Event Notification Report for December 12, 2022

EN Revision Imported Date: 12/12/2022

EN Revision Text: HIGH PRESSURE COOLANT INJECTION SYSTEM INOPERABLE

The following information was provided by the licensee via email:

"At 0400 EST on November 28, 2022, during the performance of Division 2 Residual Heat Removal (RHR) cooling tower fan operability and RHR Service Water valve lineup verification, it was reported that the Mechanical Draft Cooling Tower (MDCT) Fan 'B' was making a loud metallic noise. The cause of the metallic noise is unknown at this time. The MDCT fans are required to support operability of the Ultimate Heat Sink (UHS). The UHS is required to support operability of the Division 2 Emergency Equipment Cooling Water (EECW) system. The EECW system cools various safety related components including the High Pressure Coolant Injection (HPCI) system room cooler. An unplanned HPCI inoperability occurred based on inoperable cooling water to the HPCI room cooler, per LCO 3.0.6.

"Investigation into the Division 2 MDCT Fan 'B' abnormal noise is in progress.

"This report is being made pursuant to 10 CFR 50.72(b)(3)(v)(D) based on an unplanned HPCI inoperability.

"The NRC Resident Inspector has been notified."

* * * RETRACTION FROM JEFF MYERS TO LLOYD DESOTELL AT 1615 EST ON 12/09/2022 * * *

The following information was provided by the licensee via email:

"The purpose of this notification is to retract a previous Event Notification 56241 reported on 11/28/2022. On 11/28/22, an event notification to the NRC was made when mechanical draft cooling tower (MDCT) Fan B was declared inoperable and issued Limited Condition of Operation (LCO) 2022-0428 for Division 2 MDCT Fan B abnormal noise. The MDCT fans are required to support operability of the Ultimate Heat Sink (UHS) (Technical Specification [TS] 3.7.2). The UHS is required to support operability of the Division 2 Emergency Equipment Cooling Water (EECW) system (TS 3.7.2), which cools various safety related components, including the High-Pressure Coolant Injection (HPCI) system room cooler (TS LCO 3.0.6).

"Subsequent inspection and evaluation determined that the brake noise is expected while fans are running at low speeds. This is supported by plant technical procedure, 24.205.10 `Div. 2 RHR Cooling Tower Fan Operability and RHRSW Valve Line-up Verification' (line item 2.2 in Precautions and Limitations) which states `Chatter from the brakes of the MDCT Fans is expected and no cause for discontinuing the test.' The equipment vendor stated that brake chatter is possible and common given that the internal components are free to move along the splined connections. Internal Operating Experience from experienced station operators and maintenance technicians confirmed that the condition is normal and expected. Both Division 2 MDCTs exhibited the same behavior at low speed and passed surveillance testing satisfactorily.

"No other concerns were noted during fan operation. Therefore, HPCI remained operable and there was no loss of safety function. The event did not involve a condition that could have prevented the fulfillment of the safety function of structures or systems that are needed to mitigate the consequences of an accident under 10 CFR 50.72(b)(3)(v)(D).

"EN 56241 is retracted and no Licensee Event Report under 10 CFR 50.73(a)(2)(v)(D) is required to be submitted."

The NRC Resident Inspector has been notified.

Notified R3DO (Stoedter).

AGREEMENT STATE REPORT - PATIENT UNDERDOSE

The following information was provided by the North Carolina Division of Radiation Protection via email:

"The state of North Carolina Radioactive Materials Branch received a report at 1050 EST on December 2, 2022, from Duke University Medical Center (license number: 032-0247-4) of a possible medical event involving a patient receiving Yttrium-90 therapy for treatment of a liver tumor. The treatment had an intended dosage of 91.6 mCi with a delivered dosage of 54.6 mCi resulting in a 40 percent under dosing that did not appear to involve stasis. The patient and the patient's representative were notified at the time of the treatment and the referring physician was notified the morning of December 2, 2022. The licensee is currently investigating the root cause but initially believes it to be caused by equipment failure. The State is currently investigating and will provide more information as it becomes available."

NC Incident No.: NC220015

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.

