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Event Notification Report for August 11, 2018

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
8/10/2018 - 8/11/2018

** EVENT NUMBERS **


53532 53534 53535 53536 53546

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Agreement State Event Number: 53532
Rep Org: PA BUREAU OF RADIATION PROTECTION
Licensee: ALARON NUCLEAR SOLUTIONS
Region: 1
City: WAMPUM   State: PA
County:
License #: PA-0678
Agreement: Y
Docket:
NRC Notified By: JOHN CHIPPO
HQ OPS Officer: BRIAN LIN
Notification Date: 08/02/2018
Notification Time: 11:48 [ET]
Event Date: 07/26/2018
Event Time: 00:00 [EDT]
Last Update Date: 08/30/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
ANNE DEFRANCISCO (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - UNPLANNED CONTAMINATION EVENT

The following information was received via E-mail:

"During the process of shredding filters for cement solidification, the licensee had an unplanned contamination event. Loose surface contamination was spread throughout the building with an estimate of total activity being 2 milliCuries and the primary isotope being Cobalt-60. In addition to building surfaces, several personnel who were working in the area at the time were contaminated. It is unclear at this time the extent of the personnel contamination but inhalation and skin contamination are believed to have occurred. The licensee is currently decontaminating the area using protective clothing and respiratory protection, monitoring the individuals who were working in the area during the time of the event, and has sent a sample of the material to an independent lab for isotopic analysis. The licensee will be performing a root cause analysis and the state will perform a reactive inspection. The cause of the event is unknown at this time."

PA Event Report ID No: PA180016

* * * UPDATE ON 8/29/2018 AT 1354 EDT FROM JOHN CHIPPO TO BRIAN LIN * * *

The following update was provided via E-mail:

"During the process for cement solidification of shredded filter materials the licensee's mixing unit auger became stuck. Technicians eventually, through the use of various manual and air tools, were able to remove the blockage and resume the solidification process. At this time the unit was run again with only a cement mixture with no filter media to create a cap in the disposal container. Upon completion of this procedure a crane operator entered the containment area to remove the filter media hopper from atop the unit. He had forgotten his hard hat and immediately left containment and the H-1 building to retrieve his hat. Upon entering the Personnel Contamination Monitor (PCM) he then set off the alarm. This was the first indication of contamination. The RSO was immediately contacted and all remaining personnel exited the building and were found to be contaminated. Immediately upon discovery of the incident, all doors to the contaminated building (the H-1 building) were locked, all operations equipment was placed in the off position, and the building was secured. Building access was then restricted. The plant manager stopped all work at the site and informed his chain of command. In the days following the event the licensee performed a detailed survey to assess the extent of contamination. The survey showed general distributed contamination of the horizontal surfaces within the building. The maximum contamination level identified with this survey was 800,000 dpm/100cm2. The primary isotope was Co-60 (-90%), with Mn-54 and Sb-125 as other contributors.

"Seven personnel exhibited general distributed contamination of varying amounts on their exterior clothing and/or shoes and had indication of inhalation of radioactive material. All showered in the onsite Decontamination Room and then were monitored with an extended count in the PCM and all were released with only gamma related upper torso activity. Nasal swabs from affected personnel were analyzed, however the license has yet to share these or any other personnel dose data. Daily extended PCM counts continue for available personnel who exhibit upper torso gamma activity. Four individuals continue to exhibit this activity. In addition, in-vivo and in-vitro bioassay measurements were initiated and are in progress to complete the internal dose assessment process. It is expected that the offsite laboratory bioassay measurement data will be available in 2-3 weeks and the internal dose assessment will then be completed.

"The H-1 Building Containment itself remains restricted. The H-1 Building Containment will remain restricted and the work activities related to the encapsulation of materials inside this containment have been suspended indefinitely. This status will continue until corrective actions have been implemented in order to prevent a reoccurrence of this incident. The licensee contends the initial root cause of the incident was inadequate procedure implementation and training regarding radiological containment inspection and certification.
Corrective actions that are planned include:

"1. H-1 Building Containment program overhaul.
2. Upgrade procedures to include routine containment inspections to be conducted and implement additional independent verification by Alaron's Radiation Safety staff.
3. Highlight Operational procedures to require signature requirement verifying proper ventilation alignment is functioning prior to commencement of work.
4. Alarming differential pressure gauges will be installed on the HEPA units to provide warning of both HEPA buildup and/or breakthrough.
5. The RSO will review the current application of constant air monitors against problematic conditions such as radon gas buildup to ensure alarm setpoints can adequately protect workers from excessive derived air concentrations in the work zone and retrain all staff.
6. The RSO will review and upgrade shield frisking stations to ensure proper contamination control in areas that have a high dose background.
7. Implement a recurring refresher training program in addition to the recertification training programs.
8. General Manager to conduct an all hands 1-day stand down to communicate priorities (i.e. Safety, Health and environmental stewardship are the top priorities; anyone can stop a job if they feel any of these are being compromised, etc.)

