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Event Notification Report for March 15, 2007

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
03/14/2007 - 03/15/2007

** EVENT NUMBERS **


43139 43214 43235 43236 43238 43239 43240

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
Power Reactor Event Number: 43139
Facility: THREE MILE ISLAND
Region: 1 State: PA
Unit: [1] [ ] [ ]
RX Type: [1] B&W-L-LP,[2] B&W-L-LP
NRC Notified By: STUART BRANTLEY
HQ OPS Officer: BILL HUFFMAN
Notification Date: 02/02/2007
Notification Time: 21:05 [ET]
Event Date: 02/02/2007
Event Time: 13:50 [EST]
Last Update Date: 03/14/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
CHRISTOPHER CAHILL (R1)

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

Event Text

LOW PRESSURE INJECTION (LPI) NET POSITIVE SUCTION HEAD FLOW REQUIREMENTS NOT MET FOR CERTAIN ACCIDENT SEQUENCES

"At 1350 hours on February 2, 2007, with the plant at 100% power, it was determined [that] the low pressure injection (LPI) system net positive suction head calculation does not account for the additional flow through the failed LPI pump recirculation line during certain accident scenarios. The additional flow is upstream of the flow element used by control room operators to throttle system flow to maintain net positive suction head flow requirements. The additional flow could result in net positive suction head below required design limits. The system design is not affected in events where both LPI trains perform as designed.

"Emergency operating procedures direct control room operators to open the LPI system discharge flow cross-connect line isolation valves, if accessible, following a LPI pump failure. Operators are then directed to throttle system flow through the operable LPI pump to maintain proceduralized values. These values are designed to provide sufficient design flow and maintain pump NPSH. During a simulator training scenario, operators identified when the discharge cross-connect line isolation valves were opened, the idle Building Spray train indicated flow. Follow-up investigation identified the increased flow was due to back flow through the failed LPI pump minimum flow recirculation line. This additional flow is upstream of the flow element used by operators to maintain adequate net positive suction head for the operable LPI pump. The additional flow could result in not meeting NPSH design requirements.

"The licensee entered the 72 hour Technical Specification limiting condition for operation (LCO) for one inoperable LPI train. The licensee is revising calculations and emergency operating procedures to account for the additional flow.

"This condition is reportable in accordance with 10CFR 50.72(b)(3)(ii) and (b)(3)(v) as an unanalyzed condition, and a condition that could have prevented the fulfillment of the safety function of the LPI system to mitigate the consequences of an accident, respectively. "

The NRC Resident Inspector was notified of this event by the licensee.

*** RETRACTION FROM MILLER TO KNOKE AT 11:11 ON 03/14/07 ***

"The purpose of this report is to retract the ENS report made on February 2, 2007 at 2105 hours ( ENS #43139) under 10CFR50.72(b)(3)(ii) and (b)(3)(v) as an unanalyzed condition, and a condition that could have prevented the fulfillment of the safety function of the Low Pressure Injection (LPI) system to mitigate the consequences of an accident, respectively. The initial report was made when it was determined that the LPI system net positive suction head (NPSH) calculation does not account for the additional flow through the LPI pump recirculation line during certain accident scenarios. The additional flow could result in net positive suction head below required design limits. Due to this condition, it was not certain if the LPI system could have met its design basis requirements. The licensee entered the 72 hour Technical Specification limiting condition for operation (LCO) for one inoperable LPI train. The LCO was exited on February 3, 2007 at 9:25PM following implementation of a procedure change that accounted for the additional flow and ensured that adequate NPSH was maintained. A subsequent engineering evaluation has determined that sufficient LPI pump NPSH would have been available to perform its design basis function prior to the procedure change. The engineering evaluation shows that the LPI pumps remained capable of performing their design basis functions based on the following three independent assessments:

1) the LPI pumps would have operated well beyond their mission time without significant cavitation damage at the available NPSH
2) proceduralized operator actions would have throttled flow to restore required NPSH if signs of cavitation occurred
3) an evaluation using realistic Reactor Building pressures showed that sufficient NPSH would exist."

The licensee notified the NRC Resident Inspector. Notified R1DO (Hott)

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
General Information or Other Event Number: 43214
Rep Org: OR DEPT OF HEALTH RAD PROTECTION
Licensee: EMANUEL HOSPITAL
Region: 4
City: PORTLAND State: OR
County:
License #: 90014
Agreement: Y
Docket:
NRC Notified By: KEVIN SIEBERT
HQ OPS Officer: JOHN KNOKE
Notification Date: 03/05/2007
Notification Time: 15:38 [ET]
Event Date: 11/01/2006
Event Time: 00:00 [PST]
Last Update Date: 03/14/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
VINCE GADDY (R4)
G. MORELL (FSME)

Event Text

AGREEMENT STATE - PERSONNEL UNDEREXPOSURE

The State was notified by the licensee's RSO that a patient had an underexposure by 24%. The State will provide updates as licensee information is received.

