Event Notification Report for September 19, 2012

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
09/18/2012 - 09/19/2012

** EVENT NUMBERS **


48291 48292 48298 48299 48317 48318 48319

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Agreement State Event Number: 48291
Rep Org: KENTUCKY DEPT OF RADIATION CONTROL
Licensee: DOMTAR PAPER COMPANY
Region: 1
City: HAWESVILLE State: KY
County:
License #: 201-174-57
Agreement: Y
Docket:
NRC Notified By: MARISSA VEGA VELEZ
HQ OPS Officer: STEVE SANDIN
Notification Date: 09/10/2012
Notification Time: 14:15 [ET]
Event Date: 09/07/2012
Event Time: 11:00 [CDT]
Last Update Date: 09/10/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
CHRISTOPHER NEWPORT (R1DO)
FSME EVENTS RESOURCE ()

Event Text

AGREEMENT STATE REPORT - STUCK SHUTTER ON FIXED NUCLEAR GAUGE

The following information was received from the Commonwealth of Kentucky via fax:

"KY RHB [Kentucky Radiological Health Branch] was notified on Monday, 9/10/12 by a representative from Domtar Paper Company, a routine shutter check was performed 9/7/12 on a fixed nuclear gauge and the shutter did not function as designed. Operation of the shutter required use of a tool. The gauge involved is Ohmart model SR-A, S/N 9296GG, containing 10 mCi Cs-137. It appears corrosive atmosphere caused damage to the source holder. The licensee requested proposal from Vega Americas, Inc. to repair or replace the source holder."

KY Event Report ID No.: 48291

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Agreement State Event Number: 48292
Rep Org: ILLINOIS EMERGENCY MGMT. AGENCY
Licensee: BED BATH AND BEYOND
Region: 3
City: VERNON HILLS State: IL
County:
License #:
Agreement: Y
Docket:
NRC Notified By: DAREN PERRERO
HQ OPS Officer: VINCE KLCO
Notification Date: 09/10/2012
Notification Time: 15:47 [ET]
Event Date: 07/15/2012
Event Time: 16:00 [CDT]
Last Update Date: 09/10/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JOHN GIESSNER (R3DO)
FSME RESOURCES (EMAI)
ILTAB (EMAI)

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

Event Text

AGREEMENT STATE REPORT - LOST TRITIUM SIGN

The following information was received on 9/7/2012 via email:

"The Corporate RSO for Bed, Bath and Beyond (B3) called to advise that an exit sign containing H-3 appears to be missing from their Illinois store. The sign had been taken down by an electrician in July in anticipation of recovery and disposal by Shaw Environmental. A representative from Shaw had arrived this past week to collect and package the sign only to find that the sign was missing from the storage location where it had been placed at the time of removal. The electrical company hired by the licensee to perform the un-installation had noted that there were no signs of damage or loss of contents at the time of removal on July 13, 2012. The manager of the licensee's store can only definitely recall having seen the sign on July 14 or 15th in secure storage. Subsequent visual surveys of the store were conducted in an attempt to locate the sign with no success.

"The sign involved is made by Safety Light Corporation (m/n SLX-60). It was purchased in November of 2004. Based on the serial number involved (289354) it was determined that the sign was sold with a nominal H-3 content of 11.5 Ci. As of this date, that activity is approximately 7.4 Ci. Currently, it is believed that the device has been inadvertently disposed with the facilities normal trash stream."

Illinois Number: IL-12014

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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Agreement State Event Number: 48298
Rep Org: RI DEPT OF RADIOLOGICAL HEALTH
Licensee: ROGER WILLIAMS MEDICAL CENTER
Region: 1
City: PROVIDENCE State: RI
County:
License #: 7D-026-01
Agreement: Y
Docket:
NRC Notified By: CHARMA WARING
HQ OPS Officer: STEVE SANDIN
Notification Date: 09/11/2012
Notification Time: 13:07 [ET]
Event Date: 08/28/2012
Event Time: [EDT]
Last Update Date: 09/11/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
CHRISTOPHER NEWPORT (R1DO)
FSME EVENTS RESOURCE (EMAI)

Event Text

AGREEMENT STATE REPORT - PATIENT RECEIVED TWO UNDERDOSES OF Y-90 TO DIFFERENT TREATMENT SITES

The following information was received from the State of Rhode Island via fax:

"Event Type: Medical event involving the administration of Yttrium-90 microspheres.

