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Event Notification Report for December 9, 2010

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
12/08/2010 - 12/09/2010

** EVENT NUMBERS **


46452 46453 46454 46458 46459 46464 46465 46466 46467 46469

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General Information Event Number: 46452
Rep Org: ARKANSAS DEPARTMENT OF HEALTH
Licensee: GRUBBS, HOSKYN, BARTON AND WYATT, INC
Region: 4
City: LITTLE ROCK State: AR
County:
License #: ARK0456-03121
Agreement: Y
Docket:
NRC Notified By: ANGELA MINDEN
HQ OPS Officer: ERIC SIMPSON
Notification Date: 12/03/2010
Notification Time: 11:18 [ET]
Event Date: 12/02/2010
Event Time: 12:30 [CST]
Last Update Date: 09/06/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DALE POWERS (R4DO)
ANGELA MCINTOSH (FSME)
ILTAB VIA EMAIL ()

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

Event Text

AGREEMENT STATE REPORT - LOST TROXLER MOISTURE DENSITY GAUGE

The following was received via email from the State of Arkansas:

"The Arkansas Department of Health, Radioactive Materials Program, was notified at 1315 CST on December 2, 2010 by licensee Grubbs, Hoskyn, Barton, and Wyatt, Inc. (ARK-0456-03121) of a missing Troxler moisture/density gauge. The gauge was being transported between their office in Little Rock, Arkansas and a job-site in Bryant, Arkansas. The authorized user observed the gauge was missing at approximately 1230 CST. The gauge had apparently fallen from the transport vehicle.

"The Troxler gauge is a Model 3430 (SN 63492) containing 40 mCi Am-241:Be and 8 mCi Cs-137.

"It appears that the gauge was not properly secured in the vehicle. The Arkansas Department of Health is investigating the circumstances surrounding this event.

"The Arkansas Department of Health prepared a press release concerning this event. Arkansas Department of Health also notified the Police Departments of Little Rock and Bryant, the Sheriff's Offices of Saline and Pulaski Counties, the Arkansas State Police, and the Arkansas Department of Emergency Management.

"Arkansas has assigned event report ID number AR-12-10-02."

* * * UPDATE AT 1147 EDT ON 9/6/11 FROM PEMBERTON TO HUFFMAN VIA E-MAIL * * *

"On August 30, 2011, the Arkansas Department of Health, Radioactive Material Division was informed by [the] Radiation Safety Officer for Grubbs, Hoskyn, Barton and Wyatt, that the Troxler 3430 Moisture/Density Gauge, SN#63492, lost on December 2, 2010, had been recovered.

"A Departmental investigation confirmed that the gauge recovered on August 30, 2011, was in fact the device lost on December 2, 2010. The Department considers this incident to be closed."

The State Department of Health Representative indicated that the gauge was returned to the licensee by a private citizen who wished to remain anonymous.

R4DO (Drake) and FSME (McIntosh) notified. ILTAB notified via e-mail.


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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General Information Event Number: 46453
Rep Org: COLORADO DEPT OF HEALTH
Licensee: PROSTATE SEED CENTER
Region: 4
City: LITTLETON State: CO
County:
License #: 972-01
Agreement: Y
Docket:
NRC Notified By: EDGAR ETHINGTON
HQ OPS Officer: ERIC SIMPSON
Notification Date: 12/03/2010
Notification Time: 15:39 [ET]
Event Date: 12/02/2010
Event Time: 16:00 [MST]
Last Update Date: 12/03/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DALE POWERS (R4DO)
JAMES DANNA (FSME)

Event Text

AGREEMENT STATE REPORT - DELIVERED DOSE GREATER THAN PRESCRIBED DOSE

The following information was received via email from the State of Colorado:

"At approximately 1600 MST, 12/2/10, the Colorado Department of Public Health and Environment received a report of a possible misadministration at the Prostate Seed Center, a Colorado radioactive materials licensee.

"Additional information was received on 12/3/10 that there was indeed a misadministration of I-125 in seed form. An excess dose of 27 to 32% was administered above the prescribed dose.

"There was an apparent miscommunication between the supplier and the Prostate Seed Center about the units of dose the seeds were to contain. Apparently, Air Kerma units were ordered and milliCuries were delivered.

"An investigation as to the cause of the misadministration is being performed. A written report on the incident is required by the Department within 30 days."

