Event Notification Report for December 19, 2018
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
12/18/2018 - 12/19/2018
EVENT NUMBERS
5379553796537985380453797
Agreement State
Event Number: 53795
Rep Org: COLORADO DEPT OF HEALTH
Licensee: THERMO MF PHYSICS, LLC
Region: 4
City: COLORADO SPRINGS State: CO
County:
License #: CO 803-02
Agreement: Y
Docket:
NRC Notified By: PHILLIP PETERSON
HQ OPS Officer: KAREN COTTON
Licensee: THERMO MF PHYSICS, LLC
Region: 4
City: COLORADO SPRINGS State: CO
County:
License #: CO 803-02
Agreement: Y
Docket:
NRC Notified By: PHILLIP PETERSON
HQ OPS Officer: KAREN COTTON
Notification Date: 12/19/2018
Notification Time: 17:28 [ET]
Event Date: 12/19/2018
Event Time: 00:00 [MST]
Last Update Date: 12/20/2018
Notification Time: 17:28 [ET]
Event Date: 12/19/2018
Event Time: 00:00 [MST]
Last Update Date: 12/20/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RYAN ALEXANDER (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
RYAN ALEXANDER (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
AGREEMENT STATE REPORT- CONTAMINATED PACKAGE
The following was received from the State of Colorado via email:
"Event description: Thermo MF Physics, LLC received 2 packages of radioactive materials, both containing approximately 700 Ci of H-3. When performing contamination surveys as part of the package receipt, wipe tests indicated approximately 600 dpm/cm2 of removable H-3. A third package that was received at the same time, which did not contain any radioactive materials, also exhibited removable contamination. Thermo MF Physics, LLC has contacted the final delivery carrier and made them aware of the situation. Thermo MF Physics, LLC is continuing to count removable contamination samples to determine the extent of the contamination event."
Colorado Event Report ID No.: CO180033
The following was received from the State of Colorado via email:
"Event description: Thermo MF Physics, LLC received 2 packages of radioactive materials, both containing approximately 700 Ci of H-3. When performing contamination surveys as part of the package receipt, wipe tests indicated approximately 600 dpm/cm2 of removable H-3. A third package that was received at the same time, which did not contain any radioactive materials, also exhibited removable contamination. Thermo MF Physics, LLC has contacted the final delivery carrier and made them aware of the situation. Thermo MF Physics, LLC is continuing to count removable contamination samples to determine the extent of the contamination event."
Colorado Event Report ID No.: CO180033
Power Reactor
Event Number: 53796
Facility: WATERFORD
Region: 4 State: LA
Unit: [3] [] []
RX Type: [3] CE
NRC Notified By: TRACEY BERRY
HQ OPS Officer: BRIAN P. SMITH
Region: 4 State: LA
Unit: [3] [] []
RX Type: [3] CE
NRC Notified By: TRACEY BERRY
HQ OPS Officer: BRIAN P. SMITH
Notification Date: 12/20/2018
Notification Time: 05:32 [ET]
Event Date: 12/19/2018
Event Time: 00:00 [CST]
Last Update Date: 12/20/2018
Notification Time: 05:32 [ET]
Event Date: 12/19/2018
Event Time: 00:00 [CST]
Last Update Date: 12/20/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
RYAN ALEXANDER (R4DO)
RYAN ALEXANDER (R4DO)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 3 | N | Y | 100 | Power Operation | 100 | Power Operation |
CONTROL ROOM ENVELOPE INOPERABLE
"On December 19, 2018, at 2322 CST, the shift operating crew declared the control room envelope inoperable in accordance with Technical Specification (TS) 3.7.6.1 due to valve HVC-102 exceeding its maximum allowed closed stroke time of 2.0 seconds during performing of surveillance procedure OP-903-119. Actual closed stroke time was 2.1 seconds. Valve HVC-102 is part of the control room envelope. TS 3.7.6.1 requires that two control room emergency air filtration trains shall be OPERABLE. Operations entered TS 3.7.6.1 action b, which requires that with one or more control room emergency air filtration trains inoperable due to inoperable control room envelope boundary in MODES 1, 2, 3, or 4, then: 1. immediately initiate action to implement mitigating actions; 2. within 24 hours, verify mitigating actions ensure control room envelope occupant exposures to radiological, chemical, and smoke hazards will not exceed limits; and 3. within 90 days, restore the control room envelope boundary to OPERABLE status. Actions b.1 and b.2 were completed by placing the control room ventilation system in isolate mode at 2355. This event is reportable pursuant to 10 CFR 50.72(b)(3)(v)(D), 'event or condition that could have prevented fulfillment of a safety function of structures or systems that are needed to (D) mitigate the consequences of an accident,' due to the control room envelope being inoperable.
