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Event Notification Report for March 04, 2020

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
3/3/2020 - 3/4/2020

** EVENT NUMBERS **


54438 54537 54540 54541 54542 54543 54544 54559 54560

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Power Reactor Event Number: 54438
Facility: SEQUOYAH
Region: 2     State: TN
Unit: [] [2] []
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: FRANCIS SCHULTE
HQ OPS Officer: JEFF HERRERA
Notification Date: 12/12/2019
Notification Time: 08:14 [ET]
Event Date: 12/12/2019
Event Time: 04:33 [EST]
Last Update Date: 03/03/2020
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):
BRIAN BONSER (R2DO)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
2 M/R Y 100 Power Operation 0 Hot Standby

Event Text



EN Revision Imported Date : 3/4/2020

EN Revision Text: MANUAL REACTOR TRIP DUE TO A LOSS OF HEATER DRAIN TANK PUMP FLOW

"At 0432 EST, on 12/12/19, Sequoyah Unit 2 experienced a manual reactor trip. The trip was initiated due to a loss all number 3 Feedwater Heater Drain Tank pump flow; plant procedures directed a manual reactor trip if power is greater than 80 percent.

"The Auxiliary Feedwater System (AFW) automatically actuated as required when the expected post trip feedwater isolation actuation actuated. Reactor Coolant System (RCS) temperature is being maintained by the steam dump system with all 4 Reactor Coolant Pumps (RCPs) in service.

"All control and shutdown rods fully inserted. All safety systems responded as designed. No primary or secondary safety valves actuated during or after the transient. Unit 2 is currently stable at normal operating temperature and normal operating pressure in Mode 3. The electrical system is in a normal alignment.

"There was no impact on U1. There was no impact to the health and safety of the public or plant personnel.

"Due to the Reactor Protection System (RPS) actuation while critical, this event is being reported as a four hour, non-emergency notification per 10CFR50.72(b)(2)(iv)(B) and an 8 hour non-emergency notification accordance with 10CFR50.72(b)(3)(iv)(A) as an event that results in a valid actuation of the AFW system."

The NRC Resident Inspector was notified.

* * * UPDATE ON 03/03/2020 AT 1320 FROM JAKE OLIVIER TO OSSY FONT * * *

"The following update to the EN submitted on 12/12/19 is being made to provide clarification on reporting criteria originally described in paragraph five of EN 54438:

"This event is being reported pursuant to 10 CFR 50.72(b)(2)(iv)(B) and 10 CFR 50.72(b)(3)(iv)(A)."

The NRC Resident Inspector was notified.

Notifed R2DO (Davis).

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Agreement State Event Number: 54537
Rep Org: GEORGIA RADIOACTIVE MATERIAL PGM
Licensee: GA PACIFIC - BRUNSWICK CELLUOSE LLC
Region: 1
City: BRUNSWICK   State: GA
County:
License #: GA 301-1
Agreement: Y
Docket:
NRC Notified By: IRENE BENNETT
HQ OPS Officer: RICHARD SMITH
Notification Date: 02/24/2020
Notification Time: 14:20 [ET]
Event Date: 04/03/2018
Event Time: 00:00 [EST]
Last Update Date: 02/24/2020
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MARC FERDAS (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

AGREEMENT STATE REPORT - STUCK OPEN SHUTTER

The following is a synopsis of a email from the state of Georgia:

On April 3, 2018, the Georgia Radioactive Material Program was informed that a fixed nuclear gauge on the number 4 Digester had a shutter stuck in the open position (normal operation mode). The shutter was made operable on the same day, that the report was made to the state of Georgia.

The gauge is a Kay Ray 7063-P and serial number 9132. The gauge contains 500 mCi of Cs-137. The gauge is in service with all radiation readings acceptable. There was no risk of exposure to employees or members of the public.

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Agreement State Event Number: 54540
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: BRAUN INTERTEC CORPATION
Region: 4
City: TYLER   State: TX
County:
License #: LL06681
Agreement: Y
Docket:
NRC Notified By: RANDALL REDD
HQ OPS Officer: RICHARD SMITH
Notification Date: 02/24/2020
Notification Time: 19:10 [ET]
Event Date: 02/24/2020
Event Time: 00:00 [CST]
Last Update Date: 02/24/2020
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JASON KOZAL (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB (EMAIL)
- CNSNS (MEXICO) (EMAIL)
This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

AGREEMENT STATE REPORT - STOLEN DENSITY GAUGE

The following is a synopsis of a event reported by the state of Texas via email and phone call:

On February 24, 2020, the Texas Department of State Health Services (Agency) was contacted by the Braun Intertec Corporation RSO to report a stolen moisture density gauge.

The gauge was last seen on February 19, 2020 at the end of work in McKinney Texas. It was locked in a box in the back of a truck which was then driven to Euless, Texas where it reported to stay until February 24, 2020. The truck was then driven to a jobsite in Richardson, TX on February 24, 2020 at which point the employee realized that the locks were gone and the moisture density gauge was removed from the box in the back of the truck.

