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Event Notification Report for November 21, 2007

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
11/20/2007 - 11/21/2007

** EVENT NUMBERS **


42186 43783 43785 43786 43790 43793 43794 43796

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General Information or Other Event Number: 42186
Rep Org: WA DIVISION OF RADIATION PROTECTION
Licensee: AEROFAB INCORPORATED
Region: 4
City: PACIFIC State: WA
County:
License #: WN-I0315-1
Agreement: Y
Docket:
NRC Notified By: ARDEN SCROGGS
HQ OPS Officer: MIKE RIPLEY
Notification Date: 12/02/2005
Notification Time: 14:18 [ET]
Event Date: 03/08/2005
Event Time: [PST]
Last Update Date: 11/20/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
ANTHONY GODY (R4)
ROBERT PIERSON (NMSS)
CANADA CNSC (FAX) ()
TAS (EMAIL) ()

Event Text

AGREEMENT STATE REPORT - MISSING RADIOACTIVE MATERIAL

The State provided the following information via email:

"Date of Event: March 8, 2005 (reported to DOH December 1, 2005)
Location of Event: Pacific, Washington

"In a phone call made Thursday, December 1, by DOH staff to set up a time to meet with a licensee for a routine inspection, we were informed that a part of the licensed material they store had been stolen. The material stolen was 2,719 pounds magnesium metal plate that contained 2 and 3 percent Thorium-232. The plate thickness varied between 1.125 inches to 2.25 inches, with most measuring 1.25 inches. The plate dimensions varied. The longest and most numerous pieces were 72 inches long. The width varied from 3.38 inches to 65 inches with most measuring 8.25 inches. The largest plate weighed 590 pounds with three plates weighing around 250 pounds. Most pieces weighed 50 pounds. This is approximately one third of the licensee's inventory of this material. The size of the material left behind was larger than that taken and could be the reason the entire inventory was not stolen.

"Bolt cutters were used to cut off the locks to the storage building where the plate was stored. The material was loaded onto trucks and driven off the premises.

"The theft was reported to the local police when the theft was discovered by the licensee. The police report number of 05378 was given to this case. An insurance claim has also been filed. The licensee replaced the locks in a manner that will prevent them from being cut through again. Each door has two locks for a total of four locks.

"No media notified.

"Isotope and Activity involved:
Thorium-232, activity less than 6 millicuries. Activity was calculated based on the entire weight of 3% thorium alloy.

"Overexposures? (number of workers/members of the public; dose estimate; body part receiving dose; consequence): Not known.
Lost, Stolen or Damaged? (mfg., model, serial number): Stolen.
Disposition/recovery: There has been no recovery to date.
Leak test? N/A
Vehicle: (description; placards; Shipper; package type; Pkg. ID number) N/A
Release of activity? Not known.
Activity and pharmaceutical compound intended: N/A
Misadministered activity and/or compound received: N/A
Device (HDR, etc.) Mfg., Model; computer program: N/A
Exposure (intended/actual); consequences: N/A"

Washington Event Report # WA-05-070

This source is not amongst those sources or devices identified by the IAEA Code of Conduct for the Safety & Security of Radioactive Sources to be of concern from a radiological standpoint. Therefore is it being categorized as a less than Category 3 source.

* * * UPDATE AT 11:49 ON 11/20/2007 FROM ARDEN SCROGGS TO MARK ABRAMOVITZ * * *

The State provided the following information via email:

"The licensee has been unable to recover any of the stolen Magnesium Thorium Plate, they have not obtained any additional information regarding this incident of 32 months ago and now regard this as a 'dead issue.'"

Notified R4DO (Clark), FSME (Burgess), Canada (E-mail), and ILTAB (E-mail).

