Event Notification Report for March 16, 2017
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
03/15/2017 - 03/16/2017
EVENT NUMBERS
52616526205261452756
Agreement State
Event Number: 52616
Rep Org: PA BUREAU OF RADIATION PROTECTION
Licensee: THE AMERICAN ONCOLOGY HOSPITAL
Region: 1
City: PHILADELPHIA State: PA
County:
License #: PA-0293
Agreement: Y
Docket:
NRC Notified By: JOSEPH MELNIC
HQ OPS Officer: BETHANY CECERE
Licensee: THE AMERICAN ONCOLOGY HOSPITAL
Region: 1
City: PHILADELPHIA State: PA
County:
License #: PA-0293
Agreement: Y
Docket:
NRC Notified By: JOSEPH MELNIC
HQ OPS Officer: BETHANY CECERE
Notification Date: 03/17/2017
Notification Time: 12:52 [ET]
Event Date: 03/16/2017
Event Time: 00:00 [EDT]
Last Update Date: 03/17/2017
Notification Time: 12:52 [ET]
Event Date: 03/16/2017
Event Time: 00:00 [EDT]
Last Update Date: 03/17/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
HAROLD GRAY (R1DO)
NMSS_EVENTS_NOTIFICA (EMAI)
HAROLD GRAY (R1DO)
NMSS_EVENTS_NOTIFICA (EMAI)
AGREEMENT STATE REPORT - PATIENT DOSAGE LOWER THAN PRESCRIBED
The following report was received via email:
"On March 16, 2017, a patient was prescribed a 12.16 milliCurie treatment dosage of Y-90 Sirspheres. As the AU [Authorized User] was pushing on the syringe he noticed a strong resistance, as did the interventional radiologist. Therefore, the administration was stopped to prevent any further safety issues. The micro catheter was pulled from the patient and the vial with the micro catheter and other radioactive waste was put in the jar for measuring. As the micro catheter was pulled, a very small defect was observed. The activity administered was 53% less than the prescribed dosage (5.64 milliCuries). The outer wrapping of the catheter was kept. The patient will be notified once recovered from the anesthesia. The licensee is investigating.
"The cause of the event may be a potential manufacturing defect.
"A reactive inspection is planned by the Department [Pennsylvania Bureau of Radiation Protection]. More information will be provided upon receipt."
PA Event Report ID No: PA 170005
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.
The following report was received via email:
"On March 16, 2017, a patient was prescribed a 12.16 milliCurie treatment dosage of Y-90 Sirspheres. As the AU [Authorized User] was pushing on the syringe he noticed a strong resistance, as did the interventional radiologist. Therefore, the administration was stopped to prevent any further safety issues. The micro catheter was pulled from the patient and the vial with the micro catheter and other radioactive waste was put in the jar for measuring. As the micro catheter was pulled, a very small defect was observed. The activity administered was 53% less than the prescribed dosage (5.64 milliCuries). The outer wrapping of the catheter was kept. The patient will be notified once recovered from the anesthesia. The licensee is investigating.
"The cause of the event may be a potential manufacturing defect.
"A reactive inspection is planned by the Department [Pennsylvania Bureau of Radiation Protection]. More information will be provided upon receipt."
PA Event Report ID No: PA 170005
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.
Agreement State
Event Number: 52620
Rep Org: CALIFORNIA RADIATION CONTROL PRGM
Licensee: GFK & ASSOCIATES
Region: 4
City: DUBLIN State: CA
County:
License #: 6810-01
Agreement: Y
Docket:
NRC Notified By: EPHRIME MEKURIA
HQ OPS Officer: MARK ABRAMOVITZ
Licensee: GFK & ASSOCIATES
Region: 4
City: DUBLIN State: CA
County:
License #: 6810-01
Agreement: Y
Docket:
NRC Notified By: EPHRIME MEKURIA
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 03/17/2017
Notification Time: 16:45 [ET]
Event Date: 03/16/2017
Event Time: 16:04 [PDT]
Last Update Date: 03/17/2017
Notification Time: 16:45 [ET]
Event Date: 03/16/2017
Event Time: 16:04 [PDT]
Last Update Date: 03/17/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
NEIL OKEEFE (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
NEIL OKEEFE (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
AGREEMENT STATE REPORT - DAMAGED MOISTURE DENSITY GAUGE
The following report was received via e-mail:
"RHB-North [Radiologic Health Branch - North] received an email from CDPH [California Department of Public Health], Emergency Preparedness Office, Disaster Information Coordinator that they received a message from CAL OES [California Office of Emergency Services] stating that a nuclear density gauge was run over and damaged by earth moving equipment.