The excess dose was delivered to the patient's prostate.

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.

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General Information Event Number: 46454
Rep Org: CALIFORNIA RADIATION CONTROL PRGM
Licensee: CALIFORNIA TRANS DISTRICT 6
Region: 4
City: FRESNO State: CA
County:
License #: 1596
Agreement: Y
Docket:
NRC Notified By: ROSE RESSER
HQ OPS Officer: VINCE KLCO
Notification Date: 12/03/2010
Notification Time: 19:20 [ET]
Event Date: 10/14/2010
Event Time: [PST]
Last Update Date: 12/03/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DALE POWERS (R4DO)
JAMES DANNA (FSME)
ILTAB VIA EMAIL ()

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

Event Text

AGREEMENT STATE REPORT - TROXER DENSITY GAUGE LOST AND THEN RECOVERED

The following information was received by e-mail:

"On 10/14/10, a soil density gauge possessed by Cal Trans District 6 (Troxler Model 3440, S/N 30696, containing 8 mCi of Cs-137 and 40 mCi of Am-241), fell from the tail gate of a pick-up truck in which it was being transported from the job site on State Highway 198 near Visalia, CA. The soil gauge was subsequently recovered by the operator and his ARSO [Assistant Radiation Safety Officer]. The soil gauge was damaged. The damaged gauge was returned to its permanent storage area in Visalia, CA. The RSO was notified, investigated the incident and reported the incident to RHB [California Radiation Health Branch] on the date it occurred. The gauge was surveyed by the RSO using a Radiation Alert Inspector PGM survey meter at the Visalia Field Site on the date of the incident. The maximum radiation level identified was 0.3 mR/hr at 1 meter from the gauge. The gauge was leak tested by the RSO with negative [satisfactory] results. The dosimeters for the gauge operator and ARSO were processed, and no radiation exposures were recorded. The Cal Trans District 6 facility in Fresno was visited by RHB on 10/28/10, and three items of noncompliance were identified.

"Until December 2, 2010, RHB was working under the assumption that the gauge was not lost, but was only damaged when it fell from the back of the truck and was never out of sight of the operator and/or ARSO. On December 2, 2010, RHB determined that the gauge was lost for a period of time between it falling from the truck and being recovered. Therefore, RHB now consider it as having been lost and are reporting it as such."

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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General Information Event Number: 46458
Rep Org: IOWA DEPARTMENT OF PUBLIC HEALTH
Licensee: UNIVERSITY OF IOWA
Region: 3
City: IOWA CITY State: IA
County:
License #: 0037152AAB
Agreement: Y
Docket:
NRC Notified By: RANDAL DAHLIN
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 12/06/2010
Notification Time: 10:56 [ET]
Event Date: 11/29/2010
Event Time: [CST]
Last Update Date: 12/06/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MARK RING (R3DO)
ANGELA MCINTOSH (FSME)

Event Text

AGREEMENT STATE REPORT - LEAKING SOURCE IN A STATIC ELIMINATOR

The following report was received via e-mail:

"The following report was received by the Iowa Department of Public Health (IDPH) on December 3, 2010. On November 29, 2010, the University of Iowa Environmental Health and Safety (EHS) staff discovered evidence that a Nickel-63 foil in a custom made static eliminator had lost its seal integrity. The source in question consists of two 10 mCi Ni-63 foils that are housed in a custom built static eliminator (2 inch diameter steel pipe with the foils glued to the walls of the pipe). The static eliminator is attached to a chamber apparatus located in a fume hood within a principal investigator's lab. The results of the leak test indicated approximately 11,500 dpm (0.0052 microCuries) of activity on a wipe taken of several areas in the apparatus housing the Ni-63 foils. EHS personnel bagged the static eliminator and returned it to EHS for disposal."