Euless Police were notified.

The activity for the density gauge is estimated to be 10 mCi Cs-137 and 40 mCi of Am241/Be.

An investigation into this event is ongoing. More information will be provided when obtained in accordance with SA- 300.

Texas Incident number: 9746

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: 54541
Rep Org: GEORGIA RADIOACTIVE MATERIAL PGM
Licensee: HONEYWELL INTERNATIONAL
Region: 1
City: DULUTH   State: GA
County:
License #: GA 832-1
Agreement: Y
Docket:
NRC Notified By: ROGER WILSON
HQ OPS Officer: HOWIE CROUCH
Notification Date: 02/25/2020
Notification Time: 06:28 [ET]
Event Date: 12/18/2018
Event Time: 00:00 [EST]
Last Update Date: 02/25/2020
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MARC FERDAS (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - LEAKING PROMETHIUM-147 SOURCE

The following information was received from the state of Georgia via email:

"On December 11, 2018, [Honeywell International] tested a sealed source for leakage or contamination and received results on December 21, 2018. The result from [their] vendor [was] 0.0113 +/- 0.0002 microCuries. This result is above the limit of 0.005 microCuries.

"The capsule has been isolated and there [was] no loose contamination detected in [their] facility. [Honeywell] will contact the vendor and arrange to return the capsule after the new year."

The source capsule, Model PHC.C2, serial no. AE5051, was manufactured with 2 Ci of Pm-147. The capsule was returned to Eckert & Ziegler who received it on 3/4/2019.

The state of Georgia considers this matter closed.

NMED Incident # 190022

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Agreement State Event Number: 54542
Rep Org: PA BUREAU OF RADIATION PROTECTION
Licensee: RI-CORP DEVELOPMENT, INC
Region: 1
City: FRACKVILLE   State: PA
County:
License #: PA-G0466
Agreement: Y
Docket:
NRC Notified By: JOHN CHIPPO
HQ OPS Officer: BRIAN LIN
Notification Date: 02/25/2020
Notification Time: 13:49 [ET]
Event Date: 02/20/2020
Event Time: 00:00 [EST]
Last Update Date: 02/25/2020
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MARC FERDAS (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - GAUGE FAILURE

The following report was received via email from the Commonwealth of Pennsylvania:

"During an inspection on February 20, 2020, an above normal reading on a Cesium-137 level gauge source head was discovered. Radiation measurements ranged from approximately 15 to 45 millirem per hour at one foot from the back of the source holder cap. It should be noted this gauge is located 11.5 feet off the ground, in an area with no stationed personnel or foot traffic. The device is a Kayray Model 7062B level gauge (Serial No. 21462) containing 25 milliCuries of Cs-137. The licensee immediately removed the device from service, the area was secured to ensure background radiation levels, and the manufacturer was contacted to initiate either a repair or replacement of the gauge. The area will remain secured until the device is able to be put into service again."

PA incident number: PA200005

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Agreement State Event Number: 54543
Rep Org: ILLINOIS EMERGENCY MGMT. AGENCY
Licensee: ILLINOIS DEPARTMENT OF PUBLIC HEALTH
Region: 3
City: PEORIA   State: IL
County:
License #: IL-01474-01
Agreement: Y
Docket:
NRC Notified By: GIBB VINSON
HQ OPS Officer: BRIAN LIN
Notification Date: 02/25/2020
Notification Time: 17:27 [ET]
Event Date: 02/21/2020
Event Time: 00:00 [CST]
Last Update Date: 02/25/2020
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
STEVE ORTH (R3DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB (EMAIL)
This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

AGREEMENT STATE REPORT - STOLEN FLUORESCENCE ANALYZER EQUIPMENT

The following report was received from the state of Illinois via email:

"The Agency [Illinois Emergency Management Agency] was notified by the Radiation Safety Officer (RSO) of the Illinois Department of Public Health (IDPH) that an XRF [X-ray fluorescence] instrument was stolen the morning of 2/21/20 in Peoria, IL. The RSO was made aware of the theft at approximately 1030 [CST] today. The vehicle had been parked overnight in the driveway of an IDPH employee who works out of the Peoria field office (site #2 on IL license). The gauge was locked in the trunk, in addition to having a lock on the case itself. However, the vehicle had been left running while the user went back into their home to retrieve a laptop, and upon their return they realized the vehicle had been stolen. Peoria Police were notified and informed of the instrument and radiation source in the trunk. The XRF is model XLP303A, serial number 14472; and the source serial number is TR2743. The IDPH will keep the Agency updated if they receive any additional information related to the vehicle or XRF instrument. The theft appears to be incidental to the theft of a vehicle and not an intentional diversion of radioactive material. The sources contained within these devices are IAEA category 5, meaning no one could be permanently injured and the amount of radioactive material, even if dispersed, could not permanently injure anyone."

