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Event Notification Report for April 15, 2019

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
4/12/2019 - 4/15/2019

** EVENT NUMBERS **


53975 53978 53979 53980 53981 53993 53997 53998 53999 54000 54001

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Agreement State Event Number: 53975
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: THERMO FINNIGAN LLC
Region: 4
City: AUSTIN   State: TX
County:
License #: Licen-RAM-L01186
Agreement: Y
Docket:
NRC Notified By: ART TUCKER
HQ OPS Officer: JOANNA BRIDGE
Notification Date: 04/04/2019
Notification Time: 09:19 [ET]
Event Date: 01/08/2019
Event Time: 00:00 [CDT]
Last Update Date: 04/15/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MICHAEL VASQUEZ (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - UNPLANNED CONTAMINATION

The following was received via e-mail:

"On January 8, 2019, the Agency [Texas Department of State Health Services] was contacted by the license and notified they have some conflicting data that suggest they may have up to three (3) leaking Nickel (Ni) - 63 ten milliCurie sources that may be slightly above the 0.005 microCuries reporting limit. The licensee stated they need to investigate further as a second set of leak tests showed no detectable activity on the same three sources. The three sealed sources in question have been bagged and are slotted for disposal. The licensee will provide additional information as it is received.

"On January 25, 2019, the licensee contacted the Agency and stated they had leak tested all similar sources in their possession. The licensee found a total of four sources exceeded the limit. The sources are all Ni-63 containing 10 milliCuries. The licensee stated they will dispose of all leaking sources. The licensee stated it believed the sources were manufactured in Singapore. The sources are used in gas chromatographs. The Agency conducted an on site investigation at the facility on March 11, 2019. During the investigation the licensee stated none of their customers who had been provided a device had reported a source that failed a leak test.

"On April 3, 2019, the Agency was notified by the licensee that they were going to restrict access to a room for more than 24 hours due to fixed and removable radioactive contamination levels. The contamination was found while performing surveys in the area in response to leak test results of four Ni-63 sources exceeding the limit (NMED report number 190032). The licensee will perform bioassay sampling of all individuals who had been in the room. The licensee stated they have begun decontamination of the room. Additional information will be provided as it is received in accordance with SA-300."

Texas Incident number: 9648

* * * UPDATE AT 1645 EDT ON 4/15/2019 FROM ART TUCKER TO MARK ABRAMOVITZ * * *

The following report was received via e-mail:

"On April 15, 2019, the Agency [Texas Department of State Health Services] was notified by the licensee that they had found additional contamination in the facility and had closed the facility until a full survey can be completed and any areas found to be contaminated released. The licensee is working on a bioassay plan for the employees."

Notified the R4DO (Pick) and NMSS (via e-mail).

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Agreement State Event Number: 53978
Rep Org: OHIO BUREAU OF RADIATION PROTECTION
Licensee: CARDINAL OPERATING COMPANY
Region: 3
City: BRILLIANT   State: OH
County:
License #: 31201420000
Agreement: Y
Docket:
NRC Notified By: STEPHEN JAMES
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 04/04/2019
Notification Time: 15:19 [ET]
Event Date: 04/03/2019
Event Time: 00:00 [EDT]
Last Update Date: 04/04/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JOHN HANNA (R3DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - FIXED GAUGE MISSING SHUTTER

The following report was received via e-mail:

"On 4/3/19, during preparation to conduct maintenance on a coal chute, workers prepared to isolate a gauge from service to prevent worker exposure to the beam. It was discovered that the gauge was missing its isolation shutter. The RSO [Radiation Safety Officer] and plant personnel conducted an extensive search and investigation of the missing shutter, but it could not be located. A six-month physical inventory of the facilities devices was conducted on 3/26/19 and 3/27/19 and there was no notation of any problems with this gauge on the inventory sheets. The gauge involved is a Texas Nuclear Model 5189 with a 20 mCi Cesium-137 source.

"The RSO and job supervisor held a discussion and decided that they could use the shutter from another Model 5189 gauge in the vicinity. The second gauge is used in a continuously operating process line and would have the shutter open for operations. The area around the second gauge will have signage and barricades installed to safely mark the area if future work activities will take place in that location. The shutter from the second gauge was placed on the first gauge and it was tagged out for maintenance of the coal chute. The second gauge remains in the open position during operation of the second process line.