Iowa Report Number: IA100008

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General Information Event Number: 46459
Rep Org: NC DIV OF RADIATION PROTECTION
Licensee: HAYNES ELECTRIC CONSTRUCTION COMPANY
Region: 1
City: ASHEVILLE State: NC
County:
License #: 011-2650-0G
Agreement: Y
Docket:
NRC Notified By: WILLIAM JOHNSON
HQ OPS Officer: STEVE SANDIN
Notification Date: 12/06/2010
Notification Time: 14:03 [ET]
Event Date: 12/06/2010
Event Time: [EST]
Last Update Date: 12/06/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
20.2201(a)(1)(i) - LOST/STOLEN LNM>1000X
Person (Organization):
CHRISTOPHER CAHILL (R1DO)
ANGELA MCINTOSH (FSME)

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

Event Text

AGREEMENT STATE INVOLVING A LOST TRITIUM EXIT SIGN

The following information was received from the State of North Carolina via fax:

"Brief Description of Incident: General License: 011-2650-0G, was issued on August 2, 2010 to HB Haynes for one Exit Light, Serial Number: 421564, from Safety Light.

"Model Number: SLX-60 for 7.5 Curies of H-3 (Tritium), Date Shipped; 7-20-2007. In August 2007, Haynes Electric installed the sign at Memorial Mission Hospital in Asheville, NC in the Stairwell at the new Dogwood Building and completed [work at] the temporary site in the fall at 2009.

"The General License was issued on August 2, 2010 and [the President of Haynes Electric] called to confirm that they had gone back to the site and could not locate the sign. [The] RSO for Mission Memorial Hospital was contacted and confirmed the sign was lost and that they did not possess any radioactive material with exit signs. Also, on December 6, 2010 [the representative] with Safety Light also listed as Isolite confirmed that they had not received the light. The light was considered lost on December 6, 2010 and the NRC was notified."

NC Incident No.: 10-51

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

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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Power Reactor Event Number: 46464
Facility: PRAIRIE ISLAND
Region: 3 State: MN
Unit: [1] [2] [ ]
RX Type: [1] W-2-LP,[2] W-2-LP
NRC Notified By: RANDY FORTIER
HQ OPS Officer: HOWIE CROUCH
Notification Date: 12/08/2010
Notification Time: 10:50 [ET]
Event Date: 12/08/2010
Event Time: 08:07 [CST]
Last Update Date: 12/08/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
ROBERT DALEY (R3DO)

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

OFFSITE NOTIFICATION DUE TO INADVERTENT ACTUATION OF EMERGENCY SIRENS

"At approximately 0807 CST on December 8, 2010, Pierce County [Wisconsin] Dispatch inadvertently activated the Pierce County sirens during the conduct of the silent siren test. The sirens were deactivated within 30 seconds."

The licensee has notified the NRC Resident Inspector.

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Non-Agreement State Event Number: 46465
Rep Org: CONTINENTAL CEMENT
Licensee: CONTINENTAL CEMENT
Region: 3
City: HANNIBAL State: MO
County:
License #: 24-20263-01
Agreement: N
Docket:
NRC Notified By: WILLIAM E. SHERMAN JR.
HQ OPS Officer: JOE O'HARA
Notification Date: 12/08/2010
Notification Time: 14:17 [ET]
Event Date: 12/08/2010
Event Time: 13:00 [CST]
Last Update Date: 12/08/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
30.50(b)(2) - SAFETY EQUIPMENT FAILURE
Person (Organization):
ROBERT DALEY (R3DO)
ANGELA MCINTOSH (FSME)

Event Text

STUCK SHUTTER ON BERTHOLD MODEL P2608-100 DUE TO CEMENT DUST BUILDUP

While performing semi-annual shutter checks on a Berthold Waybelt Scale Process Gauge Model P2608-100 containing 5 milliCuries of Cobalt 60, a technician found the shutter partially open and was not able to fully close the shutter due to cement dust buildup on the shutter mechanism. The gauge is located in a secure guarded location not readily accessible to personnel, and does not present a hazard to personnel. The company will shut down the process line on 12/21/10 and perform repairs to the process gauge at that time.

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Non-Agreement State Event Number: 46466
Rep Org: RIO TINTO MINERALS
Licensee: RIO TINTO MINERALS
Region: 4
City: THREE FORKS State: MT
County:
License #:
Agreement: N
Docket:
NRC Notified By: RON HYATTE
HQ OPS Officer: STEVE SANDIN
Notification Date: 12/08/2010
Notification Time: 15:44 [ET]
Event Date: 12/02/2010
Event Time: [MST]
Last Update Date: 12/08/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
20.2201(a)(1)(i) - LOST/STOLEN LNM>1000X
Person (Organization):
MICHAEL HAY (R4DO)
DIANA DIAZ-TORO (FSME)

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

Event Text

FIXED NUCLEAR GAUGE RECOVERED IN LOAD OF SCRAP STEEL

A 50mCi Cs-137 Kay-Ray Model 7062B (S/N 17573) Gauge was recovered in a pile of scrap steel at the Pacific Steel & Recycling Company in Bozeman, MT. The U.S. NRC Region IV contacted the device manufacturer to identify the owner of the general licensed source and dispatched an NRC Inspector on 12/3/10 to initiate a reactive inspection (PNO-RIV-2010-006).

