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Event Notification Report for November 15, 2018

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
11/14/2018 - 11/15/2018

** EVENT NUMBERS **


53650 53657 53718 53719 53720

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!!!!! THIS EVENT HAS BEEN RETRACTED.THIS EVENT HAS BEEN RETRACTED !!!!!
Power Reactor Event Number: 53650
Facility: COOPER
Region: 4     State: NE
Unit: [1] [] []
RX Type: [1] GE-4
NRC Notified By: NATE BEGER
HQ OPS Officer: ANDREW WAUGH
Notification Date: 10/06/2018
Notification Time: 05:56 [ET]
Event Date: 10/05/2018
Event Time: 00:00 [CDT]
Last Update Date: 11/15/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
THOMAS FARNHOLTZ (R4DO)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N N 0 Refueling 0 Refueling

Event Text

CONTROL ROOM EMERGENCY FILTER SYSTEM INOPERABLE

"On 10/5/2018, at 2219 CDT, the Control Room Emergency Filter (CREF) System was determined to be inoperable during a required condition of applicability due to being aligned to a Division 2 power source with its associated emergency power supply (Diesel Generator #2) removed from service earlier in the day. The power supply alignment was not identified at the time Diesel Generator #2 was removed from service (Diesel Generator #2 was rendered inoperable on 10/5/2018 at 1728 CDT). Movement of lately irradiated fuel assemblies in the Secondary Containment was in progress at the time of discovery of this condition. This condition represents an unplanned loss of safety function for a single train system during its specified condition of applicability. Movement of irradiated fuel was suspended until the power supplies to CREFs could be realigned to Division 1 which was completed at 0004 CDT on 10/6/2018.

"This represents a condition that could have prevented the fulfillment of the safety function of CREFs needed to mitigate the consequences of a fuel handling accident."

The NRC Resident Inspector has been notified.

* * * RETRACTION AT 1533 EST ON 11/15/18 FROM THOMAS FORLAND TO JEFFREY WHITED * * *

"CNS [Cooper Nuclear Station] is retracting the 8-hour non-emergency notification made on October 5, 2018 at 2219 CDT (EN# 53650). A subsequent evaluation concluded that the Control Room Emergency Filter (CREF) system remained operable in accordance with the applicable Cooper Nuclear Station Technical Specification Requirements 3.7.4 CREF System, 3.8.2 AC Sources - Shutdown, and 3.8.8 Distribution Systems - Shutdown. As a result of CREFs remaining operable throughout this period, no loss of safety function occurred. The NRC Senior Resident Inspector has been notified."

Notified R4DO (Haire)

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!!!!! THIS EVENT HAS BEEN RETRACTED.THIS EVENT HAS BEEN RETRACTED !!!!!
Power Reactor Event Number: 53657
Facility: QUAD CITIES
Region: 3     State: IL
Unit: [1] [2] []
RX Type: [1] GE-3,[2] GE-3
NRC Notified By: JEFFREY EASLEY
HQ OPS Officer: STEVEN VITTO
Notification Date: 10/10/2018
Notification Time: 03:26 [ET]
Event Date: 10/09/2018
Event Time: 00:00 [CDT]
Last Update Date: 11/14/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
AARON McCRAW (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

CONTROL ROOM EMERGENCY VENTILATION AC SYSTEM INOPERABLE

"On October 9, 2018 at 2002 CDT the Control Room Emergency Ventilation Air Condition (CREV AC) system was in the process of being returned to service following maintenance. During the return to service, the end bell on the CREV AC Condenser developed a significant leak requiring isolation. No work was performed on the CREV AC Condenser during the work window.

"The CREV AC system maintains a habitable control room environment and ensures the operability of components in the control room emergency zone during accident conditions.

"This notification is being made in accordance with 10CFR50.72(b)(3)(v)(D), "Event or Condition That Could Have Prevented Fulfillment of a Safety Function " because the CREV system is a single train system required to mitigate the consequences of an accident."

The NRC Resident Inspector has been notified.

* * * RETRACTION AT 1714 EST ON 11/14/2018 FROM JASON SWAIN TO JEFF HERRERA * * *

"The purpose of this notification today (November 14, 2018) is to retract the ENS Report made on October 10, 2018 at 0326 EDT (ENS Report #53657).

"Upon further investigation, it was determined that while the CREV AC system was out of service for planned maintenance and inoperable, the return to service valve sequencing caused an in-rush of residual heat removal service water (RHRSW) at 300 psig dead-heading into the refrigeration condensing unit (RCU). Previous normal sequencing had refilled the RCU with service water which is supplied at 100 psig. This unexpected higher than normal pressure on the RCU end bell gasket (rated at 150 psig) caused the gasket to be pushed from its normally seated position to allow a leak path. The gasket was not previously leaking; upon removal was inspected and no evidence of premature cracks or tears were found.

