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Event Notification Report for September 15, 2017

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
09/14/2017 - 09/15/2017

** EVENT NUMBERS **


52863 52949 52951 52968

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Power Reactor Event Number: 52863
Facility: WATERFORD
Region: 4 State: LA
Unit: [3] [ ] [ ]
RX Type: [3] CE
NRC Notified By: MICKEY FOLSE
HQ OPS Officer: HOWIE CROUCH
Notification Date: 07/17/2017
Notification Time: 17:37 [ET]
Event Date: 07/17/2017
Event Time: 16:17 [CDT]
Last Update Date: 09/14/2017
Emergency Class: UNUSUAL EVENT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
50.72(b)(3)(v)(A) - POT UNABLE TO SAFE SD
Person (Organization):
THOMAS HIPSCHMAN (R4DO)
MICHAEL F. KING (NRR)
BRIAN HOLIAN (NRR)
KRISS KENNEDY (R4RA)
JEFF GRANT (IRD)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
3 A/R Y 100 Power Operation 0 Hot Standby

Event Text

UNUSUAL EVENT DECLARED DUE TO LOSS OF OFFSITE POWER

During a rain and lightning storm, plant operators observed arcing from the main transformer bus duct and notified the control room. The decision was made to trip the main generator which resulted in an automatic reactor trip. The plant entered EAL SU.1 as a result of the loss of offsite power for greater than fifteen minutes. Plant safety busses are being supplied by both emergency diesel generators while the licensee inspects the electrical system to determine any damage prior to bringing offsite power back into the facility. Offsite power is available to the facility. No offsite assistance was requested by the licensee.

During the trip, all rods inserted into the core. Decay heat is being removed via the atmospheric dump valves with emergency feedwater supplying the steam generators. The main steam isolation valves were manually closed to protect the main condenser. There were no safeties or relief valves that actuated during the plant transient. There is no known primary-to-secondary leakage. Reactor cooling is via natural circulation. All safety equipment is available for the safe shutdown of the plant.

The licensee has notified the NRC Resident Inspector, Louisiana Department of Environmental Quality and the local Parish emergency management agencies.

Notified DHS SWO, FEMA, DHS NICC, FEMA National Watch Center (email) and Nuclear SSA (email).

* * * UPDATE ON 7/17/17 AT 2007 EDT FROM MARIA ZAMBER TO DONG PARK * * *

This notification is also made under 10 CFR 50.72(b)(3)(v)(D).

"This is a non-emergency notification from Waterford 3.

"On July 17, 2017 at 1606 CDT, the reactor automatically tripped due to a loss of Forced Circulation, which was the result of Loss of Offsite Power (LOOP) to the electrical (safety and non-safety) buses. Both 'A' and 'B' trains of Emergency Diesel Generators (EDGs) started as designed to reenergize the 'A' and 'B' safety buses. The LOOP caused a loss of feedwater pumps, resulting in an automatic actuation of the Emergency Feedwater (EFW) system.

"Prior to the reactor trip, at 1600 CDT, personnel noticed the isophase bus duct to main transformer 'B' glowing orange due to an unknown reason. Due to this, the main turbine was manually tripped at 1606 CDT. Following the turbine trip, the electrical (safety and non-safety) buses did not transfer to the startup transformers as expected due to an unknown reason.

"The plant entered the Emergency Operating Procedure for LOOP/Loss of Forced Circulation Recovery.

"At 1617 CDT, an Unusual Event was declared due to Initiating Condition (IC) SU1 - Loss of all offsite AC power to safety buses [greater than] 15 minutes.

"All safety systems responded as expected.

"The plant is currently in mode 3 and stable with the EDGs supplying both safety buses and with EFW feeding and maintaining both steam generators. Offsite power is in the process of being restored."

The licensee has notified the NRC Resident Inspector, Louisiana Department of Environmental Quality and the local Parish emergency management agencies.

* * * UPDATE FROM ADAM TAMPLAIN TO HOWIE CROUCH AT 2203 EDT ON 7/17/17 * * *

The licensee terminated the Notification of Unusual Event at 2056 CDT. The basis for terminating was that offsite power was restored to the safety busses.