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
Fuel Cycle Facility Event Number: 43783
Facility: PORTSMOUTH GASEOUS DIFFUSION PLANT
RX Type: URANIUM ENRICHMENT FACILITY
Comments: 2 DEMOCRACY CENTER
                   6903 ROCKLEDGE DRIVE
                   BETHESDA, MD 20817 (301)564-3200
Region: 2
City: PIKETON State: OH
County: PIKE
License #: GDP-2
Agreement: Y
Docket: 0707002
NRC Notified By: GARY SALYERS
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 11/14/2007
Notification Time: 21:04 [ET]
Event Date: 11/14/2007
Event Time: 08:30 [EST]
Last Update Date: 11/20/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
OTHER UNSPEC REQMNT
Person (Organization):
GEORGE HOPPER (R2)
LARRY CAMPER (FSME)

Event Text

24-HR INCIDENT REPORT - SAFETY SYSTEM ACTUATION

"At 0830 hours, Autoclave #5 in the X-343 Facility experienced a Steam Shutdown due to high condensate level alarm (B) actuating. The autoclave was in TSR applicable Mode IV 'Feeding, Transfer or Sampling' when the actuation occurred. This is considered a valid actuation of a 'Q' Safety System. The autoclave was placed in Mode VII 'Shutdown' and declared inoperable by the Plant Shift Superintendent (PSS). An investigation is underway to determine the cause of the actuation. No release of radioactive material occurred as a result of the incident. This is being reported in accordance with UE-RA-RE1030 Appendix D.J.2. 'Safety Equipment Actuations.'"

The licensee notified the NRC Program Manager and will notify the DOE site representative.

* * * RETRACTION FROM G. SALYERS TO P. SNYDER AT 1553 ON 11/20/07 * * *

"Following an investigation into the circumstances surrounding this incident by PORTS Nuclear Regulatory Affairs and Engineering, a recommendation was made to the PSS Office that this event be retracted. The recommendation was based upon the determination that 'Steam Shutdown' occurred as a result of an invalid signal to 'B' condensate level alarm. The follow-up testing of the redundant 'A' condensate level probe and condensate drain system confirmed a high condensate level condition was not present when 'B' condensate level alarm actuated. Per the reporting criteria as stated in PORTS SAR section 6.9, Table 1, criteria J.2, this is not a reportable event due to the 'Q' system actuation being caused by an invalid signal. Based upon the information provided, the PORTS PSS Office is retracting this event."

Notified R2DO (Henson) and FSME EO (Morell).

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General Information or Other Event Number: 43785
Rep Org: CALIFORNIA RADIATION CONTROL PRGM
Licensee: STORK MATERIALS TESTING AND INSPECTION
Region: 4
City: RANCHO DOMINGUEZ State: CA
County:
License #: 1880-19
Agreement: Y
Docket:
NRC Notified By: BARBARA HAMRICK
HQ OPS Officer: PETE SNYDER
Notification Date: 11/15/2007
Notification Time: 13:27 [ET]
Event Date: 11/06/2007
Event Time: [PST]
Last Update Date: 11/15/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
VIVIAN CAMPBELL (R4)
GREG MORELL (FSME)

Event Text

AGREEMENT STATE REPORT - DISCONNECTED RADIOGRAPHY CAMERA SOURCE

On November 6, 2007, a radiography camera source was found by licensee personnel to be disconnected from the camera. The Assistant Radiation Safety Officer was notified, reported to the site and retrieved the source into a source changer for safe transport back to the licensee's facility. The camera contained a 69 curie Ir-192 source.

The State of California is following up on this incident.

CA identification number: 110807.

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General Information or Other Event Number: 43786
Rep Org: OHIO BUREAU OF RADIATION PROTECTION
Licensee: OHMART-VEGA
Region: 3
City: CINCINNATI State: OH
County:
License #: 03214310002
Agreement: Y
Docket:
NRC Notified By: STEPHEN JAMES
HQ OPS Officer: JASON KOZAL
Notification Date: 11/16/2007
Notification Time: 09:15 [ET]
Event Date: 11/14/2007
Event Time: [EST]
Last Update Date: 11/16/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DAVE PASSEHL (R3)
CINDY FLANNERY (FSME)
ILTAB (E-MAIL) ()
CANADA (EMAIL) ()

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

Event Text

AGREEMENT STATE REPORT - LOST Cs-137 SOURCE HOLDER

"Ohmart-VEGA RSO was informed on 11/14/07 that a shipment of SR-1A source holders sent to Gibraltar Mines in McLeese Lake, BC, Canada has been lost in transit. The missing consignment consists of 5 devices, each containing 100 mCi of Cs-137. The shipment left the Ohmart facility on 10/25/07. The Ohmart representative in Canada [DELETED] is leading the effort to locate the missing shipment. [DELETED] of the CNSC was notified by Canadian Freightways personnel on 11/14/07.