"The RSO contacted ThermoFisher Scientific and discovered that because of the age of the gauge, replacement parts could not be obtained. They were provided with a list of third-party service providers to assist with proper repair or removal and disposal of the gauge. The licensee will explore options and inform ODH [Ohio Department of Health] of the actions to be taken."

Ohio Item Number: OH190005

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Agreement State Event Number: 53979
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: ACUREN INSPECTIONS INC.
Region: 4
City: LA PORTE   State: TX
County:
License #: RAM-L01774
Agreement: Y
Docket:
NRC Notified By: ART TUCKER
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 04/04/2019
Notification Time: 16:50 [ET]
Event Date: 04/03/2019
Event Time: 00:00 [CDT]
Last Update Date: 04/05/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MICHAEL VASQUEZ (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - UNABLE TO RETRACT RADIOGRAPHY SOURCE

The following report was received via e-mail:

"On April 4, 2019, the Agency was notified by the licensee that one of their radiography crews was unable to retract a source on April 3, 2019, when a jig on a ladder fell on the source tube. The crew contacted the RSO [Radiation Safety Officer]. The RSO, an authorized source retriever, reported to the temporary job site in approximately 20 minutes and retrieved the source.

"No member of the general public received an exposure from this event. No additional information has been provided. The radiographers were to be interviewed on April 4, 2019. Additional information will be provided as it is received in accordance with SA-300."

Texas Incident: 9670

* * * UPDATE ON 4/5/2019 AT 1222 EDT FROM ART TUCKER TO MARK ABRAMOVITZ * * *

The following information was received via e-mail:

"On April 5, 2019, the licensee provided the following information. The device was a QSA 880D exposure device containing a 62 curie iridium-192 source. The highest exposure received from this event to any of the individuals involved was to the individual who retrieved the source. [The RSO] received 370 millirem whole body dose and his right hand received 350 millirem. No individual exceeded any exposure limits due to this event. The exposure device has been returned to the manufacturer for service and the guide tube has been taken out of service. Additional information will be provided as it is received in accordance with SA-300."

Notified the R4DO (Kozal) and NMSS Events Notification (via e-mail).

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Agreement State Event Number: 53980
Rep Org: LOUISIANA RADIATION PROTECTION DIV
Licensee: TECHNICAL TESTING SERVICES, INC.
Region: 4
City: SHREVEPORT   State: LA
County:
License #: LA-3773-L01A
Agreement: Y
Docket:
NRC Notified By: JOE NOBLE
HQ OPS Officer: DONALD NORWOOD
Notification Date: 04/04/2019
Notification Time: 17:36 [ET]
Event Date: 03/12/2019
Event Time: 10:00 [CDT]
Last Update Date: 04/04/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JASON KOZAL (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - POTENTIAL EXCESSIVE EXPOSURE AND SAFETY EQUIPMENT FAILURE

The following information was received via e-mail:

"Louisiana Department of Environmental Quality (LDEQ) was notified of this event on Monday, April 1, 2019. This event occurred in a manufacturing fabrication shop in a fixed shooting bay.

"On Tuesday, March 12, 2019, the Radiation Safety Officer (RSO) and a radiography trainee were shooting welds at the Steel Forgigs, Inc. (SF) site. The RSO stated the QC/QA [Quality Control/Quality Assurance] safety checks had been performed before the 'radiography work' began. During radiography work of shooting welds and exchanging out pipe to be x-rayed, the trainee proceeded to change out the film on the pipe while the RSO went to retrieve a new piece of pipe. The safety alarm/lights were not flashing and the trainee assumed the source had been retracted into the shielded position. However, the trainee's survey meter saturated and his pocket dosimeter went off scale. The lights and alarm were still not responding. The RSO stated 'I knew the trainee did not exceed the 5 REM exposure limit due to my work experience.'

"The survey meter was functioning properly when removed from the 'high radiation' field and his pocket dosimeter appeared to function properly when re-zeroed after the off-scale reading. The trainee's personnel monitor was sent to be processed for his personal exposure. The exposure results were 2.488 REM exposure.

"The equipment involved in the incident was a QSA 880 Delta, s/n D5843, exposure device with a QSA source model A424-9, Ir-192 source, s/n 71973G with an activity of 19 Ci.

"The internal investigation documented there was no excessive exposure to the trainee. However, the late reporting of the incident, not reporting of the incident by regulatory requirement and no commitment to corrective actions to prevent these events from reoccurring in the future are still outstanding.