The licensee has notified Louisiana Department of Environmental Quality, St. John and St. Charles Parishes, Louisiana Homeland Security Emergency Preparedness, and will be notifying the NRC Resident Inspector.

Notified IRD (Stapleton), NRR (King), R4DO (Hipschman), DHS SWO, FEMA, DHS NICC, FEMA National Watch Center (email) and Nuclear SSA (email).

* * * UPDATE FROM SCOTT MEIKLEJOHN TO HOWIE CROUCH AT 1724 EDT ON 7/19/17 * * *

This update is being reported under 10 CFR 50.72(b)(3)(v)(B).

"During the event discussed in EN# 52863, at 1642 CDT [on July 17, 2017], Condensate Storage Pool (CSP) level lowered to less than 92% resulting in entry to Technical Specification (TS) 3.7.1.3. Level in the CSP was lowered due to feeding from both Steam Generators with EFW. Normal makeup to the CSP was temporarily unavailable due to the LOOP. Filling the CSP commenced at 1815 CDT [on July 17, 2017], and TS 3.7.1.3 was exited on July 18, 2017 at 0039 CDT."

The licensee notified the NRC Resident Inspector. Notified R4DO (Hipschman).

* * * UPDATE FROM SCOTT MEIKLEJOHN TO HOWIE CROUCH AT 1233 EDT ON 9/14/17 * * *

"Waterford 3 is retracting a follow up notification made on July 19, 2017 for EN# 52863, concerning the loss of safety function associated with the Condensate Storage Pool (CSP) per 10 CFR 50.72(b)(3)(v)(B). The Condensate Storage Pool was performing its required safety function by providing inventory to the Emergency Feed Water pumps when the required Tech Spec level (T.S. 3.7.1.3) dropped below 92%. The Technical Specification was entered at 1624 [CDT] on July 17, 2017 and exited after filling at 0039 on July 18, 2017. The total allowed outage time allowed by Tech Spec 3.7.1.3 is 10 hours to be in Hot Shutdown if not restored. The Condensate Storage Pool level was restored to greater than 92% prior to exceeding the allowed outage time. Based on level being restored and the Condensate Storage Pool performing its required safety function, 10 CFR 50.72(b)(3)(v)(B) does not apply. Prior to the automatic reactor trip, Condensate Storage Pool level was greater than 92%.

"The NRC Resident Inspector has been notified of the retraction."

Notified R4DO (Groom).

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Non-Agreement State Event Number: 52949
Rep Org: WEST VIRGINIA UNIVERSITY HOSPITAL
Licensee: WEST VIRGINIA UNIVERSITY HOSPITAL
Region: 1
City: MORGANTOWN State: WV
County:
License #: 47-23066-02
Agreement: N
Docket:
NRC Notified By: NASSER RAZMIANFAR
HQ OPS Officer: DONG HWA PARK
Notification Date: 09/06/2017
Notification Time: 15:25 [ET]
Event Date: 09/05/2017
Event Time: 16:30 [EDT]
Last Update Date: 09/06/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(1) - DOSE <> PRESCRIBED DOSAGE
Person (Organization):
GLENN DENTEL (R1DO)
NMSS_EVENTS_NOTIFICA (EMAI)

Event Text

BRACHYTHERAPY TREATMENT DELIVERED DOSE LESS THAN PRESCRIBED DOSE

"In compliance with 10CFR35.3045(c), WVU [West Virginia University] Hospitals License # 47-23066-02, Docket # 03020233 is making telephone notification declaring a medical event.

"On September 5, 2017 a patient was being administered the first fraction of a planned five fraction HDR interstitial brachytherapy treatment, treating the cervix. The written directive prescribed 5, 5Gy fractions for a total dose of 25Gy. During the first fraction, 5 separate interlocks were tripped at which time the manufacturer was contacted [at] 1535 [EDT]. Based on discussions between the medical physics team and the manufacturer, the manufacturer determined the error was caused by fluid in the catheter which may have contaminated the source and the afterloader unit. The manufacturer advised to suspend treatment, and stop all use of the afterloader until it could be decontaminated and the source could be exchanged. (Scheduled for September 7, 2017).

