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Event Notification Report for September 19, 2011

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
09/16/2011 - 09/19/2011

** EVENT NUMBERS **


47258 47260 47262 47263 47264 47267 47269 47271 47273 47274 47275

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Power Reactor Event Number: 47258
Facility: DIABLO CANYON
Region: 4 State: CA
Unit: [1] [2] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: BOB KLINE
HQ OPS Officer: CHARLES TEAL
Notification Date: 09/13/2011
Notification Time: 01:57 [ET]
Event Date: 09/12/2011
Event Time: 17:45 [PDT]
Last Update Date: 09/16/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
Person (Organization):
GREG PICK (R4DO)

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

CONTROL ROOM ENVELOPE DECLARED INOPERABLE

"On September 12, 2011, at 1745 PDT operators declared the control room envelope (CRE) inoperable and entered Technical Specification (TS) 3.7.10 Action B. This was due to discovery of inadequately documented CRE inleakage test data.

"On September 12, 2011, DCPP [Diablo Canyon Power Plant] personnel reviewing the CRE testing dated February 3, 2005 determined that the test report provided inadequate information to conclude that the most limiting alignment for control room pressurization would result in zero cubic feet per minute (CFM) inleakage into the CRE, contrary to the Final Safety Analysis Report (FSAR) accident analysis for the most limiting design basis accident. Three of the four ventilation alignments tested had reported values of inleakage greater than zero CFM.

"Plant staff implemented compensatory measures by placing the control room ventilation system into its pressurization accident alignment at 1828 PDT using the alignment from the test which had a reported value of zero CFM inleakage. Additionally, administrative controls are being established to maintain post-Loss of Coolant Accident Emergency Core Cooling System leakage at a rate that would ensure operator doses are maintained less than the FSAR accident analysis results for the highest inleakage rate reported by the test.

"Plant personnel notified the NRC Resident Inspector."


* * * UPDATE FROM MICHAEL KENNEDY TO JOHN KNOKE AT 1816 EDT ON 09/16/2011 * * *

"On 9/13/11 procedure revisions were approved with reduced limits for post-Loss of Coolant Accident Emergency Core Cooling System (ECCS) leakage. These reduced limits ensure operator doses are maintained less than the FSAR accident analysis results for the highest inleakage rate reported by the CRE inleakage test. Plant staff has since determined that the potential benefit of operating the control room ventilation system in its pressurization alignment was unnecessary with the ECCS leakage restriction and on 9/16/11 operators restored the control room ventilation system into its normal operating alignment. "

The licensee has notified the NRC Resident Inspector. Notified R4DO (Greg Pick)

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Power Reactor Event Number: 47260
Facility: FORT CALHOUN
Region: 4 State: NE
Unit: [1] [ ] [ ]
RX Type: (1) CE
NRC Notified By: KLINT KUDLACEK
HQ OPS Officer: STEVE SANDIN
Notification Date: 09/13/2011
Notification Time: 13:00 [ET]
Event Date: 09/13/2011
Event Time: 08:22 [CDT]
Last Update Date: 09/16/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
GREG PICK (R4DO)

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

Event Text

LOSS OF TECHNICAL SUPPORT CENTER VENTILATION

"VA-106, TSC HVAC Unit VA-107 Rooftop Condensing Unit, tripped off and attempts to restart were unsuccessful. The cause of VA-106 tripping is unknown at this time. Troubleshooting is in progress.

"This condition renders the Technical Support Center unavailable for Emergency Planning Responses. Approved compensatory actions are to relocate personnel to alternate facilities if required. This condition is being reported pursuant to 10 CFR 50.72(b)(3)(xiii) for Loss of Emergency Preparedness Capabilities."

The licensee informed the NRC Resident Inspector.


* * * UPDATE FROM ERICK MATZKE TO DONALD NORWOOD AT 1245 EDT ON 9/16/2011 * * *

"TSC ventilation troubleshooting has been completed and the system was determined to be functional today, September 16, 2011 at 1115 CDT."

The licensee notified the NRC Resident Inspector.

Notified R4DO (Pick).

