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Event Notification Report for October 6, 2005

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
10/05/2005 - 10/06/2005

** EVENT NUMBERS **


42033 42035 42038 42039 42041

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General Information or Other Event Number: 42033
Rep Org: NC DIV OF RADIATION PROTECTION
Licensee: DEPARTMENT OF TRANSPORTATION
Region: 1
City: Raleigh State: NC
County:
License #: 092-0104-1
Agreement: Y
Docket:
NRC Notified By: SHARN JEFFRIES
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 10/03/2005
Notification Time: 08:08 [ET]
Event Date: 10/03/2005
Event Time: 07:51 [EDT]
Last Update Date: 10/03/2005
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JOHN ROGGE (R1)
CHARLIE PAYNE (R2)
GREG MORELL (NMSS)
E-MAIL (TAS)

Event Text

AGREEMENT STATE REPORT - TWO STOLEN MOISTURE DENSITY GUAGES

"Two Troxler Gauges stolen from storage container at temporary jobsite. NCDOT Gauge Manager called NC Radioactive Materials Branch at 7:45 AM to alert AGENCY. Only two gauges were stolen, and a torch was used to cut the security lock from the container.

"Location of job site: NC Highway 98 Bypass in Wake Forest, NC.

"Troxler Model 3450, Serial #298 - 8 mCi (milliCuries) CS-137, 40 mCi Am-241.

"Troxler Model 4640B, Serial #952 - 8 mCi Cs-137."

The Agreement State notified: NC PIO, FBI, SBI, Troxler, and the NCHP.

NC Incident # 05-34.

* * * UPDATE ON 10/3/2005 @ 11:25 FROM JEFFRIES TO ABRAMOVITZ * * *

"Troxler 3450 S/N 298 Cs-137 8 mCi S/N 750-5221 and Am-241:Be 40 mCi S/N 472355

"Troxler 4640B S/N 952 Cs-137 8 mCi S/N 50-9198

"Chain link fence was cut with bolt cutters. Gauges were stored in rear of tractor trailer storage unit. Torch and bolt cutters used to remove lock on trailer. Gauges with cases no longer on site. Both gauges had trigger locks and were locked in respective cases."

Contacted the R1DO (Rogge), the NMSSEO (Morell), and E-mailed TAS.

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General Information or Other Event Number: 42035
Rep Org: OK DEPT OF ENVIRONMENTAL HEALTH
Licensee: SANDS SPRINGS METAL PROCESSING
Region: 4
City: SANDS SPRINGS State: OK
County:
License #: N/A
Agreement: Y
Docket:
NRC Notified By: KEVIN SAMPSON
HQ OPS Officer: BILL HUFFMAN
Notification Date: 10/03/2005
Notification Time: 18:43 [ET]
Event Date: 10/03/2005
Event Time: 11:00 [CDT]
Last Update Date: 10/05/2005
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
TROY PRUETT (R4)
C.W. (BILL) REAMER (NMSS)

Event Text

AGREEMENT STATE REPORT ON A SOURCE OF UNKNOWN ORIGIN FOUND AT METAL PROCESSOR

The State representative reported that scrap metal received by a metal processor in Sand Springs, OK, set off the facility's gate radiation monitor. Investigation into the alarm determined that the radiation was coming from a foil source of unknown origin. The source dimensions are 3 inches by 1/2 inch with a contact reading (using a Ludlum Model 3) of 200 mR/hr. The scrap metal processor notified the State which dispatched inspectors to the site.

The State found that the source also had loose surface contamination. Investigation has determined that four individuals had handled the source. The State was able to contact one of those individuals and a survey of the individual revealed no indication of contamination. The State has not yet been able to contact the other three people involve in handling the source. The source has been wrapped in lead shielding material and secured in a safe location. The State plans to perform a Gamma Spec analysis of the source to determine the isotope. The investigation into the origin of the source has been unproductive so far. It appears that the scrap metal came from a intermediary scrap metal dealer.

* * * UPDATE ON 10/5/05 @ 15:20 FROM SAMPSON TO ABRAMOVITZ * * *

The source (foil) was determined to be Radium-226. The Curie content was not determined but was estimated to be in the micro Curie range. The loose contamination was not found on any other surfaces, only on the test swipe. The four individuals who contacted this source were contacted and an estimate of their dose is in progress.

Notified R4DO D. Graves.

