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Event Notification Report for September 3, 2015

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
09/02/2015 - 09/03/2015

** EVENT NUMBERS **


51275 51334 51335 51342 51346 51350 51363 51364

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Non-Agreement State Event Number: 51275
Rep Org: CHEVRON USA, INC
Licensee: CHEVRON USA, INC
Region: 4
City: Covington State: LA
County:
License #: 17-29267-01
Agreement: Y
Docket:
NRC Notified By: JAMES GRIMSLEY
HQ OPS Officer: DANIEL MILLS
Notification Date: 07/29/2015
Notification Time: 20:14 [ET]
Event Date: 07/21/2015
Event Time: [CDT]
Last Update Date: 09/02/2015
Emergency Class: NON EMERGENCY
10 CFR Section:
30.50(b)(2) - SAFETY EQUIPMENT FAILURE
Person (Organization):
GREG WARNICK (R4DO)
NMSS_EVENTS_NOTIFIC (EMAI)

Event Text

FIXED GAUGE SHUTTER STUCK IN THE OPEN POSITION

A fixed gauge shutter was determined to be stuck in the open position on 7/21/15. The device manufacturer was called and arrived on location on 7/24/15, and determined that the device "dip tube" is bent and the device will have to be removed for repair. The device is a Tracerco Profiler Series Fixed Density Profiler (Serial # 101020) with either 49 or 62 30mCi Am-241 sources (1470 mCi or 1860 mCi Am-241 aggregate). The device is located inside a process vessel on an offshore platform. Radiation measurements taken outside the process vessel indicate no detectable radiation. The have been no radiation exposures. The manufacturer will remove the device and repair it.

* * * UPDATE FROM RUSTY GRIMSLEY TO DANIEL MILLS AT 1852 EDT ON 7/30/15 * * *

The following was received from the licensee via email:

"In accordance with 10 CFR 30.50(b)(2), Chevron submitted a verbal notification to the NRC Operations Center at 2014 hrs. EDT on July 29, 2015. We [Chevron USA, Inc.] are submitting this written report to verify the information conveyed in the verbal report.

"Test separator MBD1010 on Chevron's Jack/St. Malo oil and gas production platform is equipped with a Tracerco Profiler Series Model T-240 fixed density profiler, serial number T240-FM-1-324. On July 21, 2015, it was discovered that this profiler's shutter was in the open position and would not close. Tracerco, the manufacturer of the device, was immediately notified. Tracerco inspected the profiler on July 24, 2015 and confirmed that the shutter would not close. Tracerco's initial investigation indicated that the density profiler source and detector tubes were bent, prohibiting the movement of the shutter.

"The Jack/St. Malo platform is located in Walker Ridge Block 718, OCS-G 32703, approximately 190 miles offshore Louisiana in the Outer Continental Shelf. The test separator is located on the Production Module lower deck. The shielded source housing and shutter mechanism are located on the Production Module mezzanine deck, which sits immediately above the separator.

"The profiler source tube contains 62 Americium 241 sources, 30 milliCuries per source, for a total of 1,860 milliCuries.

"Tracerco, the manufacturer of the profiler, is onsite and is developing a plan for disassembly and removal of the device from the separator using appropriate shielding and other protective measures to minimize potential exposures. If entry into the separator with the sources still in place is deemed necessary, Tracerco will implement appropriate radiation safety measures to minimize exposures. The device and sources will be stored in appropriate containers during shipment to Tracerco; turnover of the sources to Tracerco will be documented. As any repairs to the device or vessel entry would not constitute routine maintenance, Chevron personnel will not be involved in repairing or removing the profiler.

"There has been no exposure of platform personnel. Although the shutter remains in the open position, no one has entered the separator, and no radiation is detectable at the exterior of the separator. The separator is coated in insulation, covering the manways that provide access to the interior of the separator.