"The cause of the event is believed to be inadequate procedure implementation and training."

RIDO (Lilliendahl) and NMSS were notified.

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Agreement State Event Number: 53534
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: ATLAS ROOFING CORPORATION
Region: 4
City: DAINGERFIELD   State: TX
County:
License #: GLA 02416
Agreement: Y
Docket:
NRC Notified By: ART TUCKER
HQ OPS Officer: BRIAN LIN
Notification Date: 08/02/2018
Notification Time: 14:23 [ET]
Event Date: 08/02/2018
Event Time: 00:00 [CDT]
Last Update Date: 08/02/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
VINCENT GADDY (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - STUCK SHUTTER

The following information was received from the State of Texas:

"On August 2, 2018, the Incident Investigation Program (IIP) was given a copy of a request for reciprocity to perform work on a nuclear gauge stuck shutter at the licensee's location. IIP searched its database and found that the gauge, a ThermoFisher model SUP-1C gauge containing a 100 millicurie (original activity) strontium - 90 source, had been reported as stuck and repaired on June 20, 2018 (EN 52815). The licensee was contacted
and the radiation safety officer (RSO) stated the gauge General Lic - GLA had stuck again this time in the closed position. The gauge does not present an exposure risk to any individual. The RSO stated he did not realize a shutter in the stuck closed position needed to be reported. Additional information will be provided as it is received in accordance with SA-300."

Texas Incident Number: 9603

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Agreement State Event Number: 53535
Rep Org: LOUISIANA RADIATION PROTECTION DIV
Licensee: EXXONMOBIL CHEMICAL CO.
Region: 4
City: BATON ROUGE   State: LA
County:
License #: LA-2349-L01
Agreement: Y
Docket:
NRC Notified By: JOE NOBLE
HQ OPS Officer: VINCE KLCO
Notification Date: 08/02/2018
Notification Time: 16:46 [ET]
Event Date: 08/02/2018
Event Time: 00:00 [CDT]
Last Update Date: 08/02/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
VINCENT GADDY (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - GAUGE FAILURES

The following information was received from the State of Louisiana via email:

"On 07/26/2018, [the] Radiation Safety Officer (RSO) for ExxonMobil Chemical Co. (ExMCo) reported a multi-source gauge failure to the Department [Louisiana Department of Environmental Quality], LDEQ by e-mail. On 07/25/2018 during routine annual maintenance and pm [preventative maintenance] checks it was discovered the level/density gauge had several shutters stuck in the open position. Three sources would not retract into the shielded position. However, the remaining four sources are functioning properly.

"The gauge is a Berthold Technologies USA multi-source device, Model LB 300 IS, utilizing AEA Technologies, Model CKC.P4 sources. There are seven [nominal] 50 mCi Co-60 sources in the device. The sources involved in this malfunction are source #1 s/n 1369-08-02, source #2 s/n 1370-08-02, and source #6 s/n 1374-08-02. All three sources will not retract into the shielded position. The device has a SS&D Registration # TN-1031-D-801-S.

"Only one device was manufactured and is no longer being manufactured. The manufacturer is Berthold Technologies GmbH & Co. KG, D-75323 Bad Wildbad Germany. The Berthold Model LB300 IS level density gauge is installed on G-Line High Pressure Reactor Vessel, V5300 and G-Line high pressure separator production line.

"ExMCo engineers and Flowmaster/Berthold engineers & service company have been contacted to fix the problem by repairing the source holders or replace the device with other comparable technology.

"Event type: The gauge is installed on processes and does not pose a health and safety threat to the general public or the ExMCo employees. The gauge will remain on the operational process until the repair is made to the device. This is considered an equipment failure for reporting requirements.

"Event Location: ExxonMobil Chemical Co.
Baton Rouge Plastics Plant
11675 Scotland Avenue, (Hwy 19)
Baton Rouge, LA 70807,

"Event description: Shutters stuck in the open position or difficult to operate shutters were detected on a level/density gauge installed on processes at ExMCo. A service company has been contacted to make the repair or replace the device. The Department will be provided a final report with corrective actions. The Department was notified and the incident was reported to the NRC Operation Center. The report to the NRC as required by 10 CFR Part 30.50 (b) (2) and required by LAC 33:XV.341.B.2.b."