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Agreement State Event Number: 47262
Rep Org: GEORGIA RADIOACTIVE MATERIAL PGM
Licensee: N/A
Region: 1
City: ATLANTA State: GA
County: COBB
License #: N/A
Agreement: Y
Docket:
NRC Notified By: ERIC JAMESON
HQ OPS Officer: STEVE SANDIN
Notification Date: 09/13/2011
Notification Time: 16:52 [ET]
Event Date: 09/13/2011
Event Time: 00:00 [EDT]
Last Update Date: 09/13/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
ART BURRITT (R1DO)
TIM MCCARTIN (NMSS)
ADELAIDE GIANTELLI (FSME)

Event Text

AGREEMENT STATE REPORT INVOLVING A TRACTOR-TRAILER INCIDENT WHILE TRANSPORTING NUCLEAR GAUGES

The following report was received from the State of Georgia via fax:

"Location of Event: I-20 EB near Six Flags Road (near exit 46)

"A tandem tractor trailer carrying 8 Troxler moisture-density gauges overturned at [about 2330 EDT] on 9/12/2011 after hitting the guardrail. Gauges were en route from Alexandria, LA to Cleveland, TN to be calibrated.

"County HAZMAT arrived on the scene, assisted by GA Environmental Radiation Program personnel (paged by GEMA at [0047 EDT], 9/13/2011). All 8 shipping containers sustained damage. Seven (7) gauges were intact in the shipping containers. One (1) gauge sustained damage: electronic components were separated from the gauge body, survey and wipe smear indicated shielding was still intact, no release of radioactive material.

"At [about 0445 EDT], 9/13/2011, a local Environmental Cleanup Company took temporary possession of the gauges and secured them at their facility. A representative from the calibration lab in Cleveland, TN will bring replacement shipping containers and repackage the gauges on 9/14/2011.

"Isotope: Cs-137; Am-241
"Amount of Activity: 8 mCi; 40 mCi (per gauge)

"Date of Event: 9/12-13/2011 (overnight)
"Date of Report to RCP (Radioactive Control Program: 9/13/2011, [0047 EDT]
"Describe clean-up actions taken by RCP: Performed area surveys and took wipes to confirm integrity of the gauges (no release of radioactive material)

"List radiation measurements taken by RCP:
"Background: 10 uR/hr
"Highest reading, outside trailer: 120 uR/hr
"Damaged gauge, contact: 50 mR/hr
"Damaged gauge, @1m: 50 uR/hr"

GA Incident No.: GA-2011-46i

National Response Center Incident No.: 989403

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Hospital Event Number: 47263
Rep Org: QUEEN'S MEDICAL CENTER
Licensee: QUEEN'S MEDICAL CENTER
Region: 4
City: HONOLULU State: HI
County:
License #: 53-16533-02
Agreement: N
Docket:
NRC Notified By: BRIAN OYADOMARI
HQ OPS Officer: STEVE SANDIN
Notification Date: 09/13/2011
Notification Time: 22:01 [ET]
Event Date: 09/13/2011
Event Time: 10:30 [HST]
Last Update Date: 09/13/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(2) - DOSE > SPECIFIED EFF LIMITS
Person (Organization):
GREG PICK (R4DO)
ADELAIDE GIANTELLI (FSME)

Event Text

MEDICAL EVENT INVOLVING THE ADMINISTRATION OF THE WRONG RADIOPHARMACEUTICAL

At approximately 1000 HST a patient scheduled to receive an administration of 5 mCi In-111 for an imaging scan (Octreotide) received instead a 1.55 mCi Sr-89 injection. The Sr-89 dose, originally 4mCi, was expired (89 days) and administered unintentionally due to personnel error. The RSO calculates that the red bone marrow will receive a dose of 63 rem.

The patient was informed and is being monitored for changes in blood chemistry. The attending and prescribing physician will be informed.

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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Agreement State Event Number: 47264
Rep Org: FLORIDA BUREAU OF RADIATION CONTROL
Licensee: DELRAY MEDICAL CENTER, INC
Region: 1
City: DELRAY BEACH State: FL
County:
License #: 3519-1
Agreement: Y
Docket:
NRC Notified By: SHAWN ANDERSON
HQ OPS Officer: DONALD NORWOOD
Notification Date: 09/14/2011
Notification Time: 13:07 [ET]
Event Date: 08/12/2011
Event Time: [EDT]
Last Update Date: 09/14/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
ART BURRITT (R1DO)
ANGELA MCINTOSH (FSME)
JIM WHITNEY BY EMAIL (ILTA)

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

Event Text

AGREEMENT STATE REPORT - MISSING CS-137 SOURCE

The following information was received via facsimile:

"[The State of Florida] received a report from licensee of a missing 144.6 microCurie Cs-137 sealed source used as a dose calibrator. Source was first discovered missing by inventory on Aug 12, 2011. Also reported by licensee that the Hot Lab was broken into 2 weeks ago and items were missing from a crash cart. Advised licensee to make a police report. Central Inspection Office assigned to investigate."