A "Medical Event" may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.

* * * RETRACTION PROVIDED BY K. SIEBERT TO KOZAL ON 3/14/07 AT 1333 EDT * * *

After review of the event by the licensee and the State, the material involved in this event (Palladium -103) is accelerator produced and is not regulated by the NRC. Therefore, this event is not reportable and is retracted.

Notified R4DO (Shannon) and FSME (G. Morell)

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General Information or Other Event Number: 43235
Rep Org: FAIRBANKS MORSE
Licensee: FAIRBANKS MORSE
Region: 3
City: BELOIT State: WI
County:
License #:
Agreement: Y
Docket:
NRC Notified By: DOMINIC DEDOLPH
HQ OPS Officer: JOHN MacKINNON
Notification Date: 03/14/2007
Notification Time: 11:41 [ET]
Event Date: 03/13/2007
Event Time: 12:00 [CDT]
Last Update Date: 03/14/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21 - UNSPECIFIED PARAGRAPH
Person (Organization):
RICHARD SKOKOWSKI (R3)
OMID TABATABAI (NRR)

Event Text

10 CFR 21 NOTIFICATON - IDENTIFICATION OF DEFECT WOODWARD GOVERNOR PIVOT PIN DEFECT

This Part 21 was received via facsimile

Pursuant to 10 CFR 21.21 (d)(3)(ii), Fairbanks Morse Engine is submitting a written notification on the identification of a defect that is considered to be a substantial safety hazard.


(II) Identification of the facility, the activity, or the basic component supplied for such facility or such activity within the United States which fails to comply or contains a defect.

Facility:

Duane Arnold Energy Center

Basic component which fails to comply or contains a defect:

Woodward governor actuator model EGB13P, part number 16403190, Woodward part number 9903-561 for Fairbanks Morse Engine Emergency Diesel Generator (EDG).

(iii) Identification of the firm constructing the facility or supplying the basic component which fails to comply or contains a defect.

Fairbanks Morse Engine
701 White Avenue
Beloit, WI 53511

(IV) Nature of the defect or failure to comply and the safety hazard which is created or could be created by such defect or failure to comply.

Nature of defect:

Per Woodward service bulletin 01393 dated January 2007, a pivot pin within the governor actuator was manufactured from incorrect material. The subsequent case hardening of the pivot pin made from incorrect material resulted in through hardening, making the pivot pin more brittle.

Safety hazard which could be created by such defect:

Per Woodward service bulletin 01393, a potential for pivot pin fracture exists which would result in the governor actuator going to the minimum fuel setting. The EDG would not be capable of carrying load under this condition.

The inability of an EDG to carry a load during a design basis event would be considered a loss of safety function.


(v) The date on which the information of such defect or failure to comply was obtained.

Fairbanks Morse Engine received Woodward service bulletin 01393 on 1/11/07. Duane Arnold Energy Center was notified of this situation via e-mail dated 1/12/07.


(vi) In the case of a basic component which contains a defect or fails to comply, the number and location of all such components in use at, supplied for, or being supplied for one or more facilities or activities subject to the regulations in this part.


The list of potentially affected governor actuators identified in Woodward service bulletin 01393 contains only 3 units (serial numbers 14693610, 14687576 and 14699005) that were purchased by Fairbanks Morse Engine on purchase order 1079037-I. All 3 units were sold to Duane Arnold Energy Center and had not been assembled to the EDGs.


(vii) The corrective action which has been, is being, or will be taken; the name of the individual or organization responsible for the action; and the length of time that has been or will be taken to complete the action.


The 3 units were repaired at Woodward on 1/18/07 by replacing the though hardened pivot pin with one that was from a lot that was verified via destructive analysis to be hardened to the properly case depth. All future lots of pivot pins will have case depth measurements taken to ensure proper case depth.


(viii) Any advice related to the defect or failure to comply about the facility, activity, or basic component that has been, Is being, or will be given to purchasers or licensees.


The need for repair of the 3 units was communicated to Duane Arnold Energy Center on 1/12/07. The repaired governor actuators were returned to Duane Arnold Energy Center on 1/26/07.

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Other Nuclear Material Event Number: 43236
Rep Org: MC SQUARED, INC.
Licensee: MC SQUARED, INC.
Region: 1
City: TAMPA State: FL
County:
License #:
Agreement: Y
Docket:
NRC Notified By: CHRISTOPHER DIVICAR
HQ OPS Officer: PETE SNYDER
Notification Date: 03/14/2007
Notification Time: 16:15 [ET]
Event Date: 03/07/2007
Event Time: [EDT]
Last Update Date: 03/14/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
20.2201(a)(1)(ii) - LOST/STOLEN LNM>10X
Person (Organization):
JOHN CARUSO (R1)
GREG MORELL (FSME)
ILTAB (E-MAIL) ()

This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

LOST TROXLER MOISTURE DENSITY GAUGE


This event was entered per the request of NRC Region 1


On the morning of 3/7/07 the reporting company noticed that a Troxler Moisture Density Gauge (Model 3411B, Serial Number 13563) was missing. The gauge was used Friday 3/2/07 at a jobsite at 35050 Halls Road, Clewiston, Florida and placed in a storage trailer. The jobsite was on a Seminole Indian Reservation.