"Tracerco has been working on the Production Module mezzanine deck and has partially removed the profiler from the separator to assess its condition. Tracerco has established a barricade around the work area to prevent unauthorized access. Their monitoring indicates no exposures beyond five feet from the sources. Tracerco reports that the radiation detected appears to be lower than expected for fully unshielded sources. Tracerco has conducted wipe tests and has found no leakage from the sources."

Notified R4DO (Warnick) and NMSS Events Notification via email.

* * * UPDATE AT 1641 EDT ON 9/2/2015 FROM J. GRIMSLEY TO MARK ABRAMOVITZ * * *

The following report was received via e-mail:

"The incident investigation indicated a deflector plate inside the test separator became disconnected and struck the profiler. Under the supervision of Tracerco, entry was made into the vessel and the damaged profiler removed and returned to Tracerco's Pasadena, Texas facility for repairs. The deflector plate was reinstalled in the separator per manufacturer's specifications. The profiler was not re-installed.

"Tracerco reported the results of the wipe test taken at the time of the removal of the profiler showed no contamination."

Notified the R4DO (Warnick) and NMSS Events Resource (via e-mail).

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Power Reactor Event Number: 51334
Facility: BRAIDWOOD
Region: 3 State: IL
Unit: [1] [2] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: JOHN LOGAN
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 08/20/2015
Notification Time: 22:28 [ET]
Event Date: 08/20/2015
Event Time: 17:10 [CDT]
Last Update Date: 09/02/2015
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
Person (Organization):
KENNETH RIEMER (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

CONDITION THAT COULD PREVENT PRESSURIZER PORV BLOCK VALVES FROM OPERATING

"On 8/20/2015 at 1710 CDT, a design flaw was discovered with the pressurizer power operated relief valve (PZR PORV) block valve control circuitry. Specifically, the circuit deficiency for which a design basis fire in the Main Control Room (MCR) or cable spreading room could prevent the PZR PORV block valves from being closed from the local control switch at their associated motor control center (MCC). Engineering has reviewed this issue and determined that a potential fire induced ground in the MCR or cable spreading room could clear the associated control power fuses which would prevent the block valves from operating at the local control switch.

"These valves are considered to form a High/Low pressure interface which requires postulating a proper polarity DC cable to cable fault. Engineering has reviewed the circuit design and cable routing associated with PORVs 1(2)RY455A and 1(2)RY456 and determined that their associated cables are routed with other DC circuit cables in the MCR control board and cable spreading room raceways, such that this postulated fault could potentially cause spurious opening of one of the PORVs even after the control power fuses have been removed as directed by the station abnormal operating procedures for control room inaccessibility.

"This identified block valve circuit deficiency prevents the credited safe shutdown action of locally closing the block valves to mitigate the spurious operation of a PORV.

"Hourly fire watches of the affected MCR and cable spreading room fire zones have been implemented. In addition, the MCR is continuously staffed and the affected cable spreading room fire zones are equipped with detection and automatic suppression.

"This event is being reported under 10CFR50.72(b)(3)(ii)(B) for 'Any event or condition that results in the nuclear power plant being in an unanalyzed condition that significantly degrades plant safety.'

"The licensee has notified the NRC Resident Inspector."

* * * UPDATE PROVIDED BY ROB SHERMAN TO JEFF ROTTON AT 1845 EDT ON 09/02/2015 * * *

"During the extent of condition review, an additional design deficiency was identified with respect to the PZR PORV and PZR PORV Block valves. Specifically, the current mitigating strategy for removing PZR PORV control power fuses does not adequately prevent a PZR PORV from spuriously opening due to fire induced hot short. Furthermore, local actions to close the associated PZR PORV block valve at the motor control center (MCC) may not be effective because the MCC may not have electrical power during the design basis fire. Therefore, the credited safe shutdown action to remove the PZR PORV control power fuses does not prevent the PZR PORV from spuriously opening during design basis fires in some of the upper and lower cable spreading room fire zones.

