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Event Notification Report for January 29, 2009

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
01/28/2009 - 01/29/2009

** EVENT NUMBERS **


44780 44794 44795 44802 44803 44804 44806 44810 44811 44812 44814

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General Information or Other Event Number: 44780
Rep Org: MISSISSIPPI DIV OF RAD HEALTH
Licensee: JANX INTEGRITY GROUP
Region: 4
City: HATTIESBURG State: MS
County:
License #: 21-16560-01
Agreement: Y
Docket:
NRC Notified By: JAYSON MOAK
HQ OPS Officer: JASON KOZAL
Notification Date: 01/16/2009
Notification Time: 13:16 [ET]
Event Date: 01/15/2009
Event Time: [CST]
Last Update Date: 01/28/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RYAN LANTZ (R4)
ANGELA MCINTOSH (FSME)

Event Text

AGREEMENT STATE - FIRE INVOLVING RADIOGRAPHY CAMERA

The following was provided by the State via e-mail:

"On 1-15-09, DRH was notified by the Forrest County ERC that JANX Integrity Group had an accident with one of their darkroom trucks off Hwy 59 N., in Hattiesburg, MS. The driver for JANX struck a tree off the side of the interstate causing the vehicle to catch fire. The driver then left the scene of the accident. The radiography camera, SPEC-150, SN 150 (Ir-192, 65 Ci), was not discovered until the fire department saw a 'Caution Radiation Area' sign in the bed of the darkroom truck after extinguishing the fire. Surveys were conducted by firefighter personnel for their safety and to pinpoint the location of the radioactive device in the darkroom truck. The Forrest County ERC contacted an industrial radiography company and MS Licensee located in Hattiesburg to take possession of the camera and secure it in their storage vault. The radiography camera was retrieved off the darkroom truck and out of its locked storage box by the MS Licensee. The radiography camera was surveyed by the MS Licensee before being transported to their storage facility. On 1-15-09, JANX retrieved the radiography camera out of storage for transport back to the manufacturer to assess the damage.

"DRH took surveys of the darkroom truck and the radiography camera. Radiation measurements were as follows: 24 mR/hr at the surface of the camera; 4 mR/hr at 6 inches from the camera; levels were background at the vehicle. DRH coordinated the receipt of radiography camera between JANX and a MS licensee for delivery back to the manufacturer."

MS report number - MS 09001

* * * UPDATE FROM JAYSON MOAK TO HOWIE CROUCH AT 1739 ON 1/23/09 * * *

The following was provided by the State via e-mail:

"On 1-15-09, swipes were taken on the camera and revealed no removable contamination. Leak test results for the source and DU shielding were received from SPEC on 1-23-09 and also revealed no removable contamination."

Notified FSME EO (Chang) and R4DO (Farnholtz).


* * * UPDATE FROM JAYSON MOAK (VIA EMAIL) TO JASON KOZAL AT 1232 ON 1/28/09 * * *

The following was provided by the State via e-mail:

"On 1-28-09, DRH received the SPEC - 150, Exposure Device S/N 150 Final Inspection Certificate from SPEC. The camera met the requirements contained in 10 CFR 34.20, ANSI N432 1980, USA/9263/B(U)-96 and SPEC's QA Program approval number 102."

Notified FSME EO (White) and R4DO (Cain).

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General Information or Other Event Number: 44794
Rep Org: NH DEPT OF HEALTH & HUMAN SERVICES
Licensee: WALMART
Region: 1
City:  State: NH
County:
License #: GL
Agreement: Y
Docket:
NRC Notified By: TWILA KENNA
HQ OPS Officer: HOWIE CROUCH
Notification Date: 01/22/2009
Notification Time: 13:25 [ET]
Event Date: 01/22/2009
Event Time: [EST]
Last Update Date: 01/22/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
WILLIAM COOK (R1)
MICHELE BURGESS (FSME)
ILTAB via email ()