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Hospital Event Number: 42038
Rep Org: PHILADELPHIA VA MEDICAL CENTER
Licensee: DEPARTMENT OF VETERANS
Region: 1
City: PHILADELPHIA State: PA
County:
License #: 03-23853-01VA
Agreement: N
Docket:
NRC Notified By: PAUL YURKO
HQ OPS Officer: PETE SNYDER
Notification Date: 10/05/2005
Notification Time: 13:17 [ET]
Event Date: 10/03/2005
Event Time: [EDT]
Last Update Date: 10/05/2005
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(3) - DOSE TO OTHER SITE > SPECIFIED LIMITS
Person (Organization):
JOHN ROGGE (R1)
GREG MORELL (NMSS)
DAVID GRAVES (R4)
BRUCE BURGESS (R3)

Event Text

MEDICAL EVENT - SOME BRACHYTHERAPY SEEDS ADMINISTERED TO WRONG SITE

"l am calling per 10 CFR 35.3045 to notify you of a possible medical event at the VA Medical Center, Philadelphia, Pennsylvania. On October 3, 2005 a permanent implant prostate brachytherapy procedure was performed at the medical center. A written directive prescribed 90 Iodine 125 seeds to be implanted in the patient's prostate.

"However, 45 of the seeds were implanted mistakenly in bladder. The seeds were recovered from the bladder prior to completion of the procedure in the operating room.

"The written directive was revised by the authorized user prior to completion of the procedure in the operating room to document the actual number of seeds implanted in the prostate (45).

"Based on dosimetry calculations performed October 4, 2005, a medical event may have occurred since the dose to the prostate and other tissues may differ from that originally prescribed in the written directive by values greater than those given in 10 CFR 35.3045.

"These circumstances appear to be similar to a previously reported event (Event No. 39586), which NRC ultimately decided did not represent a medical event.

"However, the NHPP has decided conservatively to perform an on-site review at the medical center next week to assess the particular circumstances of this event."

At the time of this report the licensee did not know why the event happened but will be investigating to determine the cause and the significance on 10/13/2005. The licensee stated that the patient was notified of the situation.

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Other Nuclear Material Event Number: 42039
Rep Org: BOEING COMPANY
Licensee: BOEING COMPANY
Region: 3
City: ST. LOUIS State: MO
County:
License #: 24-02261-03
Agreement: N
Docket:
NRC Notified By: RODNEY CADANAU
HQ OPS Officer: JOHN MacKINNON
Notification Date: 10/05/2005
Notification Time: 14:27 [ET]
Event Date: 09/07/2005
Event Time: 13:00 [CDT]
Last Update Date: 10/05/2005
Emergency Class: NON EMERGENCY
10 CFR Section:
20.2201(a)(1)(i) - LOST/STOLEN LNM>1000X
Person (Organization):
BRUCE BURGESS (R3)
LYDIA CHANG (NMSS)
D. PEREZ (e-mailed) (NMSS)

Event Text

EXIT SIGNS CONTAINING TRITIUM BELIEVED TO HAVE BEEN TAKEN TO LOCAL LANDFILL


On 09/07/05 during an inventory check it was discovered that 9 exit signs were missing from Building 102C, used as a storage building, at Boeing Company located in Berkeley, MO (suburb of St. Louis). They were last seen in May of 2005. The person that looks after the signs took an extended sick leave for several weeks during July. Three of the Exit signs were made by Self Powered Lighting and the other 6 were from SRB. The original total activity of the 9 Exit Signs was 119 curies and the current total activity of the Exit Signs is now 54 curies. It is believed that the Exit Signs were discarded in a dumpster and then the dumpster was taken to the local landfill. Exit Signs were made between 1988 and 1996.

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Power Reactor Event Number: 42041
Facility: INDIAN POINT
Region: 1 State: NY
Unit: [2] [ ] [ ]
RX Type: [2] W-4-LP,[3] W-4-LP
NRC Notified By: STEVE PRUSSMAN
HQ OPS Officer: PETE SNYDER
Notification Date: 10/05/2005
Notification Time: 21:22 [ET]
Event Date: 10/05/2005
Event Time: 15:20 [EDT]
Last Update Date: 10/05/2005
Emergency Class: NON EMERGENCY
10 CFR Section:
OTHER UNSPEC REQMNT
Person (Organization):
JOHN ROGGE (R1)
PETER WILSON (IRD)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N Y 100 Power Operation 100 Power Operation

Event Text

TRITIUM DETECTED IN TRANSFORMER YARD MONITORING WELL

"On October 5, 2005, at approximately 1520 hours a condition report was written to report that tritium was detected in monitoring well MW-111 located in the Indian Point [Unit] 2 transformer yard. The sample indicated 2.11E-4 micro curies per cc [cubic centimeter]. Other [nearby] sampling wells showed negative. Follow up samples and an investigation are in progress. The sampling that was done was part of an ongoing investigation to verify and quantify previously identified leakage, potentially from the spent fuel pool. Courtesy calls have been made to local officials to notify them of these findings."

The licensee notified the NRC Resident Inspector.

Page Last Reviewed/Updated Friday, March 30, 2012
Friday, March 30, 2012