Event Notification Report for August 29, 2014

UNPLANNED CONTAMINATION INCIDENT IN THE RESEARCH REACTOR FACILITY

At approximately 1600 EDT on 08/29/14, a 60 nanocurie Pu-239 wafer source dropped from its holder during change out following neutron irradiation in building 235 (Research Reactor Test Facility). The wafer struck the floor and cleaved in half. Radiation surveys confirmed alpha contamination of approximately 200 counts per minute. The area was decontaminated, resurveyed and released.

The licensee will notify their NMSS PM (Naquin) and the State of Maryland Department of Environment as a courtesy.

* * * UPDATE AT 1840 EDT ON 08/30/14 FROM TOM O'BRIEN TO STEVE SANDIN VIA EMAIL * * *

"Follow-up to the dropped source (Pu-239 RS# 87-0039(4) on 8/29/14)) at NG-6MAll personnel involved have been evaluated, with the exception of two nasal swipes, on two separate individuals not directly involved with the incident, but near the location, reporting about 0.17 dpm alpha each, all surveys find the personnel to be clear of contamination. It is believed the two 0.17 dpm nasal swipes are statistically not different than zero, follow-up measurements will be done to confirm this. Even if we assume them to be positive, the resulting estimated dose from these measurements would be on the order of 10 mrem.

"The NG-6M instrument area has been surveyed and cleared for normal use. All contamination swipe surveys of the floor, tools, furniture and equipment potentially involved in this incident have been found to be clean. With the exception of one alpha instrument survey, all surveys with alpha and beta/gamma survey instruments have found levels less than or equal to background. The one survey where positive indication was found was performed at the source drop location, directly underneath where the source fell. This survey was done after the source was retrieve. Initially measured about 200 cpm alpha contamination and very localized, the spot was carefully deconned and subsequent surveys found to be less than or equal to background. All swipes of this spot were also found to be clean.

"The source has been safely retrieved, secured and is locked in our safe in A134. No removable contamination was found on the source containers or during retrieval of the source. Gamma spectrum measurements of the retrieved source, detecting the Am-241 trace nuclide, and correlating this activity by know nuclide ratios find that the Pu-239 activity of the source is within good agreement of the original activity of the source (2190 Bq). While this confirmation has many errors incorporated into it, it is the best measurement we can make at this time, that along with the negative findings of any removable contamination to speak of, and visual inspections of the source, I conclude that to the best of my knowledge, the source material is intact on the broken source substrate pieces, inside the source container. Careful follow-up measurements would need to be performed to confirm this for certain, but based on the info I have at present this is my conclusion."

Notified R1DO (Mangan), NMSS EO (Stablein) and NMSS PM (Naquin).

* * *RETRACTION PROVIDED FROM TOM O'BRIEN TO JEFF ROTTON AT 1425 EDT ON 09/04/2014 * * *

"Upon detailed review of the incident data NIST is requesting retraction of this notification on the basis that 70.50 (b)(1)(i) and (ii) are not applicable to this event and therefore no 24 hour (or other notification) was required. Access to the contaminated area was restricted for less than 24 hours. Additionally, at the time of initial reporting on 8/30/2014, the most conservative annual limit on intake (ALI) was used as the chemical composition was not yet known. As of today, 9/3/2014, we have confirmed that the radioactive material is in the form of PuO2. This additional information indicates that the involved quantity of radioactive material was less than five times the lowest ALI for Pu-239.

"Since the initial report of 8/30/2014, there has been no other contamination detected. The nasal-swab measurements were analyzed for a longer time period and have been determined to be less than the minimum detectable activity.

"NIST is evaluating the incident for lessons learned and extent of conditions and will advise [NRC] Region I and our [NRC] Project Manager of the outcome.

"Licensee also requested that the first sentence of the [original] Event Text be corrected as indicated below as the source was not subjected to neutron irradiation. 'At approximately 1600 EDT on 08/29/14, a 60 nanocurie Pu-239 wafer source (that was going to be used to calibrate an instrument detector) dropped from its holder during transfer in building 235 (Research Reactor Test Facility).'"

Notified R1DO (Ferdas), NMSS EO (Smith) and NMSS PM (Naquin).

AGREEMENT STATE REPORT - MEDICAL EVENT

The following information was received via facsimile:

"On August 29, 2014, the licensee made a telephone notification of a medical event which occurred during a skin treatment using a Nucletron microSelecton 106.990 HDR. The Radiation Safety Officer indicated that a decay corrected value for the source activity was used during data entry for the treatment plan. The licensee discovered, after the administration of the treatment fraction, that the software also corrected for decay in determining the exposure time for the fraction. The extra decay correction resulted in a dose approximately twice the prescribed fraction dose of 600 cGy. The licensee has informed the referring physician and held a staff meeting to discuss the circumstances. Any future treatment fractions for the patient will be reviewed and the licensee will review its nine previous skin treatment procedures to determine if additional medical events may have occurred. Additional information, including the administered dose, will be provided by the licensee in its written report."

Event Report ID No.:VA-2014-005

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.

DIGITAL RADIATION MONITORING SYSTEM OPERATING INTERMITTENTLY

"At 0932 EDT on August 29, 2014, Beaver Valley Power Station (BVPS) Unit 2 determined that the Digital Radiation Monitoring System (DRMS) was operating intermittently. This resulted in an intermittent loss of radiation monitor capability to alarm and indicate in the control room. BVPS Unit 2 DRMS was declared non-functional. Repair efforts were initiated and compensatory measures were established.

"At 1556 EDT on August 29, 2014, following initial investigation and repairs, BVPS Unit 2 DRMS was declared functional.

"Since the BVPS Unit 2 DRMS was non-functional, this event resulted in a loss of emergency assessment capability and is reportable per 10 CFR 50.72(b)(3)(xiii).

"The NRC Resident Inspector has been notified."

The cause was attributed to an automatic reboot of the computer based on lack of disk space.

NOTIFICATION TO STATE OF VIRGINIA REQUIRED BY SITE DISCHARGE PERMIT

"On 08/29/2014 at 1457 hours [EDT], Surry Power Station notified the State of Virginia Department of Environmental Quality (DEQ) that two of the three turbine building sumps, required to be sampled by the discharge permit VA00004090, indicated an out of specification condition for oil and grease parameters. The laboratory supervisor reviewed the analysis and found no discrepancies. Sample methods and sample locations were reviewed and were unchanged from previous samples. A review of the operation of the sump oil skimmers indicated that they have been operating properly. In addition, there have been no oil spills or maintenance that would cause elevated readings in the sumps.

"Backup samples of both sumps were obtained on 08/27/14 and 08/28/14. The results of the backup samples were received on 08/29/2014 and all samples indicated a less than the detectable levels.

"Based upon an initial review of the issue, the results of the backup samples, and at least 5-year history of less than detectable oil and grease levels in the sump, the original samples for the sumps are considered anomalous. The results, however, are being reported in accordance with the permit requirements. This report is being issued in accordance with 10 CFR 50.72(b)(2)(xi), any event or situation related to the protection of the environment for which notification to other government agencies has been made.

"The Surry NRC Senior Resident Inspector has been notified."