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

Event Text

AGREEMENT STATE REPORT - MISSING TRITIUM EXIT SIGNS

The State of New Hampshire was notified by a Walmart corporate representative located in Bentonville, AR, indicating that Walmart was unable to account for 35 tritium exit signs (which are general licensed materials) that were used at one time in Walmart stores throughout the State of New Hampshire. The Walmart representative informed the State office that Walmart had exhausted searching for the tritium exit signs and considered them to be lost and/or missing. The state of New Hampshire was provided a listing from corporate Walmart of the store locations along with information on the tritium exit sign manufacturers, model and serial numbers, and curie content where known.


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.

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

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General Information or Other Event Number: 44795
Rep Org: NH DEPT OF HEALTH & HUMAN SERVICES
Licensee: WALMART
Region: 1
City:  State: NH
County:
License #: GL
Agreement: Y
Docket:
NRC Notified By: TWILA KENNA
HQ OPS Officer: HOWIE CROUCH
Notification Date: 01/22/2009
Notification Time: 13:25 [ET]
Event Date: 01/22/2009
Event Time: [EST]
Last Update Date: 01/22/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
WILLIAM COOK (R1)
LYDIA CHANG (FSME)

Event Text

AGREEMENT STATE REPORT - DAMAGED TRITIUM EXIT SIGNS

The State of New Hampshire was notified by a Walmart corporate representative located in Bentonville, AR, of a total of three (3) tritium exit signs (TES) (which are general licensed materials) that were damaged at Walmart stores throughout the State of New Hampshire. All three signs have been properly packaged and shipped to a specific licensee authorized to receive damaged TES. There were no overexposures to Walmart personnel. All contamination has been cleaned and all areas were free released.

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General Information or Other Event Number: 44802
Rep Org: NC DIV OF RADIATION PROTECTION
Licensee: QSL INSPECTIONS
Region: 1
City: MONROE State: NC
County:
License #: 0901058-1
Agreement: Y
Docket:
NRC Notified By: SHARN JEFFRIES
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 01/23/2009
Notification Time: 13:03 [ET]
Event Date: 01/13/2009
Event Time: 15:00 [EST]
Last Update Date: 01/23/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
WILLIAM COOK (R1)
MICHELE BURGESS (FSME)

Event Text

AGREEMENT STATE REPORT - STUCK RADIOGRAPHY SOURCE

"Licensee performing a routine radiography source exchange. New source (100 Ci) would not come out of source exchanger. Licensee Asst RSO attempted to withdraw old source (22 Ci), and old source came out of source exchanger and had to be recovered.

"WB [Whole Body] Dosimetry From Landauer (confirmed)
"317 [mR] WB for Asst RSO
"366 [mR] WB for Radiographer who retrieved source

"Dose Estimates to Extremity
"7.5 Rem to left hand for Asst RSO
"1.73 Rem to right hand for Radiographer who retrieved source
"REACTS has received blood tube for testing for Asst RSO."

The licensee is shipping both sources back to the manufacturer.

Location of the event: 1721 William Road, Monroe, NC 28110

NC Incident: 09-06

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General Information or Other Event Number: 44803
Rep Org: NC DIV OF RADIATION PROTECTION
Licensee: CHARLOTTE MECKLENBERG HOSPITAL AUTHORITY
Region: 1
City: CHARLOTTE State: NC
County:
License #: 060-0014-3
Agreement: Y
Docket:
NRC Notified By: SHARN JEFFRIES
HQ OPS Officer: HOWIE CROUCH
Notification Date: 01/23/2009
Notification Time: 13:42 [ET]
Event Date: 01/21/2009
Event Time: 11:30 [EST]
Last Update Date: 01/23/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
WILLIAM COOK (R1)
MICHELE BURGESS (FSME)

Event Text

AGREEMENT STATE REPORT - LEAKING I-125 BRACHYTHERAPY SEEDS

The following information was obtained from the State of North Carolina by fax:

"[The] Licensee stores unused I-125 Brachytherapy seeds in bulk with other unused I-125 sources. A routine leak test of the bulked I-125 seeds in October yielded no removable contamination. A routine leak test of the bulked I-125 seeds in January 2009 showed removable contamination: 2.3-2.8 microCuries.