"Notification(s): On August 30, 2012, the RI Department of Health Office of Facilities Regulation, Radiation Control Program received a phone call from the facility's Radiation Safety Officer, with a follow-up e-mail the same day.

"Event Description: On 08/28/2012, two incorrect doses were prepared for a Y-90 microsphere treatment. Both doses were for the same patient (i.e., two different treatment sites). One dose was drawn at 28.7% less than prescribed and the other dose was drawn at 22.9% less than prescribed. The final administered doses were less than 40.3% and 27.2% prescribed, respectively.

"Cause of the event: Under investigation and unknown at this time.

"Actions: Adverse effects to the patient are not expected; a follow-up reactive inspection is planned.

"[Rhode Island] Event Report ID: 2012-001"

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: 48299
Rep Org: MA RADIATION CONTROL PROGRAM
Licensee: WOOD'S HOLE OCEANOGRAPHIC INSTITUTION
Region: 1
City: WOOD'S HOLE State: MA
County:
License #: 00-0643
Agreement: Y
Docket:
NRC Notified By: JOHN SUMARES
HQ OPS Officer: STEVE SANDIN
Notification Date: 09/11/2012
Notification Time: 14:28 [ET]
Event Date: 09/11/2012
Event Time: 12:05 [EDT]
Last Update Date: 09/11/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
CHRISTOPHER NEWPORT (R1DO)
FSME EVENTS RESOURCE (EMAI)

Event Text

AGREEMENT STATE REPORT - LEAK TEST RESULTS FOR NI-63 SOURCE > .005 MICROCURIES

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

"[The licensee] called the Agency [Massachusetts Radiation Control] to report that [the licensee] received leak test results that were above 0.005 microCurie for their 'Shimadzu' [Manufacturer] Ni-63 gas chromatograph instruments, each containing approximately 10 milliCurie foil sources. [The licensee] reported that the leak test results were 0.0053 and 0.0069 microCurie. [The licensee] stated that wipe surveys for Ni-63 were taken of the lab areas where these instruments were used. [The licensee] did not yet have the LSC [liquid scintillation counter] results of the wipe surveys. [The licensee] also disassembled the electron capture detectors (ECD) from the GC [Gas Chromatograph] instruments and placed them inside a scaled poly bag to store the ECD's until [the licensee] can return the ECD's to 'Shimadzu'."

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Power Reactor Event Number: 48317
Facility: LASALLE
Region: 3 State: IL
Unit: [1] [2] [ ]
RX Type: [1] GE-5,[2] GE-5
NRC Notified By: TODD GRANLUND
HQ OPS Officer: VINCE KLCO
Notification Date: 09/18/2012
Notification Time: 05:59 [ET]
Event Date: 09/18/2012
Event Time: 01:15 [CDT]
Last Update Date: 09/18/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(C) - POT UNCNTRL RAD REL
Person (Organization):
MARK RING (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

MALFUNCTION OF THE SECONDARY CONTAINMENT DOOR INTERLOCK

"This report is being made pursuant to 10CFR50.72(b)(3)(v)(C), Event or Condition that could have prevented fulfillment of a Safety Function needed to Control the Release of Radioactive Material. An employee entered a secondary containment interlock and identified that both doors of the interlock opened simultaneously when the door on the reactor building side was opened. The employee immediately secured both doors in the interlock and notified the Main Control Room Supervisor. Both doors in the interlock were open for approximately 10 seconds. With both doors open, TS SR 3.6.4.1.2 was not met. This rendered secondary containment inoperable per TS 3.6.4.1. Reactor Building differential pressure, as observed in the Main Control Room, has remained less than -0.25" H20 at all times. Initial investigation determined that a mechanical interlock for the doors was malfunctioning. Administrative controls have been put in place to ensure the doors remain closed pending repairs to the mechanical interlock."