"The CREV AC system leak was induced by an improper coordination of return to service activities at the time of discovery, and the leak path was not previously present. This was not a latent failure. As such, a pre-exiting condition that could have prevented the fulfillment of a safety function did not exist, and based on this information, ENS Report# 53657 is being retracted.

"Note: On October 11, 2018 at 1330 hours CDT, the CREV RCU System gaskets were replaced and the system was returned to service under the properly sequenced tagout and was returned to Operable status.

"The NRC Resident Inspector has been notified. "

Notified the R3DO (Peterson).

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Agreement State Event Number: 53718
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: INTEC
Region: 4
City: SAN ANTONIO   State: TX
County:
License #: Licen-RAM-L05150
Agreement: Y
Docket:
NRC Notified By: MATTHEW KENNINGTON
HQ OPS Officer: RICHARD SMITH
Notification Date: 11/07/2018
Notification Time: 14:49 [ET]
Event Date: 11/07/2018
Event Time: 00:00 [CST]
Last Update Date: 11/07/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MARK HAIRE (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - DAMAGED DENSITY GAUGE

The following was received via email from Texas Department of State Health Services:

"On November 7th, 2018, the Agency [Texas Department Of State Health Services] was notified by the licensee's radiation safety officer that a moisture density gauge was damaged by heavy equipment [at a construction site in San Antonio, TX]. The gauge was manufactured by Troxler, serial number 38348, with Cs-137 (S/N:77-5682) and Am-241:Be (S/N:47-8792) sources of 8 mCi and 40 mCi respectively. The technician was operating the gauge at a construction site and a heavy equipment operator failed to notice the technicians attempts to stop him, and subsequently ran the gauge over. The source rod remained intact, however it could not be retracted into the shielded position. The licensee contacted the manufacturer and received shielding instructions. The gauge and the soil surrounding it were removed and transported to the licensee's office. The gauge will be sent back to Troxler for repair in an approved type package. No overexposures to the technician or to the public were reported."

Texas Incident #: I-9631

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Agreement State Event Number: 53719
Rep Org: KENTUCKY DEPT OF RADIATION CONTROL
Licensee: VERSO CORPORATION
Region: 1
City: Wickliffe   State: KY
County:
License #: 201-705-56
Agreement: Y
Docket:
NRC Notified By: ERIC PERRY
HQ OPS Officer: VINCE KLCO
Notification Date: 11/07/2018
Notification Time: 17:28 [ET]
Event Date: 11/06/2018
Event Time: 00:00 [CST]
Last Update Date: 11/07/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DAVE WERKHEISER (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB (EMAIL)
This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

AGREEMENT STATE REPORT - GAUGE LOST AND THEN FOUND

The following information was received from the Commonwealth of Kentucky by email:

"On 11/6/2018, a former licensee [formerly licensed as Wickliffe Paper Co.] reported discovery of a nuclear gauging device (TN [Texas Nuclear] model 5036 originally containing 200 mCi assayed 12/94) that it was unaware it possessed. The license was terminated on August 9, 2016 and at that time, the former licensee provided information related to the disposition of all devices the licensee was aware it possessed. License termination was due to plant closure. During engineering surveys to assess plant conditions for restart, personnel discovered the device still mounted on plant equipment. The former licensee is taking steps to have the device transferred to a licensed manufacturer for disposal. There is no reason to believe any individuals received any exposure at levels which would exceed the regulatory limits."

Kentucky Event: KY180004

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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Agreement State Event Number: 53720
Rep Org: FLORIDA BUREAU OF RADIATION CONTROL
Licensee: AKUMIN
Region: 1
City: JACKSONVILLE   State: FL
County:
License #: 4510-4,6
Agreement: Y
Docket:
NRC Notified By: MATTHEW SENISON
HQ OPS Officer: VINCE KLCO
Notification Date: 11/07/2018
Notification Time: 15:44 [ET]
Event Date: 11/01/2018
Event Time: 00:00 [EST]
Last Update Date: 11/07/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DAVE WERKHEISER (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - MISADMINISTRATION DUE TO BATCH ERROR

The following information was received by the State of Florida:

"At noon [on 11/7/18], [Akumin] called [the State of FL Bureau of Radiation Control] to report that both Akumin Hollywood and Akumin Aventura View ordered F-18 Fluciclovine, and received packages that were labeled as F-18 Fluciclovine, but were subsequently notified by their radiopharmaceutical vendor PET NET Solutions-Ft Lauderdale, on Thursday, November 1, 2018 that due to a 'batch error,' the packages actually contained F-18 FDG [Fludeoxyglucose]."

Three patients were reported as receiving the incorrect radiopharmaceutical. Activity reported as approximately 10 mCi.

Florida Incident: FL18-137

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.


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