Illinois report no.: IL200006



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: 54544
Rep Org: FLORIDA BUREAU OF RADIATION CONTROL
Licensee: CLEVELAND CLINIC FLORIDA
Region: 1
City: WESTON   State: FL
County:
License #: 3748-2
Agreement: Y
Docket:
NRC Notified By: MATTHEW SENISON
HQ OPS Officer: BETHANY CECERE
Notification Date: 02/25/2020
Notification Time: 18:03 [ET]
Event Date: 02/24/2020
Event Time: 13:15 [EST]
Last Update Date: 02/25/2020
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MARC FERDAS (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - PATIENT UNDERDOSE

The following was received from the state of Florida via email:

"On 24 Feb. 2020, at 1315 EST, an underdose of radiation to a patient receiving skin therapy occurred. The patient was scheduled to receive five fractions, at 7.5 grays per fraction, on five different parts of the left hand per fraction. On the first dose of the first fraction, it was observed that catheter numbers 1 - 15 were reversed, causing an underdose to the patient. No Authorized Users were exposed to the source or otherwise contaminated. The licensee has agreed to submit further information on 26 Feb 2020. Since the cause of this incident is machine generated, in accordance with BRC [State of Florida Bureau of Radiation Control] procedures, it is not being given an incident number, and is being forwarded to ERCX [the X-Ray Machine Section of the BRC]."

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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Power Reactor Event Number: 54559
Facility: BROWNS FERRY
Region: 2     State: AL
Unit: [] [] [3]
RX Type: [1] GE-4,[2] GE-4,[3] GE-4
NRC Notified By: MATTHEW SLOUKA
HQ OPS Officer: ANDREW WAUGH
Notification Date: 03/03/2020
Notification Time: 12:18 [ET]
Event Date: 03/03/2020
Event Time: 04:16 [CST]
Last Update Date: 03/03/2020
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
BRADLEY DAVIS (R2DO)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
3 N N 0 Refueling 0 Refueling

Event Text

EMERGENCY DIESEL GENERATOR ACTUATION

"At 0416 CST on March 3, 2020, with Browns Ferry Unit 3 in Mode 5, there was a partial loss of 161kV power due to a trip and re-closure of the feeder breaker supplying the Common Station Service Transformer (CSST) A. Unit 3 lost power to the 1A Start Bus and the 3A Unit Board, which supplies power to the 3EA and 3EB 4kV Shutdown Boards. The loss of the 4kV Shutdown Boards resulted in an auto actuation of the 3A and 3B Emergency Diesel Generators (EDG). The 3C EDG and 3EC 4kV Shutdown Board were removed from service for maintenance at the time of the loss of power, and the 3ED 4kV Shutdown Board continued to be powered from the 3B Unit Board.

"All systems responded as expected for the loss of power.

"This event requires an 8 hour report per 10 CFR 50.72(b)(3)(iv)(A).

"There was no impact to the health and safety of the public or plant personnel. The NRC Resident Inspector has been notified."

The partial loss of power was caused by a storm in the area. Offsite power has been restored to the CSST and the EDGs have been secured.

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Power Reactor Event Number: 54560
Facility: PALO VERDE
Region: 4     State: AZ
Unit: [] [2] []
RX Type: [1] CE,[2] CE,[3] CE
NRC Notified By: ANTON PESTKA
HQ OPS Officer: JEFFREY WHITED
Notification Date: 03/04/2020
Notification Time: 02:07 [ET]
Event Date: 03/03/2020
Event Time: 20:50 [MST]
Last Update Date: 03/04/2020
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):
RICK DEESE (R4DO)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
2 A/R Y 100 Power Operation 0 Hot Standby

Event Text

REACTOR TRIP DUE TO LOW STEAM GENERATOR LEVEL

"At 2050 MST on March 3, 2020, Unit 2 reactor automatically tripped on Low Steam Generator (SG) Number 1 level signal from the Reactor Protection System. The low SG level occurred as the result of a trip of both Main Feedwater Pumps, which tripped during restoration of power to the Main Feedwater Pump Lube oil control panel. Auxiliary Feedwater (AFAS-1 and AFAS-2) actuated due to low SG levels in both SG post reactor trip as designed. This event is being reported as a reactor protection system and a specified system actuation in accordance with the reporting criteria of 10 CFR 50.72(b)(2)(iv)(B) and 10 CFR 50.72(b)(3)(iv)(A).

"Following the reactor trip, all [control element assemblies] CEAs inserted fully into the core. All systems operated as expected. No emergency plan classification was required per the Emergency Plan. Safety related busses remained powered during the event from offsite power and the offsite power grid is stable. Unit 2 is stable and in Mode 3. Steam Generators are being fed via the class 1 E powered motor driven auxiliary feedwater pump.

"The NRC Senior Resident Inspector has been informed."

Units 1 and 3 were unaffected by the trip and remain at 100 percent power.


Page Last Reviewed/Updated Wednesday, March 04, 2020
Wednesday, March 04, 2020