"Incident location: 308 Love Lane, Danville, CA 94526 - Contra Costa County, time 16:04 [PDT].
"RHB North contacted the Manager, Pacific Nuclear Technology (PNT), to survey the area and collect the damaged gauge. [He] went to the incident location, evaluated the moisture density gauge, and confirmed that the sealed sources Cs-137 and Am-241:Be were intact and were in the shielded position. In addition [he] surveyed the gauge and the surrounding area with a Ludlum Model 3, PR 44-9 and found no contamination, [he] further verified that exposure at 1 meter was 0.4 mRem/hr.
"Because the source was not damaged and the TI [Transportation Index] was within the limit, the licensee owner/operator insisted in taking the damaged gauge to the storage location . . . . [The owner/operator] said that the following day he will take the damaged gauge to CPN InstroTek Inc. for exchange or disposal.
"On March 17, 2017 RHB-North verified that CPN InstroTek Inc. has received the damaged gauge and the leak test result was negative.
"PNT equipment: Ludlum Model 3, PR 44-9, Calibration date 04/28/2016."
5010 Number: 031617
The following report was received via e-mail:
"RHB-North [Radiologic Health Branch - North] received an email from CDPH [California Department of Public Health], Emergency Preparedness Office, Disaster Information Coordinator that they received a message from CAL OES [California Office of Emergency Services] stating that a nuclear density gauge was run over and damaged by earth moving equipment.
"Incident location: 308 Love Lane, Danville, CA 94526 - Contra Costa County, time 16:04 [PDT].
"RHB North contacted the Manager, Pacific Nuclear Technology (PNT), to survey the area and collect the damaged gauge. [He] went to the incident location, evaluated the moisture density gauge, and confirmed that the sealed sources Cs-137 and Am-241:Be were intact and were in the shielded position. In addition [he] surveyed the gauge and the surrounding area with a Ludlum Model 3, PR 44-9 and found no contamination, [he] further verified that exposure at 1 meter was 0.4 mRem/hr.
"Because the source was not damaged and the TI [Transportation Index] was within the limit, the licensee owner/operator insisted in taking the damaged gauge to the storage location . . . . [The owner/operator] said that the following day he will take the damaged gauge to CPN InstroTek Inc. for exchange or disposal.
"On March 17, 2017 RHB-North verified that CPN InstroTek Inc. has received the damaged gauge and the leak test result was negative.
"PNT equipment: Ludlum Model 3, PR 44-9, Calibration date 04/28/2016."