"The NRC Resident Inspector has been notified."
"On December 19, 2018, at 2322 CST, the shift operating crew declared the control room envelope inoperable in accordance with Technical Specification (TS) 3.7.6.1 due to valve HVC-102 exceeding its maximum allowed closed stroke time of 2.0 seconds during performing of surveillance procedure OP-903-119. Actual closed stroke time was 2.1 seconds. Valve HVC-102 is part of the control room envelope. TS 3.7.6.1 requires that two control room emergency air filtration trains shall be OPERABLE. Operations entered TS 3.7.6.1 action b, which requires that with one or more control room emergency air filtration trains inoperable due to inoperable control room envelope boundary in MODES 1, 2, 3, or 4, then: 1. immediately initiate action to implement mitigating actions; 2. within 24 hours, verify mitigating actions ensure control room envelope occupant exposures to radiological, chemical, and smoke hazards will not exceed limits; and 3. within 90 days, restore the control room envelope boundary to OPERABLE status. Actions b.1 and b.2 were completed by placing the control room ventilation system in isolate mode at 2355. This event is reportable pursuant to 10 CFR 50.72(b)(3)(v)(D), 'event or condition that could have prevented fulfillment of a safety function of structures or systems that are needed to (D) mitigate the consequences of an accident,' due to the control room envelope being inoperable.
"The NRC Resident Inspector has been notified."
Independent Spent Fuel Storage Installation
Event Number: 53798
Rep Org: SAN ONOFRE
Licensee: SOUTHERN CALIFORNIA EDISON COMPANY
Region: 4
City: SAN CLEMENTE State: CA
County: SAN DIEGO
License #: GL
Agreement: Y
Docket: 72-41
NRC Notified By: TIM CUSICK
HQ OPS Officer: MARK ABRAMOVITZ
Licensee: SOUTHERN CALIFORNIA EDISON COMPANY
Region: 4
City: SAN CLEMENTE State: CA
County: SAN DIEGO
License #: GL
Agreement: Y
Docket: 72-41
NRC Notified By: TIM CUSICK
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 12/20/2018
Notification Time: 13:56 [ET]
Event Date: 12/19/2018
Event Time: 00:00 [PST]
Last Update Date: 12/20/2018
Notification Time: 13:56 [ET]
Event Date: 12/19/2018
Event Time: 00:00 [PST]
Last Update Date: 12/20/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
72.75(d)(1) - SFTY EQUIP. DISABLED OR FAILS TO FUNCTION
10 CFR Section:
72.75(d)(1) - SFTY EQUIP. DISABLED OR FAILS TO FUNCTION
Person (Organization):
RYAN ALEXANDER (R4DO)
RYAN ALEXANDER (R4DO)
SPENT FUEL TRANSFER VEHICLE OUTSIDE SEISMIC ANALYSIS LIMITS
"As part of the reviews following the August 3rd 2018 canister downloading event (EN#53605), SCE has identified events where the HI-PORT may have been operated outside the analytical assumptions of the seismic analysis while transporting a loaded canister in the HI-TRAC. SCE has decided to conservatively report this issue.
