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Event Notification Report for April 30, 2014

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
04/29/2014 - 04/30/2014

** EVENT NUMBERS **


49886 49992 50048

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Agreement State Event Number: 49886
Rep Org: TEXAS DEPARTMENT OF HEALTH
Licensee: AMERICAN XRAY AND INSPECTION SERVICES, INC.
Region: 4
City: MIDLAND State: TX
County:
License #: 05974
Agreement: Y
Docket:
NRC Notified By: GENTRY HEARN
HQ OPS Officer: JEFF ROTTON
Notification Date: 03/10/2014
Notification Time: 11:14 [ET]
Event Date: 03/06/2014
Event Time: 15:45 [CDT]
Last Update Date: 04/29/2014
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
THOMAS FARNHOLTZ (R4DO)
FSME EVENTS RESOURCE (EMAI)

Event Text

AGREEMENT STATE - RADIOGRAPHY CAMERA SOURCE DISCONNECT

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

"On March 10, 2014, the Agency [State of Texas] received notice of a radiography source disconnect that occurred on March 6, 2014. The source was a 92.2 curie iridium-192 radiography source. The event occurred at a temporary field site just south of the border with New Mexico near Carlsbad, NM on the Texas side. No exposures to the public resulted from this event. No overexposures resulted from this event. The cause of the event is unknown at this time. The source was retrieved by the licensee. The licensee's initial report to the Agency [State of Texas] was later than 24 hours after the event. Additional information will be supplied as it is received in accordance with SA-300."

Texas Incident #: I-9163


* * * UPDATE AT 0912 EDT ON 04/17/14 FROM ART TUCKER TO S. SANDIN VIA EMAIL * * *

"The Agency's investigation of this event has determined that there was no source disconnect, but that the radiographer failed to connect the source pigtail to the drive cable prior to connecting the drive assembly to the exposure device. Additional information will be provided in accordance with SA-300."

Notified R4DO (Gaddy) and FSME via email.


* * * UPDATE FROM ART TUCKER TO DONALD NORWOOD AT 1656 EDT ON 4/29/2014 * * *

"On April 29, 2014, the Agency received the final dose information for the radiographer who picked up the guide tube with the source still in it. A dose of 15.11 rem was assigned to his hand that picked up the guide tube and he received 509 millirem DDE on his whole body badge. Additional information will be provided as it is received in accordance with SA-300."

Notified R4DO (Haire) and FSME Events Resource.

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
Research Reactor Event Number: 49992
Facility: UNIV OF TEXAS
RX Type: 1100 KW TRIGA MARK II
Comments:
Region: 4
City: AUSTIN State: TX
County: TRAVIS
License #: R-129
Agreement: Y
Docket: 05000602
NRC Notified By: MICHAEL KRAUSE
HQ OPS Officer: DONALD NORWOOD
Notification Date: 04/03/2014
Notification Time: 09:37 [ET]
Event Date: 04/02/2014
Event Time: 11:25 [CDT]
Last Update Date: 04/29/2014
Emergency Class: NON EMERGENCY
10 CFR Section:
NON-POWER REACTOR EVENT
Person (Organization):
HEATHER GEPFORD (R4DO)
GREG SCHOENEBECK (NPR)
ALEXANDER ADAMS (NPR)

Event Text

CONSOLE KEY LEFT UNATTENDED

After performing routine maintenance and surveillance procedures, the reactor operator left the reactor control room for a rest break. During this break the reactor operator left the console key inserted and unattended in the console. Another operator came by and noticed that the key was in the console without the other reactor operator in the control room. The second reactor operator notified the reactor manager. The reactor manager immediately removed the key from the console. The reactor manager then suspended the first reactor operator's operating rights until corrective actions have been determined and implemented.

During the time the key was unattended, all control elements were fully inserted. Based upon video review, the length of time the key was unattended was 14 minutes.

The relevant Technical Specification to this situation is 6.1.3 (Staffing): the minimum staffing when the reactor is operating shall be one licensed reactor operator in the control room.

