Event Notification Report for March 08, 2022

U.S. Nuclear Regulatory Commission
Operations Center

EVENT REPORTS FOR
03/07/2022 - 03/08/2022

EVENT NUMBERS
55759 55760 55761 55769 55770
Agreement State
Event Number: 55759
Rep Org: Texas Dept of State Health Services
Licensee: Pasadena Refining System Inc
Region: 4
City: Pasadena   State: TX
County:
License #: L 01344
Agreement: Y
Docket:
NRC Notified By: Art Tucker
HQ OPS Officer: Mike Stafford
Notification Date: 03/01/2022
Notification Time: 10:17 [ET]
Event Date: 02/28/2022
Event Time: 00:00 [CST]
Last Update Date: 03/01/2022
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
Person (Organization):
Agrawal, Ami (R4)
NMSS_Events_Notification, (EMAIL)
Event Text
EN Revision Imported Date: 3/8/2022

EN Revision Text: AGREEMENT STATE REPORT - GAUGE SHUTTER STUCK CLOSED

The following information was provided by the Texas Department of State Health Services (the Agency) via email:

"March 1, 2022, the Agency was notified by the licensee's radiation safety officer (RSO) that the shutter on a Vega model SHLD-1 gauge was stuck in the closed position. The gauge contains a 100 millicurie (original activity) cesium - 137 source. The gauge was tested while it was on the side of a vessel and functioned normally. The gauge was removed from the vessel and during that process the shutter was damaged and will no longer open. The gauge has been placed in storage. The manufacturer was contacted, and repair parts have been ordered. The RSO stated no individual received any additional exposure due to the event. Additional information will be provided as it is received in accordance with SA-300."

Texas Incident #: I-9919


Non-Agreement State
Event Number: 55760
Rep Org: Atlas ATC
Licensee: Atlas ATC
Region: 1
City: East Hartford   State: CT
County:
License #: 2618254
Agreement: N
Docket:
NRC Notified By: Doug Rhoads
HQ OPS Officer: Bethany Cecere
Notification Date: 03/01/2022
Notification Time: 15:09 [ET]
Event Date: 02/02/2022
Event Time: 00:00 [EST]
Last Update Date: 03/01/2022
Emergency Class: Non Emergency
10 CFR Section:
20.2201(a)(1)(ii) - Lost/Stolen LNM>10x
Person (Organization):
Lilliendahl, Jon (R1)
ILTAB, (EMAIL)
NMSS_Events_Notification, (EMAIL)
Event Text
EN Revision Imported Date: 3/8/2022

EN Revision Text: LOST X-RAY FLUORESCENCE INSTRUMENT

The following information is a summary of information provided by the licensee ("the Company") via email:

An x-ray fluorescence instrument (XRF) went missing while in the possession of a licensed Atlas ATC employee. The employee used the XRF in the course and scope of their duties on January 31, 2022. Following completion of their last assignment of the day, which was a lead inspection in New Haven, CT, the employee left the jobsite and went home where they kept the XRF overnight, secured in its case inside of their residence. The following morning on February 1, 2022, the employee packed the secured XRF with other equipment and materials they used for work into the trunk of their car. While traveling to the East Hartford, CT office, the employee had a flat tire. The employee's direct supervisor came to provide assistance and gave him shelter alongside the highway for approximately 60 minutes until a tow truck arrived. The employee accompanied the tow truck for tire repair. The XRF remained in the trunk of the vehicle. After arriving at the service station, the employee took the XRF out of the trunk and secured it in the back seat of the vehicle, where it remained the entire time that the vehicle was being serviced. The employee left the service center at approximately 1100 EST and drove to the East Hartford, CT office where the vehicle was parked for approximately 45 to 50 minutes. At approximately 1200 EST, the employee left the office to complete a job in Springfield, MA. That job did not require the use of the XRF. The employee arrived at the Springfield, MA project site around 1255 EST and parked approximately 1,000 feet from the actual work site address, which was in a residential neighborhood. The employee completed that job at approximately 1500 EST. After leaving the project site, the employee stopped at a gas station before arriving at the Company's West Springfield, MA office at 1400 EST. After leaving the office, the employee stopped at two restaurants (one in Springfield, MA and then one in East Windsor, CT). The employee then traveled back to the East Hartford, CT office. When they went to unload their equipment, they then noticed that the XRF was not in the back seat of the vehicle. The employee checked the entire vehicle for the XRF, but it could not be located.

The Company's internal investigation has determined that the XRF was stolen out of the vehicle. There is video surveillance that confirms that the secured XRF was in the back seat of the vehicle when the employee left the service station, and the employee did not remove the XRF from the vehicle thereafter. There is no evidence that the employee willfully failed to maintain control of licensed material that was not in storage, either. Based on the investigation, the XRF was stolen somewhere between the employee's stop at the East Hartford, CT office and the time they left the restaurant in East Windsor, CT, which was around 1945 EST.

The employee notified the East Hartford, CT office's Radiation Safety Officer (RSO), Branch Manager and Building Sciences Supervisor via text around 2120 EST. Extensive efforts on the part of the employee and licensee to locate the instrument were futile. The East Hartford, CT and Springfield, MA Police Departments were notified of the lost/stolen XRF.

In furtherance of recovery efforts, the Company quickly put the appropriate regulatory authorities on notice that the XRF was missing. Immediately after the loss became known the next morning (February 2nd), the RSO contacted the CT Department of Energy and Environmental Protection Radiation Group to report that the licensed device was lost or stolen; they subsequently called the Massachusetts Department of Public Health Radiation Group as the XRF may have traveled to, but was not used in, Massachusetts.