Florida Incident Number: FL11-078.


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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Agreement State Event Number: 47267
Rep Org: TEXAS DEPARTMENT OF HEALTH
Licensee: WELD SPEC INC
Region: 4
City: LUMBERTON State: TX
County:
License #: 05426
Agreement: Y
Docket:
NRC Notified By: WELD SPEC INC
HQ OPS Officer: DONALD NORWOOD
Notification Date: 09/14/2011
Notification Time: 15:26 [ET]
Event Date: 09/12/2011
Event Time: [CDT]
Last Update Date: 09/14/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
GREG PICK (R4DO)
ADELAIDE GIANTELLI (FSME)

Event Text

AGREEMENT STATE REPORT - RADIOGRAPHER EXCEEDS FIVE REM TEDE FOR YEAR

The following information was received via E-mail:

"On September 14, 2011, the Agency was notified by the licensee that a radiographer had exceeded 5 REM TEDE for the year. On September 12, 2011, while operating an INC IR102 camera, serial number 4843, containing a 67 Curie Iridium (IR) 192 source, the radiographer failed to fully retract the source into the camera after completing three shots on a weld. This was discovered when the trainee discovered that safety lock was already in the open/unlock position when he was going to unlock the source for the first exposure on the second weld. The radiation survey meter was turned off and no radiation pagers alarmed. Both radiographers noted that their 0-200 mR pocket dosimeters were off scale. They stopped work, fully retracted the source in the camera, and reported the incident to the RSO. Their Landauer badges were sent off for emergency processing and the results were received on September 14, 2011. The trainer received 3.361 Rem deep dose equivalent whole body dose. The trainee received 2.787 Rem. The total exposure for the year of the trainer is at 5.152 Rem and the RSO is still awaiting his August 2011 dose report to add to his total dose for the year. The trainer has been removed from duty. Additional information will be provided as it is received in accordance with SA300."

This event occurred at Total Refinery, Highway 366 and 32nd St., Port Arthur, Texas, 77642.

Texas Incident Number: I-8884.

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Fuel Cycle Facility Event Number: 47269
Facility: GLOBAL NUCLEAR FUEL - AMERICAS
RX Type: URANIUM FUEL FABRICATION
Comments: LEU CONVERSION (UF6 TO UO2)
                   LEU FABRICATION
                   LWR COMMERICAL FUEL
Region: 2
City: WILMINGTON State: NC
County: NEW HANOVER
License #: SNM-1097
Agreement: Y
Docket: 07001113
NRC Notified By: SCOTT P. MURRAY
HQ OPS Officer: DAN LIVERMORE
Notification Date: 09/15/2011
Notification Time: 14:45 [ET]
Event Date: 09/14/2011
Event Time: 15:30 [EDT]
Last Update Date: 09/16/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
OTHER UNSPEC REQMNT
70.74 APP. A - ADDITIONAL REPORTING REQUIREMENTS
Person (Organization):
EUGENE GUTHRIE (R2DO)
TIM MCCARTIN (NMSS)
MARY THOMAS (R2)

Event Text

24 HOUR REPORT DUE TO DOUBLE CONTINGENCY NOT MAINTAINED

"During a GNF-A Fuel Manufacturing Operation (FMO) Integrated Safety Analysis (ISA) team walk-down of HVAC systems in the decontamination facility area, it was observed that a log entry for a waste-oil can mass was greater than the limit specified in procedural requirements.

"Upon further investigation it was determined at 3:30PM on September 14, 2011 that an operator had incorrectly processed a waste oil can with a gross weight in excess of the limit specified by criticality safety requirements. This resulted in a condition where one of the two controls on mass documented as being necessary to meet double contingency had not been maintained. The second criticality control on mass was maintained at all times.

"At no time was an unsafe condition present, however the decontamination oil processing area was shut down until necessary controls were available.

"This event is being conservatively reported pursuant to GNF-A internal procedure reporting requirements within 24 hours of discovery."

The licensee will inform the state and local agencies and the NRC Region II Office of this incident.


