the patient had been administered 191 mBq (5.16 mCi) of NaI (Iodine-131) instead of the prescribed 74 mBq (2 mCi) of NaI (Iodine-131)."
Event Report Number WA-04--57
"Per Swedish Medical Center policy, post thyroid treatment patients are prescribed 74 mBq (2mCi (milliCuries)) for the treatment follow-up scan, and 185 mBq (5 mCi) for subsequent treatment if necessary. On 24 September 2004 a patient was prescribed 74 mBq (2 mCi) of NaI (Iodine-131) for a post treatment scan. Instead, 191 mBq (5.16 mCi) of NaI (Iodine-131) were administered. The prescribing physician realized that a misadministration had occurred on 27 September 2004 when the patient underwent the scan. A viable follow-up scan was able to be performed even though the misadministration had occurred.
"There are multiple procedural checks in place to assure medical technicians administer the prescribed dose. Human error appears to have lead to checks not being performed prior to this event.
"The Radiation Safety Officer for Swedish Medical Center notified the State of Washington, of the misadministration, on 27 September 2004.
"The treating physician notified the patient on Monday, 27 September 2004, when the physician discovered the patient had been administered 191 mBq (5.16 mCi) of NaI (Iodine-131) instead of the prescribed 74 mBq (2 mCi) of NaI (Iodine-131)."
Event Report Number WA-04--57
General Information or Other
Event Number: 43691
Rep Org: WA DIVISION OF RADIATION PROTECTION
Licensee: KEYMASTER
Region: 4
City: KENNEWICK State: WA
County:
License #: WN-I0282-1
Agreement: Y
Docket:
NRC Notified By: ARDEN C. SCROGGS
HQ OPS Officer: PETE SNYDER
Licensee: KEYMASTER
Region: 4
City: KENNEWICK State: WA
County:
License #: WN-I0282-1
Agreement: Y
Docket:
NRC Notified By: ARDEN C. SCROGGS
HQ OPS Officer: PETE SNYDER
Notification Date: 10/04/2007
Notification Time: 18:29 [ET]
Event Date: 09/24/2004
Event Time: 00:00 [PDT]
Last Update Date: 10/04/2007
Notification Time: 18:29 [ET]
Event Date: 09/24/2004
Event Time: 00:00 [PDT]
Last Update Date: 10/04/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
WILLIAM JONES (R4)
NADER MAMISH (FSME)
WILLIAM JONES (R4)
NADER MAMISH (FSME)
AGREEMENT STATE REPORT - LEAKING SEALED SOURCE
"Keymaster's Radiation Safety Officer reported they had recently (in September 2004) received a batch of eleven Cobalt 57, foil sources, Model PHI-0106, from Isotope Products Laboratory. One of the eleven sources failed its receipt leak test. The others were tested and were not leaking.
The State of Washington provided the following information via e-mail:
"The contaminated foil source had Serial Number B9-774 and had an activity of 437 megabecquerels (11.8 millicuries). When wiped, the level of contamination was about 500 counts per minute above background. The source may have been leaking or could have had residual contamination; this was never determined. The source was returned to the supplier.
"The work areas and personnel were surveyed and found uncontaminated.
"No media attention at present.
"Subsequent inspections by DOH performed 10/31/2005 and 9/21/2006 found no contamination and no additional reoccurrences of receiving contaminated sources.
"Notification Reporting Criteria: WAC 246-221-250
"Isotope and Activity involved: Cobalt 57, 437 mBq (11.8 mCi).
There were no overexposures. The leaking source was an Isotope Products Laboratories XRF source Model PHI-0106, S/N B7-461. The leaking source was wiped down to 416 counts, placed back into its shield. It was returned to supplier.
There was minor contamination in the source storage area. The licensee has since cleaned the area. Wipe surveys performed by the licensee and DOH showed no contamination.
State of Washington Event Report # WA-04-042.
"Keymaster's Radiation Safety Officer reported they had recently (in September 2004) received a batch of eleven Cobalt 57, foil sources, Model PHI-0106, from Isotope Products Laboratory. One of the eleven sources failed its receipt leak test. The others were tested and were not leaking.
The State of Washington provided the following information via e-mail:
"The contaminated foil source had Serial Number B9-774 and had an activity of 437 megabecquerels (11.8 millicuries). When wiped, the level of contamination was about 500 counts per minute above background. The source may have been leaking or could have had residual contamination; this was never determined. The source was returned to the supplier.
"The work areas and personnel were surveyed and found uncontaminated.
"No media attention at present.
"Subsequent inspections by DOH performed 10/31/2005 and 9/21/2006 found no contamination and no additional reoccurrences of receiving contaminated sources.
"Notification Reporting Criteria: WAC 246-221-250
"Isotope and Activity involved: Cobalt 57, 437 mBq (11.8 mCi).
There were no overexposures. The leaking source was an Isotope Products Laboratories XRF source Model PHI-0106, S/N B7-461. The leaking source was wiped down to 416 counts, placed back into its shield. It was returned to supplier.
There was minor contamination in the source storage area. The licensee has since cleaned the area. Wipe surveys performed by the licensee and DOH showed no contamination.
State of Washington Event Report # WA-04-042.