"The HI-PORT is subject to requirements in the Certificate of Compliance that result in seismic restrictions on center of gravity and proximity to structures that could adversely affect the function of the HI-PORT along the haul route. SCE has concluded that during previous movements of loaded spent fuel canisters during 2018, the HI-PORT likely exceeded these procedural and analytical limits in some cases.
"Additional analysis is underway that may conclude that damage to the HI-PORT would not occur under these conditions. Nevertheless, this situation is being reported in accordance with 10CFR72.75(d)(1) for an important to safety component that was disabled or failed to function. There was no seismic event that resulted in damage to the HI-PORT during the fuel transfer campaign. All 29 spent fuel canisters are currently in safe storage within the ISFSI.
"NRC Region IV will be notified as SONGS does not have a NRC Resident Inspector."
"As part of the reviews following the August 3rd 2018 canister downloading event (EN#53605), SCE has identified events where the HI-PORT may have been operated outside the analytical assumptions of the seismic analysis while transporting a loaded canister in the HI-TRAC. SCE has decided to conservatively report this issue.
"The HI-PORT is subject to requirements in the Certificate of Compliance that result in seismic restrictions on center of gravity and proximity to structures that could adversely affect the function of the HI-PORT along the haul route. SCE has concluded that during previous movements of loaded spent fuel canisters during 2018, the HI-PORT likely exceeded these procedural and analytical limits in some cases.
"Additional analysis is underway that may conclude that damage to the HI-PORT would not occur under these conditions. Nevertheless, this situation is being reported in accordance with 10CFR72.75(d)(1) for an important to safety component that was disabled or failed to function. There was no seismic event that resulted in damage to the HI-PORT during the fuel transfer campaign. All 29 spent fuel canisters are currently in safe storage within the ISFSI.
"NRC Region IV will be notified as SONGS does not have a NRC Resident Inspector."
Agreement State
Event Number: 53804
Rep Org: WA OFFICE OF RADIATION PROTECTION
Licensee: SWEDISH MEDICAL CENTER
Region: 4
City: SEATTLE State: WA
County:
License #: WN-M008-1
Agreement: Y
Docket:
NRC Notified By: ANDREW HALLORAN
HQ OPS Officer: MARK ABRAMOVITZ
Licensee: SWEDISH MEDICAL CENTER
Region: 4
City: SEATTLE State: WA
County:
License #: WN-M008-1
Agreement: Y
Docket:
NRC Notified By: ANDREW HALLORAN
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 12/21/2018
Notification Time: 15:55 [ET]
Event Date: 12/19/2018
Event Time: 00:00 [PST]
Last Update Date: 01/17/2019
Notification Time: 15:55 [ET]
Event Date: 12/19/2018
Event Time: 00:00 [PST]
Last Update Date: 01/17/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RYAN ALEXANDER (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
RYAN ALEXANDER (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
AGREEMENT STATE REPORT - RADIOACTIVE SOURCE FAILS LEAK TEST
The following report was received via e-mail:
"A routine leak test at the Swedish Cancer Institute found a leaking Cs-137 e-vial source in the Physics Lab. The initial leak test was taken 12/19/2018 and analyzed on 12/20/2018. It revealed an activity of approximately 10 nanoCuries, and additional confirmation tests found contamination above the regulatory threshold for a leaking source.
"The source was immediately removed from service, contained within multiple non-permeable barriers, and placed into a larger pig while it is being held for disposal. Surveys of the original storage pig and the hot lab where the source was utilized found no removable contamination and there was no personnel contamination detected.
"The RSO [Radiation Safety Officer] was notified of the positive results the morning of 12/21/2018 and provided notification to DOH [Washington State Department of Health] at 1114 PST on 12/21/2018."