AGREEMENT STATE REPORT - LOST GAUGE

The following information was provided by the Georgia Radioactive Material Program via email:

"[The] gauge was placed on the tailgate of a truck by a technician at the Eastman Airport and not secured in the box. It fell out within 4 miles of last use in the city limits of Eastman, Dodge County. The licensee will be contacted for more detailed information. The Georgia Radioactive Material Program will update this report as more information comes in. "

Georgia Incident No.: 62


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 REPORT - RADIOGRAPHY CAMERA MALFUNCTION

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

"On December 5, 2022, the licensee reported that an equipment malfunction occurred with a Source Production & Equipment Company, Inc. (SPEC) 150 Radiography Camera, serial number 1524, containing 66 curies of Iridium-192. They were testing the camera in the office because the technician reported it started to hang up several times when retrieving the source and disconnecting the crank cables. The camera was tested and the source was retrieved but they were unable to disconnect the crank cables. They had to cut the locking device, remove the cables, and install a plug. The camera and cables are being transported to a service company for inspection and repair. No additional radiation exposure occurred from the incident. SPEC source serial number DI2710. Additional information will be provided in accordance with SA 300."

Texas Incident No.: I - 9969

EN Revision Imported Date: 12/9/2022

EN Revision Text: UNUSUAL EVENT DUE TO EXCESSIVE REACTOR COOLANT SYSTEM LEAKAGE

At 1402 EST Turkey Point Unit 3, while operating at 100 percent, declared an Unusual Event due to unidentified leakage greater than 10 gallons per minute for more than 15 minutes. The abnormal procedure for Reactor Coolant System leakage was entered. The plant remains at 100 percent power. The cause of the leakage is under investigation.

At 1446 EST it was verified that the leak had been isolated. The plant remains at 100 percent power.

Unit 4 was unaffected.

State and local authorities were notified by the licensee.

The NRC Resident Inspector has been notified.

Notified DHS SWO, FEMA Operations Center, CISA Central, FEMA NWC (email), DHS NRCC THD Dest (email), and DHS Nuclear SSA (email).


* * * UPDATE ON 12/08/22 AT 1621 (EST) FROM SZEMEI CHOI TO THOMAS HERRITY * * *

Turkey Point Unit 3 has isolated the leak. The Unusual Event was terminated at 1558 EST.

The NRC Resident Inspector has been notified.

Notified R2DO (Miller), NRR EO (Miller), and IR MOC (Crouch). Notified DHS SWO, FEMA Operations Center, CISA Central, FEMA NWC (email), DHS NRCC THD Dest (email), and DHS Nuclear SSA (email).

OFFSITE AGENCY NOTIFICATION DUE TO CHEMICAL LEAK

The following information was provided by the licensee via email:

"On 12/8/2022, Prairie Island Nuclear Generating Plant initiated a notification to the State of Minnesota due to a HVAC coolant leak reaching waters of the state. The estimated quantity is 5 gallons of NALCO LCS-60. The leak was due to a failed heat exchanger coil and has been isolated. This notification is being made solely as a four-hour, non-emergency notification for a Notification of Other Government Agency. This event is reportable in accordance with 10 CFR 50.72(b)(2)(xi). There was no impact on the health and safety of the public or plant personnel. The NRC Resident Inspector has been notified."

TECHNICAL SPECIFICATION VIOLATION

The following information was provided by the licensee via email:

"On December 6th, 2022, University of Utah Training Reactor (UUTR) was in the process of performing a research sample irradiation. The sample was known to have a negative reactivity worth and was therefore placed in the reactor prior to reactor startup. Upon commencing reactor startup procedures, the reactor operator subsequently terminated the startup attempt after noting that the sample appeared to demonstrate a larger negative reactivity worth than what was initially anticipated. After investigating, we identified that there was an inconsistency/miscommunication regarding the sample materials specifications, and the actual negative sample reactivity worth was a larger negative value than that of the original estimate. Immediately afterwards, we performed an updated materials assessment of the sample, which, following reactor calculations, revealed that the sample indeed demonstrated a larger negativity reactivity worth than was originally predicted. As a result, this report is being submitted in accordance with UUTR Technical Specification (TS) 6.7.2 due to 'observed inadequacy in the implementation of administrative or procedural controls such that the inadequacy could have caused the existence or development of an unsafe condition with regard to reactor operation.'