"The affected Fire Zones are the same upper and lower spreading rooms previously identified and fire watches of the affected areas remain in place.

"The NRC Resident Inspector has been notified."

Notified the R3DO (Skokowski)

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Power Reactor Event Number: 51335
Facility: BYRON
Region: 3 State: IL
Unit: [1] [2] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: ALAN SHEPHARD
HQ OPS Officer: HOWIE CROUCH
Notification Date: 08/20/2015
Notification Time: 23:08 [ET]
Event Date: 08/20/2015
Event Time: 17:55 [CDT]
Last Update Date: 09/02/2015
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
Person (Organization):
KENNETH RIEMER (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

CONDITION THAT COULD PREVENT PRESSURIZER PORV BLOCK VALVES FROM OPERATING

"On 8/20/2015 at 1755 [CDT], a design flaw was discovered with the pressurizer power operated relief valve (PZR PORV) block valve control circuitry. Specifically, the circuit deficiency for which a design basis fire in the Main Control Room (MCR) or cable spreading room could prevent the PZR PORV block valves from being closed from the local control switch at their associated motor control center (MCC). Engineering has reviewed this issue and determined that a potential fire induced ground in the MCR or cable spreading room could clear the associated control power fuses which would prevent the block valves from operating at the local control switch.

"These valves are considered to form a High/Low pressure interface which requires postulating a proper polarity DC cable to cable fault. Engineering has reviewed the circuit design and cable routing associated with PORVs 1(2)RY455A and 1(2)RY456 and determined that their associated cables are routed with other DC circuit cables in the MCR control board and cable spreading room raceways, such that this postulated fault could potentially cause spurious opening of one of the PORVs even after the control power fuses have been removed as directed by the station abnormal operating procedures for control room inaccessibility.

"This identified block valve circuit deficiency prevents the credited safe shutdown action of locally closing the block valves to mitigate the spurious operation of a PORV.

"Hourly fire watches of the affected MCR and cable spreading room fire zones have been implemented. In addition, the MCR is continuously staffed and the affected cable spreading room fire zones are equipped with detection and automatic suppression.

"This event is being reported under 10CFR50.72(b)(3)(ii)(B) for 'Any event or condition that results in the nuclear power plant being in an unanalyzed condition that significantly degrades plant safety.

"The licensee has notified the NRC Resident Inspector."

* * * UPDATE AT 1816 EDT ON 9/2/2015 FROM BRIAN LEWIN TO MARK ABRAMOVITZ * * *

"During the extent of condition review, an additional design deficiency was identified with respect to the PZR PORV and PZR PORV Block valves control circuitry. Specifically, the current mitigating strategy for removing PZR PORV control power fuses does not adequately prevent a PZR PORV from spuriously opening due to fire induced hot short. Furthermore, local actions to close the associated PZR PORV block valve at the motor control center (MCC) may not be effective because the MCC may not have electrical power during the design basis fire. Therefore, the credited safe shutdown action to remove the PZR PORV control power fuses does not prevent the PZR PORV from spuriously opening during design basis fires in some of the upper and lower cable spreading room fire zones.

"The affected Fire Zones are the same upper and lower spreading rooms previously identified and fire watches of the affected areas remain in place.

"The NRC Resident Inspector has been notified."

Notified the R3DO (Skokowski).