* * * UPDATE ON 01/17/2019 AT 1201 EST FROM ANDREW HALLORAN TO JEFFREY WHITED * * *
The following report was received via e-mail:
"A leaking sealed source was discovered at The Swedish Cancer Institute during periodic leak tests performed by the health physics staff. The source (MED3550 Gamma Reference Standard, SN 11345, Cs-137, initial activity 209.6 micro-Ci, reference date 8/1/2001) was used in the A Level Physics Lab as part of routine radiation oncology operations. The source was initially received by Swedish 12/6/2007.
"The sample was collected on 12/19/2018 using an alcohol wipe, and analyzed on 12/20/2018 using a Ludlum 261 single channel analyzer coupled with a NaI well detector. The system was set to detect the 662 keV photon energy for Cs-137, with a calculated efficiency of 11.71 percent. The result of the wipe test analysis was a removable activity of 9.92 Nano-Ci, above the 5 Nano-Ci threshold for a leaking source.
"After the RSO was notified of the positive result on 12/21/2018, the source was immediately removed from service, contained within multiple non-permeable barriers, and placed into a lead pig. The pig is currently being stored in the Radiation Safety Office Lab awaiting disposal. Wipes of the A Level Physics Lab source storage cabinet and all surfaces of the pig used to house the source when it was in service yielded no detectable removable contamination.
"After reviewing the final report of the licensee, this event is now closed as of 1/3/2018. DOH will verify that the source has been disposed of during the next routine inspection of the licensee."
Washington Event Report ID: WA-18-031
Notified R4DO (Drake) and NMSS Event Notification (e-mail).
The following report was received via e-mail:
"A routine leak test at the Swedish Cancer Institute found a leaking Cs-137 e-vial source in the Physics Lab. The initial leak test was taken 12/19/2018 and analyzed on 12/20/2018. It revealed an activity of approximately 10 nanoCuries, and additional confirmation tests found contamination above the regulatory threshold for a leaking source.
"The source was immediately removed from service, contained within multiple non-permeable barriers, and placed into a larger pig while it is being held for disposal. Surveys of the original storage pig and the hot lab where the source was utilized found no removable contamination and there was no personnel contamination detected.
"The RSO [Radiation Safety Officer] was notified of the positive results the morning of 12/21/2018 and provided notification to DOH [Washington State Department of Health] at 1114 PST on 12/21/2018."
* * * UPDATE ON 01/17/2019 AT 1201 EST FROM ANDREW HALLORAN TO JEFFREY WHITED * * *
The following report was received via e-mail:
"A leaking sealed source was discovered at The Swedish Cancer Institute during periodic leak tests performed by the health physics staff. The source (MED3550 Gamma Reference Standard, SN 11345, Cs-137, initial activity 209.6 micro-Ci, reference date 8/1/2001) was used in the A Level Physics Lab as part of routine radiation oncology operations. The source was initially received by Swedish 12/6/2007.
"The sample was collected on 12/19/2018 using an alcohol wipe, and analyzed on 12/20/2018 using a Ludlum 261 single channel analyzer coupled with a NaI well detector. The system was set to detect the 662 keV photon energy for Cs-137, with a calculated efficiency of 11.71 percent. The result of the wipe test analysis was a removable activity of 9.92 Nano-Ci, above the 5 Nano-Ci threshold for a leaking source.
"After the RSO was notified of the positive result on 12/21/2018, the source was immediately removed from service, contained within multiple non-permeable barriers, and placed into a lead pig. The pig is currently being stored in the Radiation Safety Office Lab awaiting disposal. Wipes of the A Level Physics Lab source storage cabinet and all surfaces of the pig used to house the source when it was in service yielded no detectable removable contamination.
"After reviewing the final report of the licensee, this event is now closed as of 1/3/2018. DOH will verify that the source has been disposed of during the next routine inspection of the licensee."
Washington Event Report ID: WA-18-031
Notified R4DO (Drake) and NMSS Event Notification (e-mail).