5010 Number: 031617
Non-Agreement State
Event Number: 52614
Rep Org: SIOUXLAND UROLOGY CENTER
Licensee: SIOUXLAND UROLOGY CENTER
Region: 4
City: DAKOTA DUNES State: SD
County:
License #: 40-34223-01
Agreement: N
Docket:
NRC Notified By: RUSS RUPOLO
HQ OPS Officer: BETHANY CECERE
Licensee: SIOUXLAND UROLOGY CENTER
Region: 4
City: DAKOTA DUNES State: SD
County:
License #: 40-34223-01
Agreement: N
Docket:
NRC Notified By: RUSS RUPOLO
HQ OPS Officer: BETHANY CECERE
Notification Date: 03/16/2017
Notification Time: 14:28 [ET]
Event Date: 03/16/2017
Event Time: 08:00 [CDT]
Last Update Date: 03/17/2017
Notification Time: 14:28 [ET]
Event Date: 03/16/2017
Event Time: 08:00 [CDT]
Last Update Date: 03/17/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(1) - DOSE <> PRESCRIBED DOSAGE
10 CFR Section:
35.3045(a)(1) - DOSE <> PRESCRIBED DOSAGE
Person (Organization):
NEIL OKEEFE (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
NEIL OKEEFE (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
MEDICAL EVENT - PATIENT DOSAGE HIGHER THAN PRESCRIBED
At approximately 0800 CDT today, a patient was treated with 110 Palladium-103 seeds (1.68 milliCuries each) to the prostrate. The quantity was determined by calculation for a prescribed dose of 125 Gy, however the calculation was incorrect. The mistake was discovered after the patient's treatment. Only 80 seeds should have been implanted. The activity injected is 38 percent higher than prescribed.
The referring physician has been notified. The physician is notifying the patient. It is believed that this event will not result in any harm to the patient. The licensee is in the process of determining corrective action to prevent reoccurrence.
* * * UPDATE FROM GREG HAAR TO BETHANY CECERE VIA EMAIL 1241 EDT ON 3/17/17 * * *
"This email is to confirm our notification to the NRC of a possible medical event that occurred during an LDR [Low Dose Rate] brachytherapy prostate seed implant at our clinic on (3/16/2017) at approximately 0800 [CDT]. The associated license number is #40-34223-01.
"The procedure was a Palladium-103 implant, with a prescribed dose of 125 Gy. The implant was using Pd-103 seeds with an average activity of 1.68 milliCuries per seed. During this implant, 110 seeds were implanted into the patient instead of 80 seeds. This resulted in a total implanted activity of 184.8 milliCuries, which we estimate to exceed the prescribed dose to the patient by 20 percent.
"The patient and the referring physician have been notified."
Notified R4DO (O'Keefe) and NMSS Events Notification (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.
At approximately 0800 CDT today, a patient was treated with 110 Palladium-103 seeds (1.68 milliCuries each) to the prostrate. The quantity was determined by calculation for a prescribed dose of 125 Gy, however the calculation was incorrect. The mistake was discovered after the patient's treatment. Only 80 seeds should have been implanted. The activity injected is 38 percent higher than prescribed.
The referring physician has been notified. The physician is notifying the patient. It is believed that this event will not result in any harm to the patient. The licensee is in the process of determining corrective action to prevent reoccurrence.
* * * UPDATE FROM GREG HAAR TO BETHANY CECERE VIA EMAIL 1241 EDT ON 3/17/17 * * *
"This email is to confirm our notification to the NRC of a possible medical event that occurred during an LDR [Low Dose Rate] brachytherapy prostate seed implant at our clinic on (3/16/2017) at approximately 0800 [CDT]. The associated license number is #40-34223-01.
"The procedure was a Palladium-103 implant, with a prescribed dose of 125 Gy. The implant was using Pd-103 seeds with an average activity of 1.68 milliCuries per seed. During this implant, 110 seeds were implanted into the patient instead of 80 seeds. This resulted in a total implanted activity of 184.8 milliCuries, which we estimate to exceed the prescribed dose to the patient by 20 percent.
"The patient and the referring physician have been notified."
Notified R4DO (O'Keefe) and NMSS Events Notification (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.
Part 21
Event Number: 52756
Rep Org: CURTISS WRIGHT FLOW CONTROL CO.