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
Agreement State Event Number: 51342
Rep Org: OHIO BUREAU OF RADIATION PROTECTION
Licensee: WOOD COUNTY HOSPITAL
Region: 3
City: BOWLING GREEN State: OH
County:
License #: 02120880005
Agreement: Y
Docket:
NRC Notified By: STEPHEN JAMES
HQ OPS Officer: JEFF ROTTON
Notification Date: 08/25/2015
Notification Time: 10:52 [ET]
Event Date: 08/19/2015
Event Time: [EDT]
Last Update Date: 08/27/2015
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RICHARD SKOKOWSKI (R3DO)
NMSS_EVENTS_NOTIFIC (EMAI)

Event Text

OHIO AGREEMENT STATE REPORT - PROSTATE TREATMENT UNDERDOSE

The following information was provided by the State of Ohio via email:

On 8/20/2015, the Ohio Department of Health (ODH) was notified by voice mail regarding a prostate seed implant to a patient performed on 07/16/2015. This implant consisted of [60] seeds (each seed - 23.6 milliCi of I-125). On 8/18/2015, a post seed implant CT scan was done to verify dose distribution. It was discovered that the D90 "dose" delivered [an under dose] that varied by 34 percent of the prescribed D90 dose for a prostate seed implant. The Referring physician and patient have been notified.

Ohio Item Number: OH150008

* * * RETRACTION PROVIDED FROM STEPHEN JAMES TO JEFF ROTTON VIA EMAIL AT 1454 ON 08/27/2015 * * *

The following information was provided by the State of Ohio via email:

"After additional reporting by the licensee and investigation by ODH, it was determined that the patient did NOT receive the under dose as initially reported and DOES NOT qualify as a medical event. This report is RETRACTED, as of 8/27/15."

Notified R3DO (Skokowski) and NMSS Events Notification via email.

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: 51346
Rep Org: ALABAMA RADIATION CONTROL
Licensee:
Region: 1
City: BIRMINGHAM State: AL
County:
License #:
Agreement: Y
Docket:
NRC Notified By: MYRON RILEY
HQ OPS Officer: NESTOR MAKRIS
Notification Date: 08/26/2015
Notification Time: 10:08 [ET]
Event Date: 08/25/2015
Event Time: 00:00 [CDT]
Last Update Date: 08/26/2015
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
PAUL KROHN (R1DO)
NMSS_EVENTS_NOTIFIC (EMAI)

Event Text

ABANDONED GAUGE FOUND IN SCRAP METAL

The following report was received from the State of Alabama Department of Public Health Office of Radiation Control via fax:

"On August 25, 2015, Sam Price, Environmental Health & Safety for Nucor Steel, Birmingham, Alabama notified the Office of Radiation Control that a load of scrap received from Covington, Georgia had set off radiation monitors and was reading 11.0 mR/hr and had been identified as Cs-137.

"Representatives from the Office of Radiation Control investigated the load and confirmed all measurements that were previously taken. The load was segregated and a single fixed type gauge was discovered in the load. The gauge contained only an unreadable general license label which was still attached. No other labels or markings were identified. The shutter appeared intact, but partially open.

"The gauge has been secured in place and is awaiting pick-up by an appropriate driver being provided by the scrap metal dealer in Covington, Georgia.

"The State of Georgia has been notified of the incident.

"As of today [August 26, 2015], 8:45 a.m. CDT, the gauge remains secure in place at Nucor Steel, Birmingham, Alabama."

Alabama Incident 15-38

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Agreement State Event Number: 51350
Rep Org: OK DEQ RAD MANAGEMENT
Licensee: TRACERCO
Region: 4
City: TULSA State: OK
County:
License #: 03096
Agreement: Y
Docket:
NRC Notified By: KEVIN SAMPSON
HQ OPS Officer: JEFF HERRERA
Notification Date: 08/26/2015
Notification Time: 17:23 [ET]
Event Date: 08/25/2015
Event Time: [CDT]
Last Update Date: 08/28/2015
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
VIVIAN CAMPBELL (R4DO)
NMSS_EVENTS_NOTIFIC (EMAI)
JAMES RUBENSTONE (NMSS)

