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Event Notification Report for December 3, 2010

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
12/02/2010 - 12/03/2010

** EVENT NUMBERS **


46354 46422 46445 46446 46447 46448 46449 46450

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
Power Reactor Event Number: 46354
Facility: DRESDEN
Region: 3 State: IL
Unit: [ ] [2] [ ]
RX Type: [1] GE-1,[2] GE-3,[3] GE-3
NRC Notified By: PHILLIP PRATER
HQ OPS Officer: VINCE KLCO
Notification Date: 10/22/2010
Notification Time: 23:05 [ET]
Event Date: 10/22/2010
Event Time: 17:51 [CDT]
Last Update Date: 12/03/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(A) - POT UNABLE TO SAFE SD
Person (Organization):
STEVE ORTH (R3DO)

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

POTENTIAL INOPERABILITY OF OSCILLATION POWER RANGE MONITORS

"At 1751 [CDT] on Oct 22, 2010, Dresden Nuclear Power Station (DNPS) determined that current Oscillation Power Range Monitors (OPRM's) setpoints, as outlined in the Core Operating Limits Report (COLR), for Dresden U2 are non-conservative. This renders the Technical Specification (TS) function of the OPRM's in the Reactor Protection System (RPS) inoperable.

"This event was initiated as a result of notification by Westinghouse Nuclear Fuels (NF-BEX-10-157) that an error exists in the McSLAP computer code which affects the Safely Limit Minimum Critical Power Ratios (SLMCPR) for Dresden. Currently the COLR and installed, amplitude setpoint (Sp) is 1.13 and the confirmation count setpoint (Np) is 15. This is required to be adjusted to 1.12 (Sp) and 14 (Np).

"Alternative methods to detect and suppress thermal hydraulic instabilities were initiated as required by Technical Specifications.

"This non-conservative computer code error could potentially have prevented fulfillment of the OPRM system's safety function and is therefore reportable per 10 CFR 50.72(b)(3)(v)(A), 'An event or condition that could have prevented the fulfillment of a safety function - shutdown the reactor and maintain it in a safe shutdown condition.'"

Corrective actions include the following:

"1. Revise U2 Core Operating Limit Report (COLR) to reflect correct values as determined by Westinghouse Nuclear Fuels Letter (NF-BEXl0-157).

"2. Adjust OPRM setpoints to comply with COLR values."

The licensee will notify the NRC Resident Inspector.

* * * RETRACTION FROM RILEY RUFFIN TO ERIC SIMPSON AT 1207 EST ON 12/3/10 * * *

"On October 22, 2010, Dresden Nuclear Power Station was notified by Westinghouse that an error in McSlap computer code resulted in a non-conservative MCPR safety limit. The preliminary results of the Westinghouse evaluation concluded that the setpoints for the Oscillation Power Range Monitors were also non-conservative. As a result of the notification, Dresden declared all channels of OPRM inoperable and took the required action of the plant's technical specifications. This was considered a loss of function.

"This condition was reported as a condition that could have potentially prevented the fulfillment of the OPRM system's safety function in accordance with 10 CFR 50.72(b)(3)(v)(A), an event or condition that could have prevented the fulfillment of a safety function - shutdown the reactor and maintain it in a safe shutdown condition.

"However, subsequent evaluation of the preliminary result determined that the original conclusions were overly conservative and the OPRM setpoints did not require revision. Based on the later evaluation, the function of the OPRMs was not adversely impacted by the installed setpoints. Thus, the system was always capable of performing its intended safety function.

"Therefore the notification associated with Event Number 46354 is being retracted."

The licensee notified the NRC Resident Inspector.

The R3DO (Ring) was notified.