"At the time the treatment was stopped, the patient received 0.32Gy of the planned 5Gy fraction, based on a 12.1 seconds treated of a planned 576.8 second treatment fraction.

"Based on 10CFR35.3045(a)(1), the fraction of the dose differed by more than 50 rem to organ or tissue, and 10CFR35.3045(a)(1)(iii) the fractionated dose delivered differs from the prescribed dose for a single fraction, by 50 percent or more.

"In compliance with 10CFR35.3045(e), the patient and referring physician have been notified.

"Upon decontamination and source exchange the patient is scheduled to complete the treatment per the written directive (September 7-9, 2017).

"In compliance with 10CFR35.3045(d), a written report will be submitted to the Region One Office within 15 days."

The Licensee has notified R1(Gallaghar).

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: 52951
Rep Org: ILLINOIS EMERGENCY MGMT. AGENCY
Licensee: INGREDION
Region: 3
City: BEDFORD PARK State: IL
County:
License #: IL-01065-02
Agreement: Y
Docket:
NRC Notified By: GARY FORSEE
HQ OPS Officer: DONG HWA PARK
Notification Date: 09/07/2017
Notification Time: 13:32 [ET]
Event Date: 09/06/2017
Event Time: [CDT]
Last Update Date: 09/07/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
ANN MARIE STONE (R3DO)
NMSS_EVENTS_NOTIFICA (EMAI)

Event Text

AGREEMENT STATE REPORT - LEVEL GAUGE STUCK SHUTTER

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

"At approximately 1052 [CDT] on 9/7/17, the RSO for lngredion (IL-01065-02) reported a shutter stuck in the 'on' position for a level gauge at their licensed facility in Bedford Park. The inoperable condition of the shutter and the resulting removal of the gauge from service occurred on 9/6/17. Reportedly, due to the mounting location of the device, no potential for exposure to personnel existed. The gauge has been removed and locked out by SAHCI [Stan A Huber Consultants, Inc.]. No surfaces of the gauge exceed 2 mR/hour and appropriate action for disposal is pending.

"The licensee reports an electronic switching device operates the shutter. This automatic device was bent and deformed as part of the operating process and the rod portion of the shutter was cracked most of the way through. As part of the remediation process, the shutter push rod broke off completely. Several unsuccessful attempts were made using WD40 and a pin to close the shutter. The gauge was removed from operation by SAHCI, keeping the primary beam away from all personnel. A 2x4x4 inch lead brick was secured to the face of the gauge. The exposure rate at the face of the gauge was less than 2mR/hr at all accessible surfaces. The gauge was secured in the locked radioactive material storage cabinet. The storage cabinet has five nuclear gauges stored within. The outside of the storage cabinet is less than 2mR/hr at the surface.

"The current plan is to properly dispose of the stuck shutter gauge. [SAHCI] request a disposal quote.

"The SSDR indicates maximum exposure rates for this device (max 500 mCi Cs-137) when the shutter is in the 'ON' position are less than 50 mR/hr at 5 cm and less than 5 mR/hr at 30 cm."

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Power Reactor Event Number: 52968
Facility: VOGTLE
Region: 2 State: GA
Unit: [3] [4] [ ]
RX Type: [3] W-AP1000,[4] W-AP1000
NRC Notified By: MARTIN WASHINGTON
HQ OPS Officer: STEVEN VITTO
Notification Date: 09/14/2017
Notification Time: 09:10 [ET]
Event Date: 09/13/2017
Event Time: 15:30 [EDT]
Last Update Date: 09/14/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
26.719 - FITNESS FOR DUTY
Person (Organization):
GERALD MCCOY (R2DO)
FFD GROUP (EMAI)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
3 N N 0 Under Construction 0 Under Construction
4 N N 0 Under Construction 0 Under Construction

Event Text

CONTRACTOR MANAGER CONFIRMED POSITIVE FOR ALCOHOL

On September 13, 2017, Southern Nuclear Operating Company (SNC) determined a Contractor Manager confirmed positive for alcohol during a for cause fitness-for-duty test. The employee's unescorted access to the plant has been terminated.

The NRC Resident Inspector has been notified.

Page Last Reviewed/Updated Friday, September 15, 2017
Friday, September 15, 2017