"The licensee has 223 total iodine brachytherapy seeds stored in the storage container and cannot determine which seeds are leaking. 164 seeds were added to the storage container since the October leak test.

"[The] Licensee has contacted [the] manufacturer (Core Oncology) to return seeds and perform assay on seeds to determine which seeds are indeed leaking.

"The licensee cannot ascertain if the I-125 seeds were damaged at patient loading (by licensee physicians) or at the manufacturer."

It is unknown if any patients have been contaminated. All patients are being contacted for bioassays.

Total activity for all the seeds to be returned is 78.71mCi (@0.3 mCi per seed).

NC Incident No. 09-10

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General Information or Other Event Number: 44804
Rep Org: MA RADIATION CONTROL PROGRAM
Licensee: DANA-FARBER CANCER INSTITUTE
Region: 1
City: BOSTON State: MA
County:
License #: 60-0037
Agreement: Y
Docket:
NRC Notified By: BRUCE PACKARD
HQ OPS Officer: HOWIE CROUCH
Notification Date: 01/23/2009
Notification Time: 17:53 [ET]
Event Date: 01/16/2009
Event Time: [EST]
Last Update Date: 01/23/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
WILLIAM COOK (R1)
LYDIA CHANG (FSME)
ILTAB VIA EMAIL ()

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

Event Text

AGREEMENT STATE REPORT - LOST RADIOACTIVE MATERIAL

The following information was received from the Commonwealth of Massachusetts via facsimile:

"A package containing 250 ÁCi P-32 was lost at Dana Farber. The package was delivered and the RP (Radiopharmaceutical) department performed a receipt survey. The package was then carried to laboratory 714. The deliverer claimed he gave it to someone in the lab. Laboratory personnel claimed not to have received it. The RP department has conducted an unsuccessful search to locate the package."

Massachusetts No. MA-09

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: 44806
Rep Org: TEXAS DEPARTMENT OF HEALTH
Licensee: ALLIED ALLOYS OF HOUSTON
Region: 4
City: HOUSTON State: TX
County:
License #: GL
Agreement: Y
Docket:
NRC Notified By: RAY JISHA
HQ OPS Officer: HOWIE CROUCH
Notification Date: 01/26/2009
Notification Time: 17:29 [ET]
Event Date: 01/25/2009
Event Time: [CST]
Last Update Date: 01/27/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
CHUCK CAIN (R4)
LYDIA CHANG (FSME)
ILTAB VIA EMAIL ()

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

Event Text

AGREEMENT STATE REPORT - STOLEN PORTABLE NUCLEAR GAUGE

The following information was obtained from the State of Texas via email:

"[On January 25, 2009], a Thermo NITON Analyzer X-Ray Fluorescence Device Model XL3p 800 was stolen from Allied Alloys [located in] Houston, TX. The device contains a 30 mCi Am-241 source with either a QSA Global AMCL or IPL XFB-4 model source. The external radiation levels on the shipping case and instrument of <0.01 mRem/hr and the useful beam measurements are 0.3, 3, and 45 mrem/hr at 100, 30, and 5 centimeters respectively according to the SSDR sheet, MA-1159-D-102-B dated August 30, 2007. The company is considering a reward as the device is valued at $30K and a police report has been filed with [Houston Police Department]. There is some suspicion of the device being stolen by a former employee as there were other articles of value in the direct vicinity of the analyzer and this was the newest model out of six in the possession of the company.