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General Information Event Number: 46422
Rep Org: NC DIV OF RADIATION PROTECTION
Licensee: DUKE UNIVERSITY AND MEDICAL CENTER
Region: 1
City: DURHAM State: NC
County:
License #: 032-0247-4
Agreement: Y
Docket:
NRC Notified By: PAUL HUGGINS
HQ OPS Officer: JOHN SHOEMAKER
Notification Date: 11/16/2010
Notification Time: 11:01 [ET]
Event Date: 11/13/2010
Event Time: [EST]
Last Update Date: 12/02/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
HAROLD GRAY (R1DO)
GLENDA VILLAMAR (FSME)

Event Text

AGREEMENT STATE REPORT - PATIENT RECEIVED A THYROID IMAGING DOSE OF I-123 THAT WAS CONTAMINATED WITH I-131

The following report was received from the State of North Carolina via email:

"This is to notify you about a medical event under the regulation .0364, i.e., within 24-hr notification requirement after discovery. The following summarizes the medical event.

"Event: Contamination of I-123 thyroid imaging dose with I-131 (WRONG RADIONUCLIDE).
"Dose: 380 rad (3.8 Gy) to the thyroid gland (EXCEEDS 50-RAD THRESHOLD FOR ORGAN DOSE)
"Notification: Patient's parent and referring physician have been notified.
"A detailed report will follow within 15 days."

This event occurred sometime on Friday 11/13/10 and was discovered on Monday 11/15/10 at 1535 hrs. The patient was a child and potential adverse effects have not been determined at this time.

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.

* * * UPDATE RECEIVED FROM PAUL HUGGINS TO JOHN SHOEMAKER VIA EMAIL ON 11/22/10 @ 0954 * * *

"DESCRIPTION OF THE EVENT:
A patient was administered 0.389 mCi of iodine-123 orally for a thyroid uptake and scan procedure. Upon imaging at 4 hours, the technologist noted excessive background in the image. The acquisition computer showed an additional peak at 364 keV, consistent with presence of iodine-131 contamination. The iodine-131 thyroid burden at 21 hours was estimated to be about 43 microcuries. Based upon an iodine-123 uptake of 30%, the intake of iodine-131 was estimated to be about 143 microcuries. The absorbed dose to the thyroid, as estimated on 11/15/2010, was about 3.8 Gy (380 rad), or an equivalent dose of 3.8 Sv (380 rem), assuming age-specific reference values for thyroid mass and effective half-life.

"An intake of 143 mCi of iodine-131 is comparable to activities that were administered in the past for diagnostic thyroid imaging, and no adverse effects are expected.

"WHY THE EVENT OCCURRED:
Interviews with staff and assaying the equipment used for the iodine-123 administration indicate that the screw-cap on the vial was the likely source of the contamination. It is unclear whether the screw-cap removal device, or improper handling of the cap, was the cause of the contamination.

"STEPS BEING TAKEN TO PREVENT A RECURRENCE:
The Authorized User and senior technical staff have educated staff about proper handling of radioiodine. To prevent a recurrence, we have changed our procedure as follows:

1) Only one radioiodine dose will be kept in the 'dosing hood' at any time.
2) The vial will be opened only when the patient and necessary staff are in the hot lab.
3) A separate cap remover will be used for each radionuclide.
4) Only one technologist will be involved with preparing dosing area, dosing the patient, cleaning up the dosing area and surveying post therapy."

North Caroline Incident #: NC 10-50

Notified R1DO - R. Conte and FSME - G. Villamar

* * * UPDATE FROM PAUL HUGGINS TO ERIC SIMPSON AT 0936 EST ON 12/2/10 * * *

The I-131 intake is being corrected to 143 microcuries, instead of 143 millicuries, as reported previously.

Notified the R1DO (Schmidt) and FSME (Villamar).

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
Power Reactor Event Number: 46445
Facility: PEACH BOTTOM
Region: 1 State: PA
Unit: [2] [3] [ ]
RX Type: [2] GE-4,[3] GE-4
NRC Notified By: PETER SCHOETTLER
HQ OPS Officer: ERIC SIMPSON
Notification Date: 12/01/2010
Notification Time: 17:40 [ET]
Event Date: 12/01/2010
Event Time: 13:59 [EST]
Last Update Date: 12/02/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
WAYNE SCHMIDT (R1DO)

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

Event Text

OFFSITE NOTIFICATION OF PETROLEUM SPILL INTO THE SUSQUEHANA RIVER

"On 12/01/10, at 1359 EST, Peach Bottom Atomic Power Station reported a petroleum product spill in the discharge canal. Total quantity of substance is less than 1 quart. Lewis Environmental agency has been contacted to aid in containment and cleanup of the spill.