The RSO also called Protec (the company from where the XRF was originally purchased) as Protec's phone number is printed inside of the XRF case in the case of an emergency. The RSO felt that this notification was a necessary step to take, and in the event that the XRF is found and Protec is called, the Company will be notified immediately.

After investigative efforts were unsuccessful in recovering the XRF, formal police reports were filed on February 4, 2022 with the Police Departments in East Hartford, CT (Case #2200003902) and Springfield, MA (Incident #22-1419-OF) regarding the theft. These cases are still open and the investigations are ongoing.

The instrument is a Protec LPA-1 x-ray fluorescence instrument, serial number: 1331, 12 mCi Co-57 source s/n NA515.

This event was also reported by the Commonwealth of Massachusetts as EN 55724.


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


Agreement State
Event Number: 55761
Rep Org: Utah Department of Environmental Quality
Licensee: IHC Health Services Inc. dba Intermountain Medical Center
Region: 4
City: Murray   State: UT
County:
License #: UT 1800494
Agreement: Y
Docket:
NRC Notified By: Gwyn Galloway
HQ OPS Officer: Bethany Cecere
Notification Date: 03/01/2022
Notification Time: 18:45 [ET]
Event Date: 03/01/2022
Event Time: 15:15 [MST]
Last Update Date: 03/01/2022
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
Person (Organization):
Agrawal, Ami (R4)
NMSS_Events_Notification, (EMAIL)
Event Text
EN Revision Imported Date: 3/8/2022

EN Revision Text: AGREEMENT STATE REPORT - Rb-82 GENERATOR FAILURE

The following information was provided by the Utah Department of Environmental Quality, Division of Waste Management and Radiation Control (the "Division") by email:

"The Division was notified at about 1515 MST, March 1, 2022, that a Bracco Rb-82 generator was not functioning as designed. The [Radiation Safety Officer (RSO)] was notified at 1353 MST by nuclear medicine personnel that a new Rb-82 Generator was received on Sunday, February 27, 2022. When the licensee pulled the first eluate and did the required QA [quality assurance review], the generator failed the tests. The nuclear medicine personnel tried to perform the QA again and the generator failed a second attempt. The manufacturer was contacted and the licensee's personnel worked all day on Monday, February 28, 2022 to try and determine what the issue was. No patients were treated using the generator. It was finally determined that the undercarriage of the generator was leaking, although all of the leakage was contained within the generator case."

Utah Event Report ID No.: UT220001


Power Reactor
Event Number: 55769
Facility: Byron
Region: 3     State: IL
Unit: [1] [2] []
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: Brandon Perlov
HQ OPS Officer: Thomas Kendzia
Notification Date: 03/06/2022
Notification Time: 00:55 [ET]
Event Date: 03/05/2022
Event Time: 21:15 [CST]
Last Update Date: 03/06/2022
Emergency Class: Non Emergency
10 CFR Section:
50.72(b)(3)(xiii) - Loss Comm/Asmt/Response
Person (Organization):
Feliz-Adorno, Nestor (R3)
Power Reactor Unit Info
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
EN Revision Imported Date: 3/8/2022

EN Revision Text: DEGRADATION OF TECHNICAL SUPPORT CENTER

The following information was provided by the licensee:

"At 2115 CST on March 5, 2022 Byron Station Technical Support Center (TSC) emergency ventilation system supply fan belt failed. This failure affected the ability of the TSC ventilation system to maintain adequate radiological habitability in the event of an emergency with an airborne radiological release. All other capabilities of the TSC are unaffected by this condition. If an emergency was declared requiring TSC activation during this period, the TSC would be staffed and activated using existing emergency planning procedures. If the TSC becomes uninhabitable, the Station Emergency Director would relocate the TSC staff to an alternate TSC location in accordance with applicable procedures.

"This event is reportable in accordance with 10 CFR 50.72(b)(3)(xiii) because the discovered condition affected the functionality of an emergency response facility.

"The licensee notified the NRC resident inspector."


Fuel Cycle Facility
Event Number: 55770
Facility: Louisiana Energy Services
RX Type:
Comments: Uranium Enrichment Facility
Gas Centrifuge Facility
Region: 2
City: Eunice   State: NM
County: Lea
License #: SNM-2010
Docket: 70-3103
NRC Notified By: Barry Love
HQ OPS Officer: Kerby Scales
Notification Date: 03/07/2022
Notification Time: 13:44 [ET]
Event Date: 03/07/2022
Event Time: 10:45 [MST]
Last Update Date: 03/07/2022
Emergency Class: Non Emergency
10 CFR Section:
PART 70 APP A (a)(4) - All Safety Items Unavailable
Person (Organization):
NMSS_EVENTS_NOTIFICATION (EMAIL)
Miller, Mark (R2DO)
Event Text
ITEM RELIED ON FOR SAFETY (IROFS) INOPERABLE

The following information was provided by the licensee via email:

"The plant is in a safe configuration. Three construction vehicles, a front end loader, road grader and roller, were allowed within the Controlled Access Area [CAA] boundary without IROFS50b and IROFS50c being declared Operable.

"The Administrative Control IROFS require physical barriers to be placed around the building of concern. Barriers had been placed but the IROFS had not been declared Operable by a Shift Manager.

"The construction vehicles were removed from the CAA and UUSA [Urenco USA] is conservatively reporting this event as a 1-hour Report. This event has been entered in UUSA's corrective action program as EV 149740 and a causal investigation will be performed."

The licensee will notify NRC Region 2.

Page Last Reviewed/Updated Tuesday, March 08, 2022