* * * UPDATE FROM SCOTT MURRAY TO DONALD NORWOOD AT 1832 EDT ON 9/16/2011 * * *

"The incorrect processing of the waste oil can as reported on 9/15/11 resulted in a failure to meet the performance requirement of 10CFR70.61 and as a result, met the reporting requirements of 10CFR70 Appendix A(b)(2) [and 10CFR70.74].

Notified R2DO (Guthrie) and NMSS EO (McCartin).

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Power Reactor Event Number: 47271
Facility: PALISADES
Region: 3 State: MI
Unit: [1] [ ] [ ]
RX Type: [1] CE
NRC Notified By: PAUL ADAMS
HQ OPS Officer: JOHN KNOKE
Notification Date: 09/16/2011
Notification Time: 15:04 [ET]
Event Date: 09/16/2011
Event Time: 14:50 [EDT]
Last Update Date: 09/16/2011
Emergency Class: UNUSUAL EVENT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED
Person (Organization):
TAMARA BLOOMER (R3DO)
SCOTT MORRIS (IRD)
MARK KING (NRR)
ANNE BOLAND Acting (RA)
ERIC LEEDS (NRR)
BILL GOTT (IRD)
JANE MARSHALL (IRD)
SULLIVAN (FEMA)
FLINTER (DHS)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 M/R Y 79 Power Operation 0 Hot Standby

Event Text

NOTIFICATION OF UNUSUAL EVENT DUE TO PRIMARY SYSTEM LEAKAGE GREATER THAN 10 GPM

The Licensee declared an Unusual Event for Palisades Unit 1 on 09/16/2011 at 1450 EDT based on EAL SU 8.1, RCS (Reactor Coolant System) leakage exceeding 10 gallons per minute (gpm). The licensee was monitoring an increase in RCS leakage, and at a rate of 3.5 gpm entered their off normal procedure and began shutting down the plant. Technical Specification requires the plant to be in Mode 3 within 6 hours. Leakage increased to greater than 10 gpm, and at 1454 EDT the reactor was manually tripped from 79% power. All control rods fully inserted, and the shutdown was described by the licensee as uncomplicated. Unit 1 is stable in Mode 3.

No safety injection was required since two charging pumps (B&C) were able to keep up with RCS leakage estimated to be between 14 and 15 gpm. Pressurizer level was restored to 43% and rising. RCS pressure was greater than 2000 psi and RCS temperature was being maintained at no load Tave of 535F on the turbine bypass valves. There is no indication of any primary-to-secondary leakage and all equipment is available except for charging pump 'A', which was tagged out of service for planned maintenance.

An entry into containment had been made and the licensee had identified the source of the RCS leakage as being in the vicinity of the 'A' pressurizer spray control valve #1057. This was based on a steam plume seen from below the pressurizer looking up through grating towards this valve.

The licensee has notified the NRC Resident Inspector.


* * * UPDATE FROM JAMES BYRD TO JOHN KNOKE AT 1952 EDT ON 09/16/11 * * *

At 1934 EDT the licensee terminated from their Unusual Event due to EAL SU 8.1. The plant is still in Mode 3 with a leak rate of 0.324 gpm..The licensee has confirmed that the leak is a result of the packing gland backing out of pressurizer spray valve #1057.

The licensee has notified the NRC Resident Inspector. The R3DO (Bloomer) was notified. Notified FEMA (Eiscoe) and DHS (Flinter).

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Power Reactor Event Number: 47273
Facility: PEACH BOTTOM
Region: 1 State: PA
Unit: [2] [3] [ ]
RX Type: [2] GE-4,[3] GE-4
NRC Notified By: PHILIP PAUTLER
HQ OPS Officer: HOWIE CROUCH
Notification Date: 09/18/2011
Notification Time: 08:52 [ET]
Event Date: 09/18/2011
Event Time: 04:44 [EDT]
Last Update Date: 09/18/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xii) - OFFSITE MEDICAL
Person (Organization):
ART BURRITT (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 N 0 Refueling 0 Refueling

Event Text

TRANSPORT OF POTENTIALLY CONTAMINATED INJURED WORKER

"A worker was transported to an off-site medical facility due to a work-related hand injury. The individual was not contaminated. The individual's left hand work glove was found to be contaminated. The individual remains under the care of physicians and all contaminated material was safely collected and is being transported back to Peach Bottom Atomic Power Station as required."

A licensee health physics employee accompanied the worker to the hospital. There was no spread of contamination in the ambulance or at the hospital.

The licensee notified the NRC Resident Inspector and will be notifying the Pennsylvania Emergency Management Agency and local authorities.