"This report is being submitted pursuant to 10 CFR 50.72(b)(2)(xi) and 10 CFR 72.75(b)(2)."

The spill did not reach Comprehensive Environmental Response Compensation and Liability Act (CERCLA) reportable quantities. The licensee notified the Pennsylvania Department of Environmental Protection, United States Coast Guard, and EPA Region 3.

The NRC Resident Inspector has been notified.

* * * RETRACTION FROM E. WRIGHT TO V. KLCO ON 12/2/10 AT 1354 EST * * *

The licensee is retracting the event due to the quantity of substance released to the environment is less than the reportable quantity.

The licensee will notify the NRC Resident Inspector.

Notified R1DO (Schmidt).

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Non-Agreement State Event Number: 46446
Rep Org: GEOCONCEPTS ENGINEERING, INC
Licensee: GEOCONCEPTS ENGINEERING, INC
Region: 1
City: ASHBURN State: VA
County:
License #: 45-25467-01
Agreement: Y
Docket:
NRC Notified By: DREW THOMAS
HQ OPS Officer: ERIC SIMPSON
Notification Date: 12/02/2010
Notification Time: 16:25 [ET]
Event Date: 12/02/2010
Event Time: 14:00 [EST]
Last Update Date: 12/14/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
20.2201(a)(1)(i) - LOST/STOLEN LNM>1000X
Person (Organization):
WAYNE SCHMIDT (R1DO)
JAMES DANNA (FSME)
ILTAB VIA EMAIL ()

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

Event Text

THEFT OF TROXLER MOISTURE DENSITY GAUGE

A Troxler moisture density gauge being used at Fort Meade (Maryland) was found to be stolen along with other industrial equipment at 1400 on 12/2/10. The Troxler gauge was last seen on Monday afternoon, 11/29/10, when it was secured in a temporary storage location inside a lock-box and chained to a sea container. Other items stolen included crane mats, a generator and miscellaneous tools.

The nuclear gauge is a Troxler Model 3430, S/N 37672, which contains two radioactive sources. One source is 44 mCi of Am-241/Be (S/N 78-2430). The other source is 9 mCi of Cs-137 (S/N 77-4907).

The licensee will notify base police to begin an investigation into the theft.

The licensee has notified the State of Maryland of the theft.

* * * UPDATE FROM DREW THOMAS TO JOE O'HARA AT 0948 ON 12/14/10 * * *

On 12/10/10, FT. Meade U.S. Army base police officers informed the licensee that the stolen container had been "dumped" back onto the jobsite. The licensee responded to the site and discovered the missing gauge inside the container. The source was in the locked and shielded position inside the gauge and the gauge doesn't appear to have been damaged. The gauge has been recovered and is now in the custody of the licensee. A leak test of the gauge is scheduled to be performed.

Notified R1DO(Holody), FSME(Reis) and ILTAB.

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. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf

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Fuel Cycle Facility Event Number: 46447
Facility: AREVA NP INC RICHLAND
RX Type: URANIUM FUEL FABRICATION
Comments: LEU CONVERSION
                   FABRICATION & SCRAP
                   COMMERCIAL LWR FUEL
Region: 2
City: RICHLAND State: WA
County: PENTON
License #: SNM-1227
Agreement: Y
Docket: 07001257
NRC Notified By: ROBERT LINK
HQ OPS Officer: JOE O'HARA
Notification Date: 12/02/2010
Notification Time: 17:39 [ET]
Event Date: 12/02/2010
Event Time: 07:15 [PST]
Last Update Date: 12/02/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
PART 70 APP A (b)(2) - LOSS OR DEGRADED SAFETY ITEMS
Person (Organization):
SCOTT SHAEFFER (R2DO)
KING STABLEIN (NMSS)

Event Text

URANIUM CONCENTRATION GREATER THAN EXPECTED IN GAS STRIPPER SYSTEM FOLLOWING AN ACID WASH

"Background:
The purpose of the Ammonia Recovery Facility (ARF) facility is to recover ammonia from the ammonium diuranante (ADU) process effluent by use of a stripper column. The feed of effluent to ARF has a uranium concentration is typically less than 1 ppm. Two uranium analyzers provide assurance that the effluent uranium concentration is less than 100 ppm prior to discharge to the Ammonia Recovery process feed tank V-621.