The licensee notified NRC NPR (Adams and Bassett).


* * * RETRACTION FROM MICHAEL KRAUSE TO DONALD NORWOOD AT 1934 EDT ON 4/29/2014 * * *

"SUMMARY: After further review the facility has determined that the 'Unattended Key Left in Console' event originally reported as a reportable occurrence was indeed not a reportable occurrence and retracts the official notice, changing the notification to a for your information only as was discussed with the facility NRC Project Manager Alexander Adams in a call following the notification.

"DETAILS: On April 2, 2014, after the reactor had been shutdown for an extended period due to maintenance repairs, an operator was performing surveillance / maintenance activities which required the console key to be inserted into the reactor control system. The maintenance was done with the reactor in the shutdown mode with the reactor subcritical by more than $1.00. After a portion of the maintenance was completed, the operator left the control room for a short break and did not remove the reactor key from the console before leaving the room. All control rods were fully down at the time the operator left the room and remained in that condition for 14 minutes until the key was removed from the console by the reactor manager. A review of video surveillance confirmed the reactor remained shutdown while the key was unattended. The facility does not normally leave the key unattended in the control console so the initial response was to report this event as a reportable occurrence based on the Standard English Dictionary definition of shutdown. A follow-up review of the requirements in the Technical Specification Section 6.1.3 required a licensed operator in the control room when the reactor was not 'Shutdown', with 'Shutdown' defined in Technical Specification Section 1.19 as the reactor subcritical by at least $1.00. Since the reactor was clearly shutdown based on the Technical Specification definition, the report of a reportable occurrence is hereby retracted and the notification can be interpreted as a for your information notice only. Nonetheless, the operator who left the key in the console was given retraining and review by the reactor manager prior to being allowed to resume licensed activities since his actions had come very close to a Technical Specification violation."

Notified R4DO (Haire), and NRC NPR (Adams and Schoenebeck).

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Agreement State Event Number: 50048
Rep Org: UTAH DIVISION OF RADIATION CONTROL
Licensee: CHURCH OF JESUS CHRIST OF LATTER DAY SAINTS
Region: 4
City: MAGNA State: UT
County:
License #:
Agreement: Y
Docket:
NRC Notified By: MIKE GIVENS
HQ OPS Officer: STEVE SANDIN
Notification Date: 04/22/2014
Notification Time: 10:25 [ET]
Event Date: 05/13/2013
Event Time: [MDT]
Last Update Date: 04/22/2014
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RAY AZUA (R4DO)
FSME_EVENTS RESOURCE (EMAI)

Event Text

AGREEMENT STATE REPORT INVOLVING A TRITIUM EXIT SIGN DESTROYED IN A FIRE

The following information was received from the State of Utah via fax.

"The Utah Division of Radiation Control [DRC] was notified at 1:38 p.m. MST on Wednesday, August 13, 2013 of an incident where a church chapel was destroyed by fire. The fire had occurred three months earlier on May 13, 2013. No one noticed the radiation symbol mixed with the trash until a representative of the church, watching the residue being shoveled from the chapel. He noted the radiation symbol stuck to the remains of the melted sign.

"The DRC contacted the church representative and was informed of the details of the fire.

"The DRC Radioactive Materials Section Manager was notified of the incident.

"Notification to the NRC was completed on January 24, 2014.

"The tritium sign was melted by the high heat of the fire. There were no remaining identifiable components. The debris from the sign was mixed with other burnt materials and the trash had been shoveled into waste containers. The church representative said there was nothing recoverable in the fire's residue.

"The EXIT sign (Model B-100) was manufactured by SRB Technologies in 2005. The sign was designed to operate for 20 years using 18.9 curies of tritium. The estimated activity of tritium remaining inside the sign when it was destroyed was approximately 12 Curies."

Utah Event Report ID No.: UT140001

Page Last Reviewed/Updated Wednesday, April 30, 2014
Wednesday, April 30, 2014