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Power Reactor Event Number: 47274
Facility: PALO VERDE
Region: 4 State: AZ
Unit: [1] [2] [3]
RX Type: [1] CE,[2] CE,[3] CE
NRC Notified By: BRAD EKLUND
HQ OPS Officer: HOWIE CROUCH
Notification Date: 09/18/2011
Notification Time: 11:00 [ET]
Event Date: 09/18/2011
Event Time: 08:30 [MST]
Last Update Date: 09/18/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
GREG PICK (R4DO)

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
3 N Y 100 Power Operation 100 Power Operation

Event Text

TECHNICAL SUPPORT CENTER OUT OF SERVICE DUE TO PLANNED MAINTENANCE

"The following event description is based on information currently available. If through subsequent reviews of this event additional information is identified that is pertinent to this event or alters the information being provided at this time a follow-up notification will be made via the ENS or under the reporting requirements of 10CFR50.73.

"This report is being made under 10 CFR 50.72(b)(3)(xiii) for unavailability of the Palo Verde Technical Support Center (TSC). On September 18, 2011, from approximately 0830 to 1700 MST, a scheduled power outage will cause the TSC to be non-functional due to the loss of lighting, ventilation, Emergency Response Facilities Data Acquisition and Display System (ERFDADS), and the Plant Information (PI) System in the TSC. Temporary lighting will be installed prior to the power outage. In the event that the TSC is required to be activated, the Emergency Response Organization (ERO) will respond to the TSC and the electrical maintenance group will stop maintenance activities and restore power. The TSC will then be declared functional after power is restored.

"In addition, due to the power outage to the TSC, PI and ERFDADS will be unavailable at the Emergency Operations Facility.

"The NRC Resident Inspector has been notified of the planned power outage."


* * * UPDATE FROM MIKE KOHART TO JOHN KNOKE AT 2200 EDT ON 9/18/11 * * *

At 2200 EDT the Palo Verde Technical Support Center (TSC) has been restored to service This includes Emergency Response Facilities Data Acquisition and Display System (ERFDADS), and the Plant Information (PI) System.

The licensee has notified the NRC Resident Inspector. Notified the R4DO (Pick).

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Power Reactor Event Number: 47275
Facility: CALLAWAY
Region: 4 State: MO
Unit: [1] [ ] [ ]
RX Type: [1] W-4-LP
NRC Notified By: DAVID LANTZ
HQ OPS Officer: JOHN KNOKE
Notification Date: 09/18/2011
Notification Time: 12:41 [ET]
Event Date: 09/18/2011
Event Time: 10:56 [CDT]
Last Update Date: 09/18/2011
Emergency Class: ALERT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED
Person (Organization):
GREG PICK (R4DO)
SCOTT MORRIS (IRD)
ERIC LEEDS (NRR)
ELMO COLLINS (RA)
JOSEPH GIITTER (NRR)
R. CANIANO (R4)
RICHARDSON (DHS)
CASTO (FEMA)
PARSONS (DOE)
HAYDEN (HQ P)

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

ALERT DECLARED DUE TO A FREON GAS RELEASE INTO A SAFE SHUTDOWN EQUIPMENT AREA

"An Alert was declared at Callaway Nuclear Plant at 1056 [CDT] due to EAL HA3.1. Access to an Auxiliary Building area which is prohibited due to release of toxic gas which jeopardizes operation of systems required to maintain safe operations or safely shutdown the reactor. EAL HU3.1 (Unusual Event) is also applicable at the same time.

"The cause of the toxic gas release was a Freon gas leak from the 'A' Control Room air conditioner unit."

The licensee has notified the NRC Resident Inspector and state and local government. Also notified USDA (Pitt) and HHS (Emerson).

* * * UPDATE FROM DAVID LANTZ TO JOHN KNOKE AT 1847 EDT ON 9/18/11 * * *

At 1737 CDT, Callaway Nuclear Plant exited from the Alert for EAL HA3.1, and exited from the Unusual Event for EAL HU3.1. The plant continues to operate at 100% power in Mode 1. There was no radiological release due to this event. Additionally, a press release will be performed after the event closeout.

The licensee has notified the NRC Resident Inspector and state and local government. Notifications were also given to R4DO (Pick), NRR EO (Giitter), IRD-MOC (Morris), HQ PAO (Hayden), DHS (Gates), FEMA (Via), DOE (Foote), USDA (Sanders) and HHS (Hoskins).

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