"The pertinent identification numbers of the Niton hand held analyzer are as follows:
Model No. XL3p 800
Serial No. 31000
Americium 241 source SN: 07-232
Detector SN: 55276"

Texas Incident No.: I-8602

* * * UPDATE FROM JISHA TO SNYDER ON 1/27/09 AT 0732 * * *

The State of Texas provided the following information via e-mail:

"[The licensee is] not considering an award at this time. More cameras are being installed and all Nitons will be locked up in the main building [of the licensee's facility] where anyone going near the Niton storage area will pass through at least 4 cameras or more. The was the first noticeable break-in [that the licensee has] had in 5 years at this location."

Notified R4DO (Cain) and FSME EO (Burgess).

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: 44810
Facility: BRUNSWICK
Region: 2 State: NC
Unit: [ ] [2] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: DAVE JESTER
HQ OPS Officer: JOE O'HARA
Notification Date: 01/28/2009
Notification Time: 03:12 [ET]
Event Date: 01/27/2009
Event Time: 20:07 [EST]
Last Update Date: 01/28/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
GERALD MCCOY (R2)

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

UNIT 2 HPCI SYSTEM INOPERABLE FOR TWO HOURS DUE TO CONDENSATE IN EXHAUST LINE

"On January 27, 2009 at approximately 2007, the Unit 2 High Pressure Coolant Injection (HPCI) System was declared inoperable due to a sustained high level in the HPCI Exhaust Line Drain Pot. This sustained high level was caused by a failure of the HPCI Barometric Condenser Condensate Pump, which prevented the removal of the accumulated condensate. An alternate drain path was established and the exhaust line drain pot high level condition was cleared at 2202. However, due to this condition existing for approximately two hours, it cannot be assured that HPCI would have been able to perform its designed function under all conditions. The potential of HPCI system component damage or isolation from an exhaust line failure due to water hammer during a system initiation could not be positively eliminated.

"Initial safety significance: Minimal. The Reactor Core Isolation Cooling (RCIC) System, Automatic Depressurization (ADS) System, and Low Pressure Emergency Core Cooling Systems (ECCS) - two Loops of Core Spray and two Loops of Low Pressure Coolant Injection (LPCI) - remain operable.

"Manual actions have been taken to drain the HPCI Exhaust Line Drain pot and have been successful. Determination of the cause of the failure of the HPCI Barometric Condenser Condensate Pump and restoration to service are in progress."

The NRC Resident Inspector has been notified.

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Power Reactor Event Number: 44811
Facility: FERMI
Region: 3 State: MI
Unit: [2] [ ] [ ]
RX Type: [2] GE-4
NRC Notified By: GREG MILLER
HQ OPS Officer: JASON KOZAL
Notification Date: 01/28/2009
Notification Time: 12:16 [ET]
Event Date: 01/28/2009
Event Time: 07:30 [EST]
Last Update Date: 01/28/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
PATTY PELKE (R3)

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

HIGH PRESSURE COOLANT INJECTION SYSTEM INOPERABLE

"On January 28, 2009 at 0730 the Division 2 Emergency Equipment Cooling Water System (EECW) was declared inoperable due to a blown control power fuse in the bucket for the P4400F604 - Div 2 EECW Supply to Control Rod Drive (CRD) pumps. This is a normally open valve and is required to close upon EECW initiation to remove non-essential loads. The blown control power fuse would have prevented this action from occurring. The ECCW System cools various safety related components including the High Pressure Coolant Injection (HPCI) System Area Cooler. An unplanned HPCI inoperability occurred due to the Division 2 EECW inoperability based on a loss of the HPCI System Area Cooler. A 14 day Limiting Condition for Operation (LCO) was entered for HPCI per LCO 3.5.1. The control power fuse was replaced, EECW and HPCI were declared operable, and LCO 3.5.1 exited on January 28, 2009 at 1025. This report is being made pursuant to 10CFR50.72(b)(3)(v)(D) as a condition that at the time of discovery could have prevented the fulfillment of a safety function needed to mitigate the consequences of an accident, based on loss of a single train safety system.