The owner, Cyprus Industrial Minerals in Ennis, Montana, had purchased the gauge in June 1984 for use in their Yellowstone mine. The company was subsequently sold to Rio Tinto Minerals located in Three Forks, MT.

The representative from Rio Tinto Minerals is currently arranging for removal and disposal of the gauge in safe storage at the Pacific Steel & Recycling Company.

A conference call was held on 12/2/10 at 1800 EST with R4 (Vivian Campbell, Tony Gaines) and FSME (James Danna).

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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Power Reactor Event Number: 46467
Facility: HARRIS
Region: 2 State: NC
Unit: [1] [ ] [ ]
RX Type: [1] W-3-LP
NRC Notified By: KIMBERLY BASS
HQ OPS Officer: STEVE SANDIN
Notification Date: 12/08/2010
Notification Time: 16:51 [ET]
Event Date: 10/28/2010
Event Time: 15:04 [EST]
Last Update Date: 12/08/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.73(a)(1) - INVALID SPECIF SYSTEM ACTUATION
Person (Organization):
JAMES MOORMAN (R2DO)

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

Event Text

INVALID ACTUATION OF THE "B" EMERGENCY SERVICE WATER (ESW) PUMP

Text provided by the licensee. Quotations omitted for readability.

Report Type: This 60-day telephone notification is being made under 10 CFR 50.73(a)(2)(iv)(A) and 10 CFR 50.73(a)(1).

Description: On October 28, 2010, during the performance of MST I0073, "Train 'B' 18 Month Manual Reactor Trip, Solid State Protection System Actuation Logic & Master Relay Test", two sequential errors resulted in the inappropriate activation of the 'B' ESW pump. During night shift on October 27/28th, the Master Relay Selector Switch was not returned to the required OFF position. This caused day shift to find one of the two general warning lights to be lit. During the troubleshooting for the light, a technician discovered the Master Relay Selector Switch out of the expected OFF position as required by the procedure. A technician moved the switch to the OFF position outside of procedural guidance, resulting in the partial activation of the Reactor Protection System, including the 'B' ESW pump.

The plant was in Mode 6 due to refueling outage 16 during the event. Actual plant conditions and parameters did not exist that required an automatic start of the 'B' ESW Pump. Therefore, this actuation is classified as invalid. The system started and functioned successfully.

This invalid actuation was entered into the corrective action program as NCR 430289.

Cause: Poor performance of task by the individual.

The licensee informed the NRC Resident Inspector.

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Power Reactor Event Number: 46469
Facility: WATTS BAR
Region: 2 State: TN
Unit: [1] [ ] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: NEWTON LACY
HQ OPS Officer: JOHN KNOKE
Notification Date: 12/09/2010
Notification Time: 12:53 [ET]
Event Date: 12/06/2010
Event Time: 08:15 [EST]
Last Update Date: 12/09/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
JAMES MOORMAN (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 - OSHA CONTACTED DUE TO FATALITY OF CONTRACTOR EMPLOYEE

"At 0815 Eastern Standard Time on December 6, 2010, TVA Construction Contractor, Bechtel, notified the Occupational Safety and Health Administration (OSHA), in accordance with 29 CFR 1904.39, that a Bechtel employee had suffered a fatality from an apparent heart attack, while working on the Watts Bar Unit 2 Construction completion project. This information was also provided to Tennessee Department of Labor and Workforce Development, Division of Occupational Safety and Health (TOSHA).

"This event had no consequences to the health and safety of the public, other onsite workers, or the environment.

"The NRC Resident Inspector has been notified of this event."

The employee's heart attack happened while he was operating a fork lift at the Parts/Receiving area. Offsite responders were called to the scene, however, the employee was unresponsive to their actions. Employee was transported to the Rhea County Hospital where he was pronounced dead.

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