"LDEQ is seeking escalated enforcement actions pertaining to this licensee and NMED incident."

Louisiana Event Report ID No.: LA-190005

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Agreement State Event Number: 53981
Rep Org: SC DEPT OF HEALTH & ENV CONTROL
Licensee: ECS SOUTHEAST, LLP
Region: 1
City: GREENVILLE   State: SC
County:
License #: 584
Agreement: Y
Docket:
NRC Notified By: ANDREW ROXBURGH
HQ OPS Officer: JEFFREY WHITED
Notification Date: 04/05/2019
Notification Time: 07:16 [ET]
Event Date: 04/04/2019
Event Time: 15:15 [EDT]
Last Update Date: 04/05/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MATT YOUNG (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - GAUGE RUN OVER BY BULL DOZER

The following was received via e-mail:

"On April 4, 2019, the Department [South Carolina Department of Health and Environmental Control] was notified by the licensee at approximately 1515 EDT that one of its gauges had been run over by a bull dozer at a jobsite. The gauge was a Humboldt Model 5001 s/n 941 containing 10 mCi of Cs-137 and 40 mCi of Am-241:Be. The sealed source serial number for the Cs-137 source is 2467GH and the sealed source serial number for the Am-241:Be source is NJ00918. A radiation surveys and wipe tests of the gauge were performed at the scene. There was no removable contamination detected. The gauge was safely transported back to the licensee's facility and placed in storage awaiting disposal."

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Part 21 Event Number: 53993
Rep Org: AMETEK
Licensee: AMETEK SOLIDSTATE CONTROLS INC.
Region: 3
City: COLUMBUS   State: OH
County:
License #:
Agreement: Y
Docket:
NRC Notified By: ETHAN SALSBURY
HQ OPS Officer: JEFFREY WHITED
Notification Date: 04/12/2019
Notification Time: 09:31 [ET]
Event Date: 04/12/2019
Event Time: 00:00 [EDT]
Last Update Date: 04/12/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21(a)(2) - INTERIM EVAL OF DEVIATION
Person (Organization):
NICOLE COOVERT (R2DO)
STEVE ORTH (R3DO)
- PART 21/50.55 REACTORS (EMAIL)

Event Text

PART 21 REPORT - OVERHEATING AND FAILURE OF TRANSFORMERS

The following was received via e-mail:

"COMPONENT DESCRIPTION: AMETEK part number 80-315382-90, T801 main transformer.

"PROBLEM YOU COULD SEE: Overheating and failure of transformers installed in equipment with 0.7 power factor load requirements

"CAUSE: The inverters on AMETEK job number C72143 were required to support a 0.7 power factor load. To meet this requirement, CVT capacitors were added which led to overcurrent on the capacitor current windings and overheating. The overheating led to a breakdown in insulation between windings, causing a premature failure of the transformer set and inverter relative to its 40-year qualification life.

"EFFECT ON SYSTEM PERFORMANCE: The overheating accelerates the degradation of the insulation between windings and eventually leads to shorting. This will cause an inverter failure and require the load to be transferred to bypass.

"ACTION REQUIRED: This is the only instance AMETEK has experienced for this issue. Therefore, action is only required for the equipment on AMETEK job number C72143, located at TVA Sequoyah. New transformers have been provided as replacements that require fewer capacitors, contain additional venting to improve cooling, and include larger winding material to reduce current density. The main transformers (T801) installed in the serial numbers associated with this job (C72143-0111 through 0911) should be replaced to prevent any similar occurrences.

"AMETEK SOLIDSTATE CONTROLS CORRECTIVE ACTION: AMETEK has enhanced this particular transformer design to improve cooling and reduce capacitor current. Additionally, corrective action #175 has been issued in AMETEK's system.

"If you have any questions, please contact Mr. Mark Shreve of the Client Services group at 1- 800-222-9079 or 1-614-846-7500 ext. 6332. mark.shreve@ametek.com."

Sequoyah is the only site affected by this Part 21 Report.