The licensee notified the NRC Resident Inspector.

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Power Reactor Event Number: 48318
Facility: COMANCHE PEAK
Region: 4 State: TX
Unit: [1] [2] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: ROBERT DANIELS
HQ OPS Officer: PETE SNYDER
Notification Date: 09/18/2012
Notification Time: 11:58 [ET]
Event Date: 09/18/2012
Event Time: 10:55 [CDT]
Last Update Date: 09/18/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
GEOFFREY MILLER (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

OUTAGE OF PLANT RADIATION MONITORING SYSTEM REMOTE READOUT DUE TO PLANNED MODIFICATION

"On September 18, 2012, power was removed from SCADA A of the Radiation Monitoring System (RMS) to perform a planned system modification. During this period, data for most Unit 1 radiation monitors will not be electronically available in the emergency response facilities and will not be supplied to the Emergency Response Data System (ERDS), if activated. System alarms and data displays will still be available to the plant operators in the Control Room. The expected duration of RMS remote data partial inoperability is approximately 72 hours. The loss of Unit 1 remote readout capability requires compensatory measures to be used for the acquisition of radiological data in the emergency response facilities. These compensatory measures have been communicated to the emergency response organization, Therefore, it is expected that appropriate assessment of plant conditions, notifications, and communications could still be made, if required, during the time that the portions of the RMS are inoperable. This report is being made in accordance with 10 CFR 50.72(b)(3)(xiii), which is any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability. An update message will be provided when the RMS is restored."

The NRC Resident has been notified.

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Power Reactor Event Number: 48319
Facility: PERRY
Region: 3 State: OH
Unit: [1] [ ] [ ]
RX Type: [1] GE-6
NRC Notified By: LLOYD ZERR
HQ OPS Officer: DONG HWA PARK
Notification Date: 09/18/2012
Notification Time: 12:58 [ET]
Event Date: 07/23/2012
Event Time: 20:57 [EDT]
Last Update Date: 09/18/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.73(a)(1) - INVALID SPECIF SYSTEM ACTUATION
Person (Organization):
MARK RING (R3DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N Y 96 Power Operation 96 Power Operation

Event Text

INVALID SYSTEM ACTUATIONS

"On July 23, 2012, at 2057 hours, the Perry Nuclear Power Plant experienced a loss of the normal power supply to the Reactor Protection System (RPS) A electrical bus. The loss of RPS bus A caused an actuation of several Division 1 containment outboard isolation valves. The actuation signal caused full closure of one or more valves in each of the following Division 1 subsystems: Main Steam line drains, Containment Radiation Monitor, Drywell Radiation Monitor, Reactor Water Cleanup, Fuel Pool Cooling and Cleanup, Liquid Radwaste Sumps, Containment Vessel Chilled Water, Containment Vacuum Relief, Condensate Transfer and Storage, Mixed Bed Demineralizer and Distribution, Containment Personnel Airlocks, Service Air, and Instrument Air. Division 2 components and valves were not affected.

"This event is considered an invalid system actuation reportable under 10 CFR 50.73(a)(2)(iv)(A). The isolation was not initiated in response to actual plant conditions or parameters, and was not a manual initiation. Therefore, this notification is provided via a 60 day optional phone call in accordance with 10 CFR 50.73(a)(1) instead of submitting a written Licensee Event Report.

"The event meets reporting criteria specified in 10 CFR 50.73(a)(2)(iv)(B)(2) as a general containment isolation valve signal affecting containment isolation valves in more than one system. All affected systems functioned as expected in response to an outboard isolation signal. The valves were reopened in accordance with plant procedures. The failure mechanism that caused the loss of RPS bus A was a degraded voltage regulator. The voltage regulator was replaced and retested with satisfactory results.

"The NRC Resident Inspector has been notified."

Page Last Reviewed/Updated Wednesday, March 24, 2021