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Event Notification Report for July 30, 2008

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
07/29/2008 - 07/30/2008

** EVENT NUMBERS **


44364 44372 44373 44374

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General Information or Other Event Number: 44364
Rep Org: MARYLAND DEPT OF THE ENVIRONMENT
Licensee: NEUTRON PRODUCTS INC
Region: 1
City: DICKERSON State: MD
County:
License #: MD-3102503
Agreement: Y
Docket:
NRC Notified By: ALAN JACOBSON
HQ OPS Officer: JASON KOZAL
Notification Date: 07/25/2008
Notification Time: 10:57 [ET]
Event Date: 07/21/2008
Event Time: 18:20 [EDT]
Last Update Date: 07/28/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JAMES TRAPP (R1)
MICHELE BURGESS (FSME)

Event Text

AGREEMENT STATE REPORT - POTENTIAL OCCUPATIONAL OVEREXPOSURE

On July 22, 2008, the State of Maryland was informed by the Teletherapy Operations Manager for Neutron Products, Inc. that one of their teletherapy service engineers performing an Alcyon Co-60 source exchange in Brazil had received a potential overexposure.

During the source exchange, the engineer's electronic dosimeter alarmed. Immediate actions were taken to properly secure the source. Preliminary dosimetry readings for the service engineer indicated a potential whole body exposure of approximately 5,211 mrem and extremity reading at the right wrist exceeding 10R (off scale high). The service engineer's film badge was sent for immediate processing to Global Dosimetry with expected results available for evaluation by Thursday, 7/24.

The results from Global Dosimetry for the service engineer prior to the incident are as follows:

Monthly whole body (DDE, mrem) - 13,465 + 92 (Jan. - May) = 13,557
Left wrist (SDE, mrem) - 73,356 + 236 (Jan. - May) = 73,592
Right wrist (SDE, mrem) - 746 + 488 (Jan. - May) = 1,234

Brazilian regulatory personnel were onsite at the hospital at the time the incident occurred and were briefed within one (1) hour by the service engineer.


* * * UPDATE FROM ALAN JACOBSON TO JOHN KNOKE AT 0739 EDT ON 07/28/08 * * *

"Per our telephone conversation of today [between the state and the licensee], this is to update our initial verbal and written Twenty-Four Hour Notifications made July 22, 2008 regarding the incident in Sao Paulo, Brazil, and to summarize our employee's written account thereof.

"On July 21, 2008 at approximately 6:20 pm EDT, Neutron Products employee #502, informed us via telephone that he may have received an over-exposure while performing a source exchange on an Alcyon II teletherapy unit located in Sao Paulo, Brazil. On July 21, 2008, employee #502 and a radiation worker from Brazil were in the process of transferring the expended cobalt-60 source from the Alcyon II unit into Neutron's transfer cask in accordance with Specification P-9, Appendix XI. After engaging the source holder with the removal tool, #502 transferred the source holder from the Alcyon II unit head into the transfer cask. Once the source holder was in the transfer cask, #502 continued making preparations to complete the removal sequence.

"Employee #502 had completed all the steps of the removal sequence and was in the process of removing the removal tool from the transfer cask, when it was determined by audible alarms and before the tool was completely out of the cask, that the cobalt-60 source was still connected to the end of the removal tool. At that point, #502 reinserted the removal tool back into the cask and repeated the steps again to make sure that the Source was disengaged from the removal tool. Once he was sure that the source was no longer attached to the removal tool, the tool was removed from the cask, and all the covers installed. The transfer cask now contains both the expended and new sources.

"Immediately after the container was secured, both men read their SRD's and reported their dose as follows: #502: WB-5,211 mrem, Left Wrist-300 mrem, and Right Wrist-off Scale (10R dosimeter); Brazilian Worker: WB-533 mrem, Left Wrist-off scale (10R dosimeter), and, Right Wrist-4,100 mrem. The TLD's were sent via FED-EX to Global Dosimetry Solutions in Irvine, CA, for emergency reading and the results are as follows: #502: Monthly WB DDE-13,465 mrem, Quarterly WB DDE-11,126 mrem, Left Wrist SDE-73,356 mrem, and Right Wrist SDE-746 mrem. Brazilian Worker: Monthly WB DDE-702 mrem, Quarterly WB DDE-1,559 mrem, Left Wrist SDE-3,030 mrem, and Right Wrist SDE-8,542 mrem.