"TST Overland confirms turning over (2) skids to Canadian Freightways on Oct 29, 2007 in Burnaby, BC for furtherance to McLeese Lake, BC. One skid containing detectors was delivered to the customer in McLeese Lake. [DELETED] was unaware of this missing item until he received a phone call from the customer. He is pressing the trucking company to locate the equipment.

"Timeline as currently known:
TST-Overland picked up two skids at Ohmart-Vega in Cincinnati, OH on 10/25/07; TST signed for them on waybill 766-4148797.
TST-Overland moved the shipment through Sarnia, ON for delivery to TST-Porter Burnaby, BC.
TST-Porter in Burnaby verified receipt of two skids.
CFL was called to pick up 2 skids from TST-Porter in Burnaby on waybill 354-982526 per the attached copy.
CFL delivered the shipment of one pallet only to Williams Lake November 2.
Trace started with CFL November 9."

Devices are five Sealed Source Fixed Gauges activity of 100 mCi each Serial Numbers (5943CN, 5950CN, 6157CN, 6160CN, 6165CN).

Ohio report number: OH070006

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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General Information or Other Event Number: 43790
Rep Org: FLORIDA BUREAU OF RADIATION CONTROL
Licensee: SHANDS HOSPITAL AT THE UNIVERSITY OF FLORIDA
Region: 1
City: GAINSVILLE State: FL
County:
License #:
Agreement: Y
Docket:
NRC Notified By: DAVID FERGUSON
HQ OPS Officer: PETE SNYDER
Notification Date: 11/18/2007
Notification Time: 14:40 [ET]
Event Date: 11/18/2007
Event Time: [EST]
Last Update Date: 11/18/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DANIEL HOLODY (R1)
LARRY CAMPER (FSME)
ILTAB (e-mail) ()

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

Event Text

AGREEMENT STATE REPORT - BRACHYTHERAPY SOURCE LOST IN LAUNDRY

The State of Florida received a report from Shands Hospital that a 6 millicurie Ir-192 brachytherapy ribbon was lost in the laundry. Apparently, the ribbon was noticed missing following a brachytherapy treatment. Following the treatment, only 9 of 10 ribbons used were accounted for. The licensee said that a warning alarm sounded when laundry was put down the laundry chute, however; the licensee was unable to retrieve the material from the laundry prior to it being shipped off-site to the hospital's laundry facility in Lakeland, FL.

The licensee will continue to try to retrieve the material from the laundry. The State of Florida is following-up on this incident.

* * * UPDATE FROM D. FERGUSON TO P. SNYDER AT 1629 ON 11/18/07 * * *

The licensee retrieved the source from the laundry. The State of Florida is following-up on this incident.

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: 43793
Facility: QUAD CITIES
Region: 3 State: IL
Unit: [1] [2] [ ]
RX Type: [1] GE-3,[2] GE-3
NRC Notified By: JOHN VESELY
HQ OPS Officer: JEFF ROTTON
Notification Date: 11/20/2007
Notification Time: 11:29 [ET]
Event Date: 11/20/2007
Event Time: 05:05 [CST]
Last Update Date: 11/20/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
MARK RING (R3)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N Y 97 Power Operation 97 Power Operation
2 N Y 96 Power Operation 96 Power Operation

Event Text

CONTROL ROOM EMERGENCY VENTILATION SYSTEM INOPERABLE

"On November 20, 2007, at 0505 hours, the Control Room Emergency Ventilation (CREV) system was declared inoperable due to an inoperable Air Filtration Unit (AFU). During monthly testing it was discovered that the AFU heater failed to operate as required. Technical Specification 3.7.4, Condition A, was entered which requires the CREV system to be restored to an operable status in seven days. This notification is being made in accordance with I0CFR50.72(b)(3)(v)(D), Event or Condition That Could Have Prevented Fulfillment of a Safety Function, because the CREV system is a single train system required to mitigate the consequences of an accident.