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Power Reactor Event Number: 53997
Facility: MONTICELLO
Region: 3     State: MN
Unit: [1] [] []
RX Type: [1] GE-3
NRC Notified By: SCOTT CHRISTOS
HQ OPS Officer: DONALD NORWOOD
Notification Date: 04/13/2019
Notification Time: 02:04 [ET]
Event Date: 04/12/2019
Event Time: 18:15 [CDT]
Last Update Date: 04/13/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
STEVE ORTH (R3DO)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N Y 25 Power Operation 25 Power Operation

Event Text

HIGH ENERGY LINE BREAK DOOR FOUND IN INCORRECT POSITION RESULTING IN LPCI AND CORE SPRAY BEING INOPERABLE

"At approximately 1815 CDT on April 12, 2019, High Energy Line Break (HELB) Door-410A in the Reactor Building was discovered in the closed position. HELB Door-410B was previously closed for maintenance. Either Door-410A or Door-410B must be open to support the current HELB analyses. With both doors closed, this is considered an unanalyzed condition resulting in the loss of a post-HELB safe shutdown path.

"With Door-410A and Door-410B closed, LPCI [Low Pressure Coolant Injection] and Core Spray injection valves in both divisions are no longer considered available.

"This condition is being reported under 10 CFR 50.72(b)(3)(ii) as an unanalyzed condition that significantly degrades plant safety and 10 CFR 50.72(b)(3)(v) as an event or condition that could have prevented the fulfillment of a safety function.

"The condition was resolved at approximately 1845 CDT on April 12, 2019 when Door-410A was blocked open. The health and safety of the public was not affected by this condition.

"The NRC Resident has been notified."

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Power Reactor Event Number: 53998
Facility: NINE MILE POINT
Region: 1     State: NY
Unit: [1] [] []
RX Type: [1] GE-2,[2] GE-5
NRC Notified By: ZACK FORD
HQ OPS Officer: JOANNA BRIDGE
Notification Date: 04/14/2019
Notification Time: 03:21 [ET]
Event Date: 04/14/2019
Event Time: 00:03 [EDT]
Last Update Date: 04/14/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
ANNE DeFRANCISCO (R1DO)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
1 A/R Y 21 Power Operation 0 Hot Shutdown

Event Text

AUTOMATIC REACTOR SCRAM AND SPECIFIED SYSTEM ACTUATION

"On April 14, 2019 at 0003 [EDT], Nine Mile Point Unit 1 experienced an automatic reactor scram during reactor startup. The cause of the automatic scram was due to high [Reactor Pressure Vessel] pressure following closure of the turbine stop valves. All control rods fully inserted and all plant systems responded per design following the scram.

"Following the automatic scram, the High Pressure Coolant Injection (HPCI) System automatically initiated as expected. At Nine Mile Point Unit 1, a HPCI System actuation signal on low Reactor Pressure Vessel (RPV) level is normally received following a reactor scram, due to level shrink. HPCI is a flow control mode of the normal feedwater systems, and is not an Emergency Core Cooling System. At 0004, RPV level was restored above the HPCI System low level actuation set point and the HPCI System initiation signal was reset. Pressure control was established on the Turbine Bypass Valves, the preferred system. No Electromatic Relief Valves actuated due to this scram.

"Nine Mile Point Unit 1 is currently in Hot Shutdown, with reactor water level and pressure maintained within normal bands. The offsite grid is stable with no grid restrictions or warnings in effect.

"The unit is currently implementing post scram recovery procedures."

The NRC Resident Inspector has been notified. The Licensee will notify the State of New York.

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Power Reactor Event Number: 53999
Facility: SEQUOYAH
Region: 2     State: TN
Unit: [1] [] []
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: CAL ATCHLEY
HQ OPS Officer: BETHANY CECERE
Notification Date: 04/14/2019
Notification Time: 06:44 [ET]
Event Date: 04/14/2019
Event Time: 03:20 [EDT]
Last Update Date: 04/14/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
NICOLE COOVERT (R2DO)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
1 A/R Y 100 Power Operation 0 Hot Standby

Event Text

AUTOMATIC REACTOR TRIP DUE TO MAIN FEEDWATER PUMP TRIP

"At 0320 EDT, April 14, 2019, Sequoyah Unit 1 experienced an automatic reactor trip. The event was initiated by the trip of the 1A main feedwater pump. During the automatic unit runback, an automatic reactor trip was initiated due to low-low level in Steam Generator number 3.