"The ISA Summary for this process states that only minute quantities of radioactive material are present in the feed to the ARF and that there are no credible accident sequences that result in intermediate or high consequences.

"Event Description:
On 12/02/2010 at 0715, a Process Engineer informed Nuclear Criticality Safety (NCS) that he had confirmed that an acid wash of ARF stripper column had recovered 8 kg of Uranium (U). The acid wash is expected to have removed all significant amounts of Uranium from the system. This resulted in a review of the adequacy of the ISA treatment for the ARF stripper column.

"Safety Significance of Event:
The safety significance is low. The amount of Uranium recovered, approximately 8 kg, is less than 25% of a minimum critical mass in spherical geometry. The concentration of the liquid is about 1 g U/liter. The 8 kg constitutes an approximate ten year accumulation since the last column acid wash in 2001. Based on the accumulation rate over the past 10-years, another 40 years of accumulation would be required without any removal during maintenance before achieving a critical mass.

"The system was down for maintenance at the time of discovery. Maintenance activities were suspended and will remain suspended until an appropriate processing path is identified to process this material and appropriate controls are established. The system will not be restarted until the system has been reanalyzed and appropriate controls are verified to be in place to meet 10CFR70.62 performance criteria.

"Potential Criticality Pathways Involved (Brief Scenarios of how criticality could occur):
Criticality is possible if material in the ARF equipment exceeds a minimum critical concentration and a minimum critical mass for a given geometry.

"Controlled Parameters:
The controlled parameters are upstream of the ARF process and are based on concentration of the feed material. The uranium concentration in ARF feed is typically less than 1 ppm. Two uranium analyzers provide assurance that the ADU effluent uranium concentration is less than 100 ppm prior to discharge to the Ammonia Recovery process.

"Estimated Amount, Enrichment, Form of Licensed Material and % of worst case Critical Mass:
The facility is only licensed to 5 wt.% U-235. The material present in the stripper column prior to being dissolved was likely ammonium diuranate. Once dissolved, the material is uranyl nitrate. The mass in the system is expected to have been less than 25% of a minimum critical mass in spherical geometry.

"When equipment geometry is taken into account, much higher masses are required to obtain a critical condition. For example, the ARF feed tank with a uniform slab of U02-H20 would require an areal density exceeding 10 kg U/ft2 (more than 500 kg U).

"Nuclear Criticality Controls) or Control System(s)) and Description of the Failure Deficiencies:
The upstream controls on concentration performed as required. The material plate-out within the stripper column was greater than anticipated.

"Corrective Actions to Restore Safety Systems and When Each Was Implemented:
The system was down for maintenance at the time of discovery. Maintenance activities were suspended and will remain suspended until an appropriate processing path is identified to process this material and appropriate controls are established. The system will not be restarted until the system has been reanalyzed and appropriate controls are verified to be in place."

The licensee initiated the acid wash of the gas stripper as a result of concerns over the differences in the inlet and outlet pressures of the system, which indicated that the system was becoming less efficient. The licensee briefed Region 2 management and Region 2 fuel cycle facility inspectors about this event.

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Power Reactor Event Number: 46448
Facility: WATTS BAR
Region: 2 State: TN
Unit: [1] [ ] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: BRIAN MCILNAY
HQ OPS Officer: VINCE KLCO
Notification Date: 12/02/2010
Notification Time: 18:32 [ET]
Event Date: 12/02/2010
Event Time: 16:10 [EST]
Last Update Date: 12/02/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
SCOTT SHAEFFER (R2DO)

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

OFFSITE NOTIFICATION DUE TO AN INDIVIDUAL CONTAMINATION

"TVA notified TN Dept of Environment and Conservation [TDEC] of an incident at Watts Bar as follows:

"On December 2, 2010, a contractor employee of PAR-Westinghouse was processing in through Watts Bar Nuclear Plant Radiological Protection Program for his first day of work. He was discovered to have been previously contaminated with radioactive material from another worksite. It is clear that the radioactive contamination did not come from any TVA source and was found before he entered the rad control area.