Licensee: CURTISS-WRIGHT
Region: 1
City: HUNTSVILLE State: AL
County:
License #: N/A
Agreement: Y
Docket:
NRC Notified By: TONY GILL
HQ OPS Officer: JEFF HERRERA
Licensee: CURTISS-WRIGHT
Region: 1
City: HUNTSVILLE State: AL
County:
License #: N/A
Agreement: Y
Docket:
NRC Notified By: TONY GILL
HQ OPS Officer: JEFF HERRERA
Notification Date: 05/15/2017
Notification Time: 18:55 [ET]
Event Date: 03/16/2017
Event Time: 00:00 [CDT]
Last Update Date: 09/11/2017
Notification Time: 18:55 [ET]
Event Date: 03/16/2017
Event Time: 00:00 [CDT]
Last Update Date: 09/11/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21(a)(2) - INTERIM EVAL OF DEVIATION 21.21(d)(3)(i) - DEFECTS AND NONCOMPLIANCE
10 CFR Section:
21.21(a)(2) - INTERIM EVAL OF DEVIATION 21.21(d)(3)(i) - DEFECTS AND NONCOMPLIANCE
Person (Organization):
MIKE ERNSTES (R2DO)
PART 21/50.55 REACTO (EMAI)
MIKE ERNSTES (R2DO)
PART 21/50.55 REACTO (EMAI)
PART 21 - POTENTIAL DEFECT IN GRAYBOOT SOCKET CONTACTS
The following information was received via email:
"This letter is issued to provide an interim notification of a potential defect in certain lots of Grayboot socket contacts supplied with EQ qualified Grayboot Connector Kits. On March 16, 2017, Curtiss-Wright, Nuclear Division, Huntsville Operations was contacted by Georgia Power Vogtle Nuclear Power Plant concerning a potential defect where the socket contact tines were in a relaxed state.
"Although we have completed some testing and verification activities, additional testing is in progress now and will provide necessary information to complete our evaluation. Current testing will be completed and final conclusions made by May 31, 2017.
"At this time, based on test results, evaluations and operating experience, Curtiss Wright is confident that any potentially affected Grayboot Assemblies will continue to perform their intended safety functions. As such, if the final recommendation is to replace the potentially defective socket contact, this can be accomplished during subsequent routine maintenance activities.
"This notification is being made to comply with 60 day interim reporting requirements as defined in 10 CFR 21.21(a)(2).
"For additional information, please contact Samuel Bledsoe, EGS Products Engineering Manager (1-256-690-7852) or Tony Gill, EGS and Trentec Quality Assurance Manager (1-256-426-4558)."
* * * UPDATE PROVIDED BY TONY GILL TO JEFF ROTTON AT 1813 EDT ON 05/31/2017 * * *
The following information was provided via email:
"This letter is issued to provide final findings associated with a potential defect concerning GRAYBOOT socket contacts. This issue was initially identified in an interim report dated May 15, 2017. As documented previously, Curtiss-Wright, Nuclear Division, Huntsville Operations was contacted by Georgia Power Vogtle Nuclear Power Plant on March 16, 2017 concerning a potential defect wherein GRAYBOOT socket contact tines were in a relaxed state. This notification of a potential defect concerns model GB-1 GRAYBOOT kits supplied with two-tined, silver-plated, 12-14 AWG socket contacts.
"Based upon this scope, potentially affected kits/parts are: 1. GB-1(12-14) GRAYBOOT kits, 2. GB-1 (12-14/ 16-18) GRAYBOOT kits, and 3. GB-1-6 GRAYBOOT 12-14 AWG socket contacts.
"This issue does not affect the following: 1. Any GRAYBOOT 'A' kits/parts, 2. Any model GB-2 or GB-3 GRAYBOOT kits/parts, or 3. Any model GB-1 GRAYBOOT kits/parts with 16-18 AWG socket contacts.
"Our evaluation is documented in Report No. EGS-TR-880708-15 and is available for review at our facility in Huntsville, AL. The results identify the most likely root cause is improper heat treating of the socket contacts during manufacturing. Additional testing and analysis was performed to confirm that any affected GRAYBOOT assemblies can still preform their safety-related function and do not present a substantial safety hazard .
"The findings outlined in Report No. EGS-TR-880708-15 provide a high level of confidence that affected GRAYBOOT assemblies do not present a substantial safety hazard. This position is further validated by the lack of negative operating experience over the last 20 plus years from properly installed GRAYBOOT assemblies. However, this condition causes the contact to be more susceptible to damage from handling during connection and disconnection, and therefore the following actions are recommended:
"1. Any affected sockets in inventory should be replaced. Affected sockets in service should be replaced during routine maintenance activities.