Event Text

AGREEMENT STATE REPORT - CONTAMINATION IN AN UNCONTROLLED AREA

The State of Oklahoma reported that contamination from a leaking Ba-137 generator was discovered in a 'shed' at the University of Tulsa. It is estimated that approximately 1 milliCurie of Cs-137, used in the generator, was leaked. The licensee, Tracerco, licensed by the State of Texas, was using the generator for tracer studies on University of Tulsa equipment under a reciprocity agreement with the State of Oklahoma. The contamination occurred between October and November of 2014. Tracerco discovered the generator leakage at their Texas facility in May, 2015 but only recently informed the University of Tulsa. The Radiation Safety Officer at the University of Tulsa surveyed the area on 8/25/15 and obtained count rates as high as 100,000 cpm inside the shed. Contamination was also found outside of the shed's location. According to Tracerco, it is estimated that approximately 1 milliCurie of Cs-137 was leaked at the University of Tulsa.

The University of Tulsa reported that approximately eight individuals work in the area at least some of the time, however, the University is working on obtaining occupancy information at the contaminated location. The shed has been quarantined.

The Ba-137 generator, which contained 50 milliCuries of Cs-137, was manufactured by the China Institute of Atomic Energy.

The State of Oklahoma will be investigating the event and will be determining the amount of exposure to the individuals. Tracerco is continuing evaluating the event.

The State of Texas reported the leaking generator under NRC EN #51102


* * * UPDATE FROM KEVIN SAMPSON TO DONALD NORWOOD AT 1640 EDT ON 8/28/2015 * * *

The following information was received via facsimile:

"On August 27, 2015 the Oklahoma Environmental Agency Radiation Management Section performed a reactive inspection of this facility. The facility consists of a closed flow-loop pipeline which water or petroleum was pumped through. A port was used to inject radioactive tracers into the material to study its behavior in the flow-loop. Normally the crew from Tracerco would set up the generator at the injection port which was located on a platform about 12 feet above grade. However for some reason, possibly bad weather, the crew that performed the work last year decided to set up in an enclosed pump house immediately adjacent to the pipeline. At some point during the procedure an estimated 0.1 mCi of Cs-137 (not 1 mCi as previously reported) was released in the interior of the structure. The material was in the form of small resin spheres, about the size of a poppy seed, with the Cesium coating the surface. Sometime around May of this year, after Tracerco discovered that the generator was leaking and their own facility was contaminated, they sent staff back to the University to survey for contamination. However, they were unaware that the previous crew had used the pump house, and only surveyed around the injection port where they found no contamination. No further action was taken until August 24 when Tracerco employees again visited the site and surveyed the pump house. After finding the contamination they decontaminated the area using adhesive tape to pick up the material. Two office chairs and a floor mat were also found to be contaminated and removed to an area the university uses for radioactive storage. None of the University employees who worked at the facility were badged.

"During our inspection we noted that the background radiation level was elevated in the vicinity of the pump house and flow-loop (approx. 100 microR/hr as measured with a Victoreen 450P, this was about 10 X background off the facility). It should be noted the University has it's own license and uses or stores about 25 fixed gauges, with a total possession limit of 15 Ci., either on or near the flow-loop. Surveys inside the pump house showed isolated areas of contamination with radiation levels as high as 500 micro-R/hr. Multiple areas (usually concrete joints or gravel at the edge of the concrete) around the exterior of the pump house were also found to be contaminated with dose rates around 200 microR/hr. One trailer adjacent to the pump house was found to have a small spot of contamination in the carpet just inside the door. This was surveyed at 260 micro-R/hr. This trailer was used for office space for two persons, one of whom is a member of the public. 14 samples were collected at various points and will be counted next week. The University has restricted access to the contaminated areas but has continued to allow essential radiation workers to enter when necessary to operate the flow-loop. They were instructed to require anyone entering to wear disposable gloves and shoe covers.

"Tracerco has arranged for Chase Environmental to characterize and remediate the facility. This will begin on August 31 and is expected to take 5 to 7 days. Tracerco has also arranged for any university staff who desire to be scanned at a full-body counter in Houston."