The trailer had not been broken into. The Seminole Reservation authorities are investigating. The licensee will submit a written report.

This report was originally reported to the state of Florida, see event # 43219 reported on 3/7/07, since the reporting company was a Florida Licensee (License Number 3424-1). The reporting company also called the NRC on 3/7/07 at 15:18 regarding this same event.


THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL

Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks.

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Power Reactor Event Number: 43238
Facility: PEACH BOTTOM
Region: 1 State: PA
Unit: [2] [ ] [ ]
RX Type: [2] GE-4,[3] GE-4
NRC Notified By: SARA ANDERSON
HQ OPS Officer: JASON KOZAL
Notification Date: 03/14/2007
Notification Time: 20:36 [ET]
Event Date: 03/14/2007
Event Time: 14:55 [EDT]
Last Update Date: 03/14/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
CHRIS HOTT (R1)

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

HPCI DECLARED INOPERABLE

"During performance of a Unit 2 High Pressure Coolant Injection System (HPCI) Pump, Valve, Flow and Unit Cooler Functional and In-service Test, the High Pressure Coolant Injection System (HPCI) was declared inoperable. The inoperability is due to failure of AO-2-23-042 "HPCI Steam Line Drain Inboard Isolation to Main Condenser" to open. The AO-2-23-042 is normally open and its passive safety function is to remove any steam condensation from the HPCI pump turbine steam supply line. HPCI is a single train safety system rendered inoperable by this condition."

The licensee notified the NRC Resident Inspector.

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Power Reactor Event Number: 43239
Facility: SUSQUEHANNA
Region: 1 State: PA
Unit: [ ] [2] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: RICH KLINEFELTER
HQ OPS Officer: BILL HUFFMAN
Notification Date: 03/14/2007
Notification Time: 22:06 [ET]
Event Date: 03/14/2007
Event Time: 23:00 [EDT]
Last Update Date: 03/14/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
CHRIS HOTT (R1)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N N 0 Refueling 0 Refueling

Event Text

OUTAGE OF SPDS AND ERDS

"At 2300 hours, on 03/14/2007, the Unit 2 SPDS and ERDS system will be removed from service to support restoration activities from a planned maintenance outage on the power supply. The duration of work is expected to be approximately 20 hours. (Scheduled for completion at 1900 hours on 03/15/2007). During this time, Control Room indications and alternate methods will be available.

"Since the Unit 2 SPDS computer system will be unavailable for greater than 8 hours, this is considered a Loss of Emergency Assessment Capability and reportable under 10CFR50.72(b)(3)(xiii)."

The licensee notified the NRC Resident Inspector.

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Power Reactor Event Number: 43240
Facility: CALLAWAY
Region: 4 State: MO
Unit: [1] [ ] [ ]
RX Type: [1] W-4-LP
NRC Notified By: MARK COVEY
HQ OPS Officer: JASON KOZAL
Notification Date: 03/14/2007
Notification Time: 22:22 [ET]
Event Date: 03/14/2007
Event Time: 14:35 [CDT]
Last Update Date: 03/14/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(A) - POT UNABLE TO SAFE SD
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
MICHAEL SHANNON (R4)

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

Event Text

TWO OUT OF THREE AUXILIARY FEEDWATER PUMPS OUT OF SERVICE

"A pinhole leak was discovered on B train Essential Service Water (ESW) system piping while preparing the pipe surface for non-destructive examination. Control room personnel were notified of the leak at 1435. B ESW was immediately declared inoperable. At the time of control room notification, surveillance testing on the Turbine Driven Auxiliary Feedwater Pump (TDAFP) was in progress. This surveillance testing made the TDAFP inoperable and non-functional. The surveillance activities were terminated and the TDAFP was returned to operable status at 1438.

"B ESW is the safety related water source for B train of auxiliary feedwater (AFW). For the three minute period between notification of the pinhole leak until the TDAFP was restored to operable status, there were two auxiliary feed pumps inoperable. This met the conditions for entry into T/S LCO Action 3.7.5.D which requires a plant shut down to Hot Standby within 6 hours. This action was exited when the TDAFP surveillance testing was terminated. Additionally, with 2 of 3 auxiliary feedwater pumps non-functional for 3 minutes, there was a condition which could have prevented fulfillment of a safety function for those 3 minutes."

The licensee notified the NRC Resident Inspector.

Page Last Reviewed/Updated Thursday, March 29, 2012
Thursday, March 29, 2012