OR
"2. In lieu of replacement, it is acceptable to perform the following [steps 1-3] to confirm a separation force greater than 0.19 lbs. This is consistent with existing Curtiss-Wright dedication acceptance criteria. It is recommended that any contacts not meeting this criteria be replaced. 1. Crimp a spare pin contact to an appropriate piece of wire. 2. Connect a force gage or 0.19 lbs. of static weight to the opposite end of the wire. 3. Insert the pin into the socket and confirm that the pin does not separate from the socket under a minimum load of 0.19 lbs.
"To confirm this deviation is not present in existing inventory or in future purchased lots, the following corrective actions have been or will be implemented by Curtiss-Wright: 1. Micro hardness testing was performed on all socket contact lots in inventory to verify their acceptability. Results confirmed that all lots were acceptable. 2. Acceptance criteria for dedication of socket contacts will be revised to include verification of acceptable contact hardness. This corrective action will be completed by June 9, 2017. No dedication of socket contacts will be performed until this corrective action is complete.
"A list of affected utilities and associated purchase orders is being developed and will be complete and submitted by June 9, 2017.
"For additional information, please contact Samuel Bledsoe, EGS Products Engineering Manager (1-256-690-7852) or Tony Gill, EGS and Trentec Quality Assurance Manager (1-256-426-4558)."
Notified R1DO (Bower), R2DO (Shaeffer), R3DO (Daley), R4DO (O'Keefe) and Part 21 Operating Reactors Group via email.
* * * UPDATE AT 1859 EDT ON 06/09/17 FROM TONY GILL TO JEFF HERRERA * * *
The following update was received via email:
"On May 31, 2017, Curtiss-Wright, Nuclear Division, Huntsville Operations issued a letter documenting final findings regarding a potential defect concerning model GB-1 GRAYBOOT kits supplied with two-tined, silver-plated, 12-14 AWG contacts. Please find that letter attached.
"Pursuant to the attached letter, please find attached a list of affected purchase orders.
"For additional information, please contact Samuel Bledsoe, EGS Products Engineering Manager (1-256-690-7852) or Tony Gill, EGS and Trentec Quality Assurance Manager (1-256-426-4558).
List of Sites Affected:
Arkansas Nuclear 1
Bruce Nuclear Power Development
Brunswick
Callaway
Calvert Cliffs
Clinton
Columbia
Cooper
CTEAM/CRIT
Davis-Besse
Diablo Canyon
Duane Arnold
Farley
FMM
Fort Calhoun
Gentilly
Ginna
Haddam Neck
Harris
Indian Point
Kewaunee
La Salle
Limerick
Millstone
Nine Mile Point
North Anna
Oconee
Oyster Creek
Peach Bottom
Pilgrim
Point Beach
Prairie Island
Quad Cities
River Bend
Saint Lucie
San Onofre
Sizewell B
South Texas
Summer
Turkey Point
Vermont Yankee
Vogtle
Waterford
Wolsong
Zion
Notified R1DO(Welling), R2DO(Suggs), R3DO(Orlikowski), R4DO(Rollins), Part-21 Reactors (via email).
* * * UPDATE AT 1612 EDT ON 09/11/17 FROM TONY GILL TO BETHANY CECERE * * *
The following information was received via email:
"At initial issuance, the evaluation documented in Report No. EGS-TR-880708-15 presented metallurgical analysis as well as thermal, functional and seismic testing. This report has been revised to include cycle aging, functional testing and pull-out force. Test results confirm that affected socket contacts will continue to perform their intended safety function throughout their qualified life.
"Based on these final findings, no further actions are recommended for the potentially affected utilities previously notified. Any potentially affected socket contacts, either in inventory or installed, are acceptable for use in their intended safety-related application.