Agreement State
Event Number: 53797
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: PASADENA REFINING SYSTEM
Region: 4
City: PASADENA State: TX
County:
License #: L01344
Agreement: Y
Docket:
NRC Notified By: Irene Casares
HQ OPS Officer: BRIAN P. SMITH
Licensee: PASADENA REFINING SYSTEM
Region: 4
City: PASADENA State: TX
County:
License #: L01344
Agreement: Y
Docket:
NRC Notified By: Irene Casares
HQ OPS Officer: BRIAN P. SMITH
Notification Date: 12/20/2018
Notification Time: 10:24 [ET]
Event Date: 12/19/2018
Event Time: 10:49 [CST]
Last Update Date: 01/30/2019
Notification Time: 10:24 [ET]
Event Date: 12/19/2018
Event Time: 10:49 [CST]
Last Update Date: 01/30/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RYAN ALEXANDER (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
RYAN ALEXANDER (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
AGREEMENT STATE REPORT - FIXED GAUGE STUCK SHUTTER
The following was received from the State of Texas via email:
"On December 19, 2018 at 10:49 am, the licensee's radiation safety officer reported a stuck shutter on a fixed gauge, found during routine maintenance. Gauge is in the open operating position; no employee or public exposures are anticipated. Gauge is attached to a vessel located several feet off the ground. Device information: source SN 8423CN, model SH-F1B, Cs-137, 100 mCi. A service company has been called to repair the gauge. Update will be sent in accordance with SA300 guidelines."
Texas Incident #: I-9646
* * * UPDATE ON 01/30/2019 AT 1135 EST FROM MATTHEW KENNINGTON TO JEFFREY WHITED * * *
The following update was received from the State of Texas via email:
"On January 29, 2019, the licensee's Radiation Safety Officer (RSO) reported to the [Texas Department of State Health Services] that after further investigation two additional gauges were found on December 19, 2018, with shutters stuck in the open position. Open is the normal operating position. The gauges are Ohmart Vega model SH-F1B serial number 8431CN and 8443CN, both containing 100 mCi of cesium (Cs)-137. The RSO stated he discovered the additional shutter failures after reviewing reports received on January 21, 2019. The gauges are located on towers, not easily accessible, and are unlikely to cause unintended exposure. The RSO has contacted a service company and is anticipating the repairs completed to all three gauges in the next week. The RSO intends to apply grease to O-rings to prevent moisture from entering and fouling the shutter mechanism."
Notified R4DO (Werner) and NMSS Events Notification via email.
The following was received from the State of Texas via email:
"On December 19, 2018 at 10:49 am, the licensee's radiation safety officer reported a stuck shutter on a fixed gauge, found during routine maintenance. Gauge is in the open operating position; no employee or public exposures are anticipated. Gauge is attached to a vessel located several feet off the ground. Device information: source SN 8423CN, model SH-F1B, Cs-137, 100 mCi. A service company has been called to repair the gauge. Update will be sent in accordance with SA300 guidelines."
Texas Incident #: I-9646
* * * UPDATE ON 01/30/2019 AT 1135 EST FROM MATTHEW KENNINGTON TO JEFFREY WHITED * * *
The following update was received from the State of Texas via email:
"On January 29, 2019, the licensee's Radiation Safety Officer (RSO) reported to the [Texas Department of State Health Services] that after further investigation two additional gauges were found on December 19, 2018, with shutters stuck in the open position. Open is the normal operating position. The gauges are Ohmart Vega model SH-F1B serial number 8431CN and 8443CN, both containing 100 mCi of cesium (Cs)-137. The RSO stated he discovered the additional shutter failures after reviewing reports received on January 21, 2019. The gauges are located on towers, not easily accessible, and are unlikely to cause unintended exposure. The RSO has contacted a service company and is anticipating the repairs completed to all three gauges in the next week. The RSO intends to apply grease to O-rings to prevent moisture from entering and fouling the shutter mechanism."
Notified R4DO (Werner) and NMSS Events Notification via email.