"The contamination was discovered during required in-processing activities for workers by TVA's radiation monitoring and detection equipment. The contamination was found to be a particle on the individual's shoe.

"The individual's clothing was also found to contain measurable contamination and was confiscated. The radioactive contamination found on the individual has been safely contained.

"TDEC Division of Radiological Health was notified of this event as of 1610 Eastern Time and this notification under 10 CFR 50.72(b)(2)(xi) is for that Government Agency notification. TVA has notified the NRC Resident Inspector and Regional Administrator of this incident."

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General Information Event Number: 46449
Rep Org: ROSEMOUNT NUCLEAR
Licensee: ROSEMOUNT NUCLEAR
Region: 3
City: CHANHASSEN State: MN
County:
License #:
Agreement: Y
Docket:
NRC Notified By: MARC BUMGARNER
HQ OPS Officer: JOE O'HARA
Notification Date: 12/02/2010
Notification Time: 20:15 [ET]
Event Date: 11/22/2010
Event Time: [CST]
Last Update Date: 12/02/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21 - UNSPECIFIED PARAGRAPH
Person (Organization):
WAYNE SCHMIDT (R1DO)
SCOTT SHAEFFER (R2DO)
MARK RING (R3DO)
DALE POWERS (R4DO)
PART 21 GRP ()

Event Text

ANOLMALY DISCOVERED ON ROSEMOUNT MODEL 1152 DIFFERENTIAL PRESSURE TRANSMITTERS WITH OUTPUT CODE "L" 10-50 mA ELECTRONICS

The following was received via fax:

Rosemount Nuclear discovered an anomaly in Model 1152 differential pressure transmitters while troubleshooting a separate, unrelated issue. The anomaly is related to the pressure transmitters response during a overpressure condition. Normally, under a low side overpressure condition, the output will go off-scale and remain off scale for conditions less than 10 mA. Rosemount has discovered that some detectors may go off-scale and then return to on-scale between 10mA and 50 mA, rather than remain off scale under 10mA. This is caused by a change made to operational amplifier components in March 2001. Rosemount recommends all customers evaluate the safety impact of this anomaly on their plants. No field failures have been reported to date.

The following sites are affected: Browns Ferry, Brunswick, Cook, Dresden, Duane Arnold, Fermi, Fort Calhoun, Ginna, Hatch, Indian Point, Kewaunee, Millstone, Nine Mile Point, Oyster Creek, Palisades, Pilgrim, Quad Cities, Sequoyah, Vermont Yankee, and Watts Bar.

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Non-Agreement State Event Number: 46450
Rep Org: ACUREN
Licensee: ACUREN
Region: 4
City: NORTH SLOPE State: AK
County:
License #: 42-32443-01
Agreement: N
Docket:
NRC Notified By: ROBERT MCCALL
HQ OPS Officer: VINCE KLCO
Notification Date: 12/02/2010
Notification Time: 20:19 [ET]
Event Date: 12/02/2010
Event Time: 10:00 [YST]
Last Update Date: 12/02/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
30.50(b)(2) - SAFETY EQUIPMENT FAILURE
Person (Organization):
DALE POWERS (R4DO)
JAMES DANNA (FSME)

Event Text

SOURCE FAILED TO RETRACT DUE TO ICE BUILD-UP

A radiography crew working on the Prudhoe Bay North Slope experienced a malfunction of the source retraction portion of their Sentinel Delta 880 radiography device due to ice intrusion. The device source is Ir-192 with a 99 Curie activity.

The radiography crew was able to retract the source into the shielded position using the device crank.

Based on pocket dosimetry readings, there were no personnel over-exposures during this incident.

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