"It is recommended that all utilities confirm that installation and handling of GRAYBOOT assemblies is in accordance with Installation Instructions EGS-TR-880707-02.
"For additional information, please contact Samuel Bledsoe, EGS Products Engineering Manager (1-256-690-7852) or Tony Gill, EGS and Trentec Quality Assurance Manager (1-256-426-4558)."
Notified R1DO(Dentel), R2DO(Michel), R3DO(Riemer), R4DO(Groom), Part-21 Reactors (via email).
The following information was received via email:
"This letter is issued to provide an interim notification of a potential defect in certain lots of Grayboot socket contacts supplied with EQ qualified Grayboot Connector Kits. On March 16, 2017, Curtiss-Wright, Nuclear Division, Huntsville Operations was contacted by Georgia Power Vogtle Nuclear Power Plant concerning a potential defect where the socket contact tines were in a relaxed state.
"Although we have completed some testing and verification activities, additional testing is in progress now and will provide necessary information to complete our evaluation. Current testing will be completed and final conclusions made by May 31, 2017.
"At this time, based on test results, evaluations and operating experience, Curtiss Wright is confident that any potentially affected Grayboot Assemblies will continue to perform their intended safety functions. As such, if the final recommendation is to replace the potentially defective socket contact, this can be accomplished during subsequent routine maintenance activities.
"This notification is being made to comply with 60 day interim reporting requirements as defined in 10 CFR 21.21(a)(2).
"For additional information, please contact Samuel Bledsoe, EGS Products Engineering Manager (1-256-690-7852) or Tony Gill, EGS and Trentec Quality Assurance Manager (1-256-426-4558)."
* * * UPDATE PROVIDED BY TONY GILL TO JEFF ROTTON AT 1813 EDT ON 05/31/2017 * * *
The following information was provided via email:
"This letter is issued to provide final findings associated with a potential defect concerning GRAYBOOT socket contacts. This issue was initially identified in an interim report dated May 15, 2017. As documented previously, Curtiss-Wright, Nuclear Division, Huntsville Operations was contacted by Georgia Power Vogtle Nuclear Power Plant on March 16, 2017 concerning a potential defect wherein GRAYBOOT socket contact tines were in a relaxed state. This notification of a potential defect concerns model GB-1 GRAYBOOT kits supplied with two-tined, silver-plated, 12-14 AWG socket contacts.
"Based upon this scope, potentially affected kits/parts are: 1. GB-1(12-14) GRAYBOOT kits, 2. GB-1 (12-14/ 16-18) GRAYBOOT kits, and 3. GB-1-6 GRAYBOOT 12-14 AWG socket contacts.
"This issue does not affect the following: 1. Any GRAYBOOT 'A' kits/parts, 2. Any model GB-2 or GB-3 GRAYBOOT kits/parts, or 3. Any model GB-1 GRAYBOOT kits/parts with 16-18 AWG socket contacts.
"Our evaluation is documented in Report No. EGS-TR-880708-15 and is available for review at our facility in Huntsville, AL. The results identify the most likely root cause is improper heat treating of the socket contacts during manufacturing. Additional testing and analysis was performed to confirm that any affected GRAYBOOT assemblies can still preform their safety-related function and do not present a substantial safety hazard .
"The findings outlined in Report No. EGS-TR-880708-15 provide a high level of confidence that affected GRAYBOOT assemblies do not present a substantial safety hazard. This position is further validated by the lack of negative operating experience over the last 20 plus years from properly installed GRAYBOOT assemblies. However, this condition causes the contact to be more susceptible to damage from handling during connection and disconnection, and therefore the following actions are recommended:
"1. Any affected sockets in inventory should be replaced. Affected sockets in service should be replaced during routine maintenance activities.