"Troubleshooting is in progress to determine the cause of the AFU heater failure to start."

The licensee notified the NRC Resident Inspector and the Illinois Emergency Management Agency (IEMA).

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Power Reactor Event Number: 43794
Facility: PILGRIM
Region: 1 State: MA
Unit: [1] [ ] [ ]
RX Type: [1] GE-3
NRC Notified By: JOHN MACDONALD
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 11/20/2007
Notification Time: 14:15 [ET]
Event Date: 11/20/2007
Event Time: 06:30 [EST]
Last Update Date: 11/20/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
JAMES DWYER (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

HIGH PRESSURE COOLANT INJECT INOPERABLE

"On November 20, 2007 at 0630 hours, with the reactor at 100% core thermal power, a power supply failure was discovered in the high pressure coolant injection (HPCI) flow controller circuitry that may have precluded the system from performing its design basis function. Therefore, in accordance with 10 CFR Part 50.72(b)(3)(v) an eight-hour notification is being made.

"As background, on November 18, 2007, at 2145 hours, the high pressure coolant injection (HPCI) system was removed from service for planned maintenance. The required risk analysis was performed and the appropriate 14 day limiting condition for operation (LCO) was entered in accordance with Technical Specification (TS) 3.5.C. Later on November 19, 2007 at approximately 2100 hours the planned maintenance had been completed and HPCI was restored to the normal standby line-up in preparation for post maintenance testing (PMT). The HPCI valve quarterly operability and HPCI pump and valve quarterly operability tests were performed as the prescribed PMT. Upon initiation, the HPCI turbine was observed to come up to expected rated speed (~4,200 rpm) and expected HPCI pump discharge pressure (~1,300 psig). However HPCI pump indicated discharge flow was observed to be ~2,300 gpm, which is less than the Technical Specification requirement of 4,250 gpm. The HPCI system was secured and remained in the original TS 3.5.C LCO and a troubleshooting plan was initiated.

"On November 20, 2007, at 0630 hours, troubleshooting identified a power supply failure in the HPCI flow control circuitry. A replacement flow controller was identified and installed and it is anticipated that appropriate PMT will be initiated by 1600 hours. The impact of the power supply failure for the design basis operability for HPCl could not be definitively established before the eight-hour notification requirement of 10 CFR Part 50.72(b)(3)(v) was exceeded."

The licensee notified the NRC Resident Inspector and the Commonwealth of Massachusetts.

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Power Reactor Event Number: 43796
Facility: SUMMER
Region: 2 State: SC
Unit: [1] [ ] [ ]
RX Type: [1] W-3-LP
NRC Notified By: JASON WEATHERBY
HQ OPS Officer: PETE SNYDER
Notification Date: 11/20/2007
Notification Time: 16:16 [ET]
Event Date: 09/27/2007
Event Time: 05:12 [EST]
Last Update Date: 11/20/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
50.73(a)(1) - INVALID SPECIF SYSTEM ACTUATION
Person (Organization):
JAY HENSON (R2)

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

INVALID EMERGENCY DIESEL GENERATOR START

"This telephone notification is being made under 10 CFR 50.73(a)(2)(iv)(A) in lieu of an LER submittal, pursuant to NUREG-1022, Section 3.2.6.

"At 0512 on 09/27/07 the 'A' Diesel Generator (DG) was being restored to its normal lineup following a maintenance run. During restoration per Station Operating Procedure SOP-306, an under instruction Operations trainee inadvertently pressed the 'Emergency Start' pushbutton instead of verifying the 'Emergency Start' status light was clear as required by Step 2.4.b of the procedure. This resulted in a start of the 'A' DG in the emergency mode. Following an equipment walk down, the 'A' DG was then secured at 0518.

"This inadvertent start of the 'A' DG was determined to be an invalid actuation since it was not the result of a valid signal nor an intentional manual actuation. This inadvertent start was complete, in that the DG started and ran, however; the bus was not required to be loaded and the output breaker did not close. Although inadvertently actuated, the 'A' DG started successfully and would have been able to function in the emergency mode if it had been required."

The licensee notified the NRC Resident Inspector.

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Thursday, March 29, 2012