"The NRC Resident Inspector has been notified."

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Power Reactor Event Number: 44812
Facility: KEWAUNEE
Region: 3 State: WI
Unit: [1] [ ] [ ]
RX Type: [1] W-2-LP
NRC Notified By: BRAD GAUGER
HQ OPS Officer: JASON KOZAL
Notification Date: 01/28/2009
Notification Time: 13:24 [ET]
Event Date: 01/28/2009
Event Time: 12:24 [CST]
Last Update Date: 01/28/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(A) - POT UNABLE TO SAFE SD
50.72(b)(3)(v)(B) - POT RHR INOP
50.72(b)(3)(v)(C) - POT UNCNTRL RAD REL
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
PATTY PELKE (R3)

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

STEAM EXCLUSION DOOR INAPPROPRIATELY HELD OPEN BY A DOOR CHOCK

"At 0834 on 01/28/2009 it was identified that a Steam Exclusion door was held open by a door chock installed on the door for less than 15 minutes. The door was open to ventilate the room during venting of carbon dioxide piping for routine maintenance. A Maintenance Mechanic was stationed at the door as per procedure. This door would have allowed steam into the emergency safeguards bus area from the Carbon Dioxide Tank room. This could have resulted in both Trains of ESF Equipment failing to perform their required functions. Upon discovery the door chock was disengaged to allow the door to self-close if required."

The NRC Resident Inspector has been notified.

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Power Reactor Event Number: 44814
Facility: SEQUOYAH
Region: 2 State: TN
Unit: [1] [2] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: MIKE BRUBAKER
HQ OPS Officer: BILL HUFFMAN
Notification Date: 01/28/2009
Notification Time: 18:00 [ET]
Event Date: 01/28/2009
Event Time: 14:25 [EST]
Last Update Date: 01/28/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
Person (Organization):
GERALD MCCOY (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
2 N Y 100 Power Operation 100 Power Operation

Event Text

UNANALYZED CONDITION RELATED TO A POSTULATED APPENDIX R FIRE SCENARIO

"A postulated Appendix R fire scenario has been identified which could result in the plant being in an unanalyzed condition that may degrade plant safety. The unanalyzed condition involves a potential loss of power to the credited train of fire safe shutdown equipment for postulated fires in two areas of the Auxiliary Building.

"Safety-related loads on the 6.9KV Shutdown Boards (Centrifugal Charging Pumps, Safety Injection Pumps, Containment Spray Pumps, Motor-Driven Auxiliary Feedwater Pumps, and Residual Heat Removal Pumps) are equipped with local control switches to allow starting or stopping the pumps from the Auxiliary Building. The DC control circuit wiring for these local switches is routed in the same area as the power cables for pump motors. If the fire damages the control circuit cables, the control circuit fuses may fail, resulting in loss of trip capability for the associated 6.9KV breaker. If the breaker is already closed (due to a spurious signal or a previous valid start signal), then the breaker could be disabled in the closed position. If the fire damages the power cables resulting in a phase-to-phase fault with the load breaker trip capability disabled, then the Shutdown Board feeder breaker is designed to trip open on overcurrent to provide backup protection. This could result in the shutdown board being de-energized.

"In two areas in the Auxiliary Building (elevation 669 and 690 common areas), the above scenario could result in a condition which is outside the fire safe shutdown analysis due to loss of power to the credited train of fire safe shutdown equipment (e.g. Centrifugal Charging Pump, Essential Raw Cooling Water Pump, and motor-operated valves).

"As a result of this condition, Sequoyah has entered the Fire Protection Report Limiting Condition for Operation 3.7.12 for inoperable fire barriers. In accordance with this LCO action, the operability of fire detectors in the affected areas has been verified and an hourly fire watch has been established in the affected areas.

"This issue has been entered into the corrective action program. A permanent resolution is being evaluated."

The NRC Resident Inspector has been notified.

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