"The Auxiliary Feedwater System (AFWS) automatically actuated as required when the expected post-trip feedwater isolation actuated. Reactor Coolant System temperature is being maintained by the AFWS and the steam dump system. During this operational cycle, one control Rod Position Indicator (RPI) for core position E-5 in shutdown bank 'A' has been inoperable, and the appropriate Condition and Required Actions of [Technical Specification Limiting Condition of Operation] 3.1.7 were complied with. Due to this inoperable RPI, the associated shutdown rod is conservatively assumed to be full out and untrippable. Consequently, boration was required to establish adequate shutdown margin. All other Control and Shutdown rods fully inserted. All safety systems responded as designed. No primary or secondary safety valves actuated during or after the reactor trip. The unit is currently stable in Mode 3. Unit 1 is in a normal shutdown electrical alignment.

"There was no impact on Unit 2.

"Due to the Reactor Protection System actuation while critical, this event is being reported as a four-hour, non-emergency notification per 10 CFR 50.72(b)(2)(iv)(B) and in accordance with 10 CFR 50.72(b)(3)(iv)(A) as an event that results in a valid actuation of the AFW system.

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

"The NRC Senior Resident Inspector has been notified."

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Power Reactor Event Number: 54000
Facility: MONTICELLO
Region: 3     State: MN
Unit: [1] [] []
RX Type: [1] GE-3
NRC Notified By: JON LAUDENBACH
HQ OPS Officer: JEFFREY WHITED
Notification Date: 04/15/2019
Notification Time: 11:36 [ET]
Event Date: 04/15/2019
Event Time: 05:11 [CDT]
Last Update Date: 04/15/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xii) - OFFSITE MEDICAL
Person (Organization):
MICHAEL KUNOWSKI (R3DO)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N N 0 Refueling 0 Refueling

Event Text

TRANSPORT OFFSITE TO MEDICAL FACILITY OF POTENTIALLY CONTAMINATED INDIVIDUAL

"At 0511 CDT on 4/15/2019, transport of a potentially radiologically contaminated person from the Monticello Nuclear Plant to a local hospital was performed prior to conducting a radiological survey as a prudent measure to ensure timely medical support. At 0658 CDT a radiological survey determined that the individual and their clothing were not contaminated.

"This is reportable under 10 CFR 50.72(b)(3)(xii). The NRC Resident Inspector has been notified."

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Part 21 Event Number: 54001
Rep Org: CURTISS-WRIGHT
Licensee: CURTISS WRIGHT ENERTECH
Region: 4
City: Brea   State: CA
County:
License #:
Agreement: Y
Docket:
NRC Notified By: ROSALIE NAVA
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 04/15/2019
Notification Time: 20:12 [ET]
Event Date: 04/15/2019
Event Time: 00:00 [PDT]
Last Update Date: 04/15/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21(d)(3)(i) - DEFECTS AND NONCOMPLIANCE
Person (Organization):
BRICE BICKETT (R1DO)
NICOLE COOVERT (R2DO)
MICHAEL KUNOWSKI (R3DO)
GREG PICK (R4DO)
- PART 21/50.55 REACTORS (EMAIL)

Event Text

PART-21 NOTIFICATION - SNUBBER HYDRAULIC FLUID BATCH CONTAINS PARTICULATES

The following report was received via fax:

"Pacific Gas and Electric notified Curtiss Wright [CW] Enertech that they observed white particulate in SF-1154 fluid in three containers. The white particulate was found settled at the bottom of the containers. The fluid was dedicated and supplied by CW Enertech in November 2016 The fluid was traced back to Momentive Batch 14ELVS145.

"The momentive batch 14ELVS145 was previously reported by Lake Engineering Company (Ref NRC ML17212A628 and ML17128A465). The white particulates/semisolid material was identified as phenyl cyclic precipitate. The safety hazard that could be created by this defect is the blockage of snubber bleed port as reported by Duane Arnold (Ref ML070300154). This blockage could prevent the snubber from unlocking after a seismic event, thus preventing the snubber to allow for system movement during normal operations.

"In addition, evaluation performed by Lake Engineering Company has found that all of the solids are dissolved back into the fluid when heated to 110 [degrees] fahrenheit. With all solids dissolved, there is no potential safety hazard with this fluid."

Affected sites: Fermi, Shearon Harris, Beaver Valley, Diablo Canyon, Watts Bar, Perry, and Almaraz (Spain).

Curtiss-Wright point of contact: Rosalie Nava, 714-528-2301 ext 1872

See also EN 43071 dated 1/3/2007


Page Last Reviewed/Updated Thursday, July 11, 2019
Thursday, July 11, 2019