OR
"2. In lieu of replacement, it is acceptable to perform the following [steps 1-3] to confirm a separation force greater than 0.19 lbs. This is consistent with existing Curtiss-Wright dedication acceptance criteria. It is recommended that any contacts not meeting this criteria be replaced. 1. Crimp a spare pin contact to an appropriate piece of wire. 2. Connect a force gage or 0.19 lbs. of static weight to the opposite end of the wire. 3. Insert the pin into the socket and confirm that the pin does not separate from the socket under a minimum load of 0.19 lbs.
"To confirm this deviation is not present in existing inventory or in future purchased lots, the following corrective actions have been or will be implemented by Curtiss-Wright: 1. Micro hardness testing was performed on all socket contact lots in inventory to verify their acceptability. Results confirmed that all lots were acceptable. 2. Acceptance criteria for dedication of socket contacts will be revised to include verification of acceptable contact hardness. This corrective action will be completed by June 9, 2017. No dedication of socket contacts will be performed until this corrective action is complete.
"A list of affected utilities and associated purchase orders is being developed and will be complete and submitted by June 9, 2017.
"For additional information, please contact Samuel Bledsoe, EGS Products Engineering Manager (1-256-690-7852) or Tony Gill, EGS and Trentec Quality Assurance Manager (1-256-426-4558)."
Notified R1DO (Bower), R2DO (Shaeffer), R3DO (Daley), R4DO (O'Keefe) and Part 21 Operating Reactors Group via email.
* * * UPDATE AT 1859 EDT ON 06/09/17 FROM TONY GILL TO JEFF HERRERA * * *
The following update was received via email:
"On May 31, 2017, Curtiss-Wright, Nuclear Division, Huntsville Operations issued a letter documenting final findings regarding a potential defect concerning model GB-1 GRAYBOOT kits supplied with two-tined, silver-plated, 12-14 AWG contacts. Please find that letter attached.
"Pursuant to the attached letter, please find attached a list of affected purchase orders.
"For additional information, please contact Samuel Bledsoe, EGS Products Engineering Manager (1-256-690-7852) or Tony Gill, EGS and Trentec Quality Assurance Manager (1-256-426-4558).
List of Sites Affected:
Arkansas Nuclear 1
Bruce Nuclear Power Development
Brunswick
Callaway
Calvert Cliffs
Clinton
Columbia
Cooper
CTEAM/CRIT
Davis-Besse
Diablo Canyon
Duane Arnold
Farley
FMM
Fort Calhoun
Gentilly
Ginna
Haddam Neck
Harris
Indian Point
Kewaunee
La Salle
Limerick
Millstone
Nine Mile Point
North Anna
Oconee
Oyster Creek
Peach Bottom
Pilgrim
Point Beach
Prairie Island
Quad Cities
River Bend
Saint Lucie
San Onofre
Sizewell B
South Texas
Summer
Turkey Point
Vermont Yankee
Vogtle
Waterford
Wolsong
Zion
Notified R1DO(Welling), R2DO(Suggs), R3DO(Orlikowski), R4DO(Rollins), Part-21 Reactors (via email).
* * * UPDATE AT 1612 EDT ON 09/11/17 FROM TONY GILL TO BETHANY CECERE * * *
The following information was received via email:
"At initial issuance, the evaluation documented in Report No. EGS-TR-880708-15 presented metallurgical analysis as well as thermal, functional and seismic testing. This report has been revised to include cycle aging, functional testing and pull-out force. Test results confirm that affected socket contacts will continue to perform their intended safety function throughout their qualified life.
"Based on these final findings, no further actions are recommended for the potentially affected utilities previously notified. Any potentially affected socket contacts, either in inventory or installed, are acceptable for use in their intended safety-related application.
"It is recommended that all utilities confirm that installation and handling of GRAYBOOT assemblies is in accordance with Installation Instructions EGS-TR-880707-02.
"For additional information, please contact Samuel Bledsoe, EGS Products Engineering Manager (1-256-690-7852) or Tony Gill, EGS and Trentec Quality Assurance Manager (1-256-426-4558)."
Notified R1DO(Dentel), R2DO(Michel), R3DO(Riemer), R4DO(Groom), Part-21 Reactors (via email).