Louisiana Event: LA 180015

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Agreement State Event Number: 53536
Rep Org: COLORADO DEPT OF HEALTH
Licensee: EB ENGINEERING, INC
Region: 4
City: BOULDER   State: CO
County:
License #: CO 434-01
Agreement: Y
Docket:
NRC Notified By: SHIYA WANG
HQ OPS Officer: BRIAN LIN
Notification Date: 08/02/2018
Notification Time: 18:34 [ET]
Event Date: 08/02/2018
Event Time: 15:30 [MDT]
Last Update Date: 08/06/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
VINCENT GADDY (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
DENNIS ALLSTON (EMAIL)

Event Text

AGREEMENT STATE REPORT - MISSING PORTABLE DENSITY GAUGE

The following information was received via E-mail:

"At [approximately] 3:30 pm [MDT] on 8/2/2018, Eb Engineering reported that a portable density gauge was missing. A technician first discovered it at about 2:00 pm on 8/2/2018 when he came back from a job site; the gauge along with the transport box, chain, and lock were all missing from the truck. However, nothing else seems to be taken from the truck. He attempted to search along the roads he had been to, but nothing was found. He reported to another staff of this company and, at the time of this report, this staff is currently driving back to the job site to conduct another search. At this point, it has not been determined whether this gauge simply fell off the truck or was stolen. More information will be provided once available.

Device Type: Density
Manufacture: Troxler
Model Number: 3411B
Isotope and Activity: Cs-137, 8 mCi and Am-241/Be, 40mCi"

* * * UPDATE ON 8/6/2018 AT 1630 EDT FROM SHIYA WANG TO ANDREW WAUGH * * *

The following information was received via email:

"The licensee attempted a few hours of search in the late afternoon and evening of 8/2/2018 but only found the chain and lock at a street cross section in Longmont, CO. In the morning of 8/3/2018, a public member contacted the licensee that he got the box. This public member found the box from the side of the street, thought it was a cooler, and brought it to his girlfriend's home. Then he saw the RAM label on the box and contacted the licensee in the morning of 8/3/2018. In the morning of 8/3/2018, the box and the gauge were then back to the licensee's possession shortly after the licensee got the call from this public member. When the box was returned from this public member to the licensee, the box was not locked but the gauge handle was locked. It did not appear to have any damage to the box or the gauge or the source. Overall, there were at least two public members involved in this event (the one who found the box and his girlfriend) but their exposures are still to be determined. Additional information will be included in the NMED report once available."

NMED Event Report ID No.: CO180016

Notified R4DO (Vasquez), ILTAB, and NMSS Events Notification via email.


THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL

Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf

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!!!!! THIS EVENT HAS BEEN RETRACTED.THIS EVENT HAS BEEN RETRACTED !!!!!
Power Reactor Event Number: 53546
Facility: PRAIRIE ISLAND
Region: 3     State: MN
Unit: [1] [2] []
RX Type: [1] W-2-LP,[2] W-2-LP
NRC Notified By: JEFFREY HUMAN
HQ OPS Officer: OSSY FONT
Notification Date: 08/10/2018
Notification Time: 23:13 [ET]
Event Date: 08/10/2018
Event Time: 00:00 [CDT]
Last Update Date: 09/29/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(A) - POT UNABLE TO SAFE SD
50.72(b)(3)(v)(B) - POT RHR INOP
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
MICHAEL KUNOWSKI (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

EMERGENCY DIESEL GENERATOR COOLING WATER PUMPS DECLARED INOPERABLE

"On 8/10/2018 at 1445 [CDT] both trains of Cooling Water [Cooling Water Pumps for Emergency Diesel Generators] were declared INOPERABLE and both units entered [Technical Specification] (TS) 3.0.3 due to corroded jacket cooling water plugs for [the] 12 and 22 cooling water pump motors; therefore this condition is being reported as an eight-hour, non-emergency notification per 10 CFR 50.72(b)(3)(v). At 1543 [CDT], 08/10/2018 the 121 Cooling Water pump was aligned to the "A" Cooling Water train and the TS 3.0.3 condition was exited for both units. [After restoring train A cooling water the site entered a seven day limiting condition for operations, TS 3.7.8 for one inoperable cooling water pump.]

"There was no impact on the health and safety of the public or plant personnel."

The NRC Resident Inspector has been notified.

* * * RETRACTION ON 09/29/2018 AT 2128 EDT FROM BRIAN JOHNSON TO OSSY FONT * * *

"Testing and forensic analysis performed subsequent to the notification has determined the as-found condition would not have impacted either diesel-driven pumps' ability to start, run, and meet flow/pressure requirements to perform their required safety function. Therefore, EN# 53546 is being retracted.

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

Notified R3DO (Kozak).


Page Last Reviewed/Updated Friday, May 03, 2019
Friday, May 03, 2019