"In accordance with UUTR TS, the reactor was secured, and Utah Nuclear Engineering Program Director notified, and operations shall not resume unless authorized by the Director."

The NRC Project manager was notified.

EN Revision Imported Date: 12/13/2022

EN Revision Text: AGREEMENT STATE REPORT - DAMAGED TROXLER GAUGE

The following information was provided by the South Carolina Department of Health and Environmental Control (The Department) via email:

"The Department was notified on 11/18/22 at 1243 EST via telephone that a Troxler 3400 series portable moisture density gauge, serial number 33556, had been hit by a piece of construction equipment.

"The Troxler 3400 series portable moisture density gauge contains a maximum activity of 9 millicuries of Cs-137 and 44 millicuries of Am-241:Be. The licensee reported the source rod had been dislodged but had been successfully inserted back into the shielded position. A Department inspector was dispatched to the location on 11/18/22 and assisted the licensee in packing the damaged Troxler 3400 series device into the transport container. Dose rate readings using a ND-2000A survey instrument, calibrated 09/16/22 indicated readings as high as 30 mR/hr on the surface of the transport container and less than 1 mR/hr at 1 meter.

"The Troxler 3400 series moisture density gauge was transported and secured at the licensee's storage location and is awaiting shipment back to the manufacturer. This event is still under investigation by the South Carolina Department of Health and Environmental Control."

* * * UPDATE ON 12/12/2022 AT 1052 EST FROM ADAM GAUSE TO BRIAN LIN * * *

The following information was provided by the South Carolina Department of Health and Environmental Control (The Department) via email:

"The licensee submitted a written report, dated 11/28/22, outlining the event details and findings. The licensee did not indicate overexposure to any individuals. Records indicate the damaged gauge was not leaking and that the gauge/sources have been transferred to the manufacturer for disposal. This event is considered closed."

Notified R1DO (Henrion) and NMSS Events Notification email group.

AGREEMENT STATE REPORT - LOST EXIT SIGNS

The following information was provided by the Colorado Department of Public Health and Environment via email:

The licensee discovered twelve tritium exit signs were lost. The exit signs are SRB Technologies Model BR20BK containing 20 Ci of tritium (H-3) each. This is being reported under Colorado Regulations Section 4.51.1.1 (10 CFR 20.2202(a)(1)(i)).

Colorado Incident No.: CO220043

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

DAMAGED RADIOGRAPHIC CAMERA

The following information was provided by the licensee via email:

"At 0200 YST on December 06, 2022, the radiation safety supervisor (RSS) received a call that the technicians had a source which refused to retract to the safe and secured position. During the exposure, the camera fell approximately 4 feet to the ground and landed on the guide tube, which then didn't allow the source to be returned to a shielded position. The radiographers on site followed their procedure and secured their boundaries and notified the RSS. Two RSSs arrived on site at 0245 YST and were able to safely return the source back to locked position. At 1000 YST, a third RSS arrived on location to assist in retrieval.

"The source that required retrieval was IR-192 at 80.6 curies in a Type B container/special form."

PART 21 - INADEQUATE TORQUE VALUES

The following information was provided by the licensee via email:

"On October 13, 2022, during Refueling Outage 25, 2 bolts and 2 washers were discovered in the strainer basket upstream of the main steam stop valve in the steam line from the 'A' steam generator. It was determined that these bolts and washers were from the main steam isolation valve (MSIV) upstream of the stop valve. One bolt and one washer were also determined to be missing from the MSIV on the line from the 'B' steam generator. The MSIVs are a similar design as the Main Feedwater Isolation Valves (MFIVs). It appears that the torque values for these backseat bolts provided by the vendor weren't sufficient to prevent the bolts from coming loose. Wolf Creek Nuclear Operating Corporation personnel evaluated the condition and determined that the inadequate torque values provided by the vendor could have constituted a substantial safety hazard if left uncorrected. In particular, if bolts had come loose from the MFIVs, they could have traveled downstream to the steam generators and then challenged the integrity of steam generator tubes.

"The NRC Senior Resident Inspector has been notified.

"This is a non-emergency notification required by 10 CFR 21.21(d)(3)(i).

"A written notification will be provided within 30 days."