"Employee #502 will be returning home sometime this weekend. He will not be involved in any radiation work for the remainder of the year."

Notified R1DO (Trapp) and FSME (M. Burgess)

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Research Reactor Event Number: 44372
Facility: REED COLLEGE
RX Type: 250 KW TRIGA MARK I
Comments:
Region: 4
City: PORTLAND State: OR
County: MULTNOMAH
License #: R-112
Agreement: Y
Docket: 05000288
NRC Notified By: STEPHEN FRANTZ
HQ OPS Officer: STEVE SANDIN
Notification Date: 07/29/2008
Notification Time: 14:30 [ET]
Event Date: 07/24/2008
Event Time: 14:00 [PDT]
Last Update Date: 07/29/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
NON-POWER REACTOR EVENT
Person (Organization):
NEIL O'KEEFE (R4)
DAN HUGHES (NRR)

Event Text

TEST REACTOR EXCEEDED LICENSED POWER LIMIT DURING CALIBRATION

"Performing calorimetric power calibration of nuclear instruments with a new fuel element installed per SOP-44. Indicated power was 230kW. Calculated power after 70 minutes was 281kW, in excess of licensed power of 250kW. Also, due to miscalibration the 110% scrams on linear and percent power would not occur until an actual power of 124%. Reactor power was lowered and another calibration confirmed the error. The reactor was shutdown and the NRR Project Manager (Dan Hughes) was called."

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Other Nuclear Material Event Number: 44373
Rep Org: ENGINEERING CONSULTING SERVICES
Licensee: ENGINEERING CONSULTING SERVICES
Region: 1
City: CHANTILLY State: VA
County:
License #: 45-24974-01
Agreement: N
Docket:
NRC Notified By: OMER DUZYOL
HQ OPS Officer: STEVE SANDIN
Notification Date: 07/29/2008
Notification Time: 15:38 [ET]
Event Date: 07/29/2008
Event Time: 14:00 [EDT]
Last Update Date: 07/29/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
30.50(b)(2) - SAFETY EQUIPMENT FAILURE
Person (Organization):
RICHARD BARKLEY (R1)
KEVIN HSUEH (FSME)

Event Text

MOISTURE DENSITY GAUGE RUN OVER BY COMPACTOR

At approximately 1400 EDT on 07/29/08 a CPN moisture density gauge, model #MC1DR - S/N M36056763, containing a Cs-137 10mCi and Am-241:Be 50 mCi source was run over by a compactor at a construction site at 7152 Heller Loop in Springfield, VA. The sources remained in the safe stored position during the incident, however, the Cesium source rod was broken off. The device was secured and removed from the construction site after a rad survey confirmed readings less than 0.4 mr/hr at 1 meter.

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Power Reactor Event Number: 44374
Facility: SAN ONOFRE
Region: 4 State: CA
Unit: [ ] [2] [3]
RX Type: [1] W-3-LP,[2] CE,[3] CE
NRC Notified By: LEE KELLY
HQ OPS Officer: BILL HUFFMAN
Notification Date: 07/29/2008
Notification Time: 19:09 [ET]
Event Date: 07/29/2008
Event Time: 14:00 [PDT]
Last Update Date: 07/29/2008
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
NEIL O'KEEFE (R4)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N Y 99 Power Operation 99 Power Operation
3 N Y 100 Power Operation 100 Power Operation

Event Text

PRESS RELEASE CONCERNING IMPACT OF EARTHQUAKE ON SOUTHERN CALIFORNIA EDISON ASSETS

On July 29, 2008, SCE issued a press release regarding the earthquake that occurred on the same day. Along with information on other facilities, the press release included information on San Onofre Nuclear Power Plant and stated:

"The earthquake was felt at the San Onofre Nuclear Generating Station site. There were no safety issues reported and no indications of any damage. The plant continues to operate normally."

The NRC Resident Inspector has been notified.

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