Notified R4DO (Campbell) and via E-mail the NMSS Events Notification group.

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Part 21 Event Number: 51363
Rep Org: SOR MEASUREMENT AND CONTROL
Licensee: SOR MEASUREMENT AND CONTROL
Region: 4
City: LENEXA State: KS
County:
License #:
Agreement: Y
Docket:
NRC Notified By: MELANIE DIRKS
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 09/02/2015
Notification Time: 15:31 [ET]
Event Date: 09/02/2015
Event Time: [CDT]
Last Update Date: 09/02/2015
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21(a)(2) - INTERIM EVAL OF DEVIATION
Person (Organization):
GREG WARNICK (R4DO)
PART 21 MATERIALS (EMAI)
NMSS_EVENTS_NOTIFIC (EMAI)

Event Text

PART-21 REPORT - NUTHERM IRRADIATION CERTIFICATION WITH INSUFFICIENT MARGIN

The following report was received via fax:

"SOR Inc. was notified by Nutherm International, Inc. that irradiation certification performed by Steris Isomedix did not meet the additional 10 percent margin to meet the requirements of IEEE 323 due to measuring and test equipment uncertainties.

"This issue was originally identified by STERIS lsomedix Services, Whippany, New Jersey as part of NRC Inspection Report No. 99901445/2014-201. Nutherm International, Inc. has completed their evaluation of work performed for SOR, Inc. and has identified a potential impact to the conclusions of equipment qualification testing under SOR Inc. purchase order number 166984. Nutherm International, Inc. has reported this potential issue and forwarded an update to the NRC per Event Notification Report Number 50359.

"SOR Inc. is conducting an evaluation of projects to determine whether a defect or failure to comply exists as defined by 10 CFR Part 21. At the conclusion of the evaluation, any customer impacted by this issue will be notified and the U.S Nuclear Regulatory Commission will be notified in accordance with 10 CFR Part 21.21.

"If you have any questions regarding this issue, please contact Mike Bequette, Vice President of-Engineering at (913) 8882630 or email mbequette@sorinc.com."

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Power Reactor Event Number: 51364
Facility: QUAD CITIES
Region: 3 State: IL
Unit: [1] [2] [ ]
RX Type: [1] GE-3,[2] GE-3
NRC Notified By: ALAN MEURS
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 09/02/2015
Notification Time: 22:11 [ET]
Event Date: 09/02/2015
Event Time: 21:00 [CDT]
Last Update Date: 09/02/2015
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
RICHARD SKOKOWSKI (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

PLANNED TECHNICAL SUPPORT CENTER (TSC) MAINTENANCE

"Planned maintenance activities will commence today (September 2, 2015) on the Quad Cities Station TSC. The activity involves inspection and replacement of the TSC charcoal absorber trays and canisters on the filtration portion of the Air Handling Unit (AHU). Work on the charcoal absorbers affects habitability of the TSC during a declared emergency when radiological conditions require activation of the filtration portion of the AHU. The duration of maintenance is currently planned to begin on September 2, 2015 at 2100 hours [CDT] and is estimated to be completed by September 3, 2015 at 1100 hours [CDT], depending on any conditions discovered during the inspections. Since restoration from this maintenance activity is expected to take longer than the required activation time of the TSC, this notification is being made.

"If an emergency is declared requiring TSC activation during this period, the TSC will be staffed and activated using existing emergency planning procedures unless the TSC becomes uninhabitable due to ambient temperature, radiological, or other conditions. If relocation of the TSC becomes necessary, the Station Emergency Director will relocate the TSC staff to an alternate location in accordance with applicable site procedures.

"This event is reportable per 10CFR50.72(b)(3)(xiii) since the maintenance activity affects an emergency response facility.

"The NRC Resident Inspector has been notified [and the Illinois Emergency Management Agency]."

Page Last Reviewed/Updated Thursday, September 03, 2015
Thursday, September 03, 2015