Event Notification Report for March 15, 2023

U.S. Nuclear Regulatory Commission
Operations Center

EVENT REPORTS FOR
03/14/2023 - 03/15/2023

EVENT NUMBERS
56392 56393 56394 56395 56409 56410
Agreement State
Event Number: 56392
Rep Org: Texas Dept of State Health Services
Licensee: Exxon Mobil Corp
Region: 4
City: Mont Belvieu   State: TX
County:
License #: L03119
Agreement: Y
Docket:
NRC Notified By: Art Tucker
HQ OPS Officer: Thomas Herrity
Notification Date: 03/07/2023
Notification Time: 17:21 [ET]
Event Date: 03/07/2023
Event Time: 00:00 [CST]
Last Update Date: 03/08/2023
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
Person (Organization):
Gepford, Heather (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
Event Text
AGREEMENT STATE REPORT - STUCK SHUTTER

The following was received from the Texas Department of State Health Services (the Agency) via email:

"On March 7, 2023, the Agency was notified by the licensee that the shutter on a Vega SH-F2 nuclear gauge had failed in the open position during routine testing. The gauge contains a 300 millicurie (original activity) Cs-137 source. Open is the normal operating position for the gauge. The licensee has contacted the manufacturer for repairs to the gauge. The licensee stated the gauge does not create an exposure risk to any individual as the gauge is located 300 feet in the air on the side of a vessel. Additional information will be provided as it is received in accordance with SA-300."

Texas event report number: 56392

* * * UPDATE ON 3/8/23 AT 1341 EST FROM THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES TO JOHN RUSSELL VIA EMAIL * * *

"On March 8, 2023, the Agency was notified by the licensee that while performing routine shutter inspections a second gauge shutter was found in the stuck open position. The gauge is a Vega model SHF2C gauge containing a 500 millicurie (original activity) cesium-137 source. Open is the normal operation position for the gauge shutter. The licensee has contacted the manufacturer for repairs. The gauge does not create an exposure risk to any personnel. Additional information will be provided as it is received in accordance with SA-300."

Notified R4DO (Heather Gepford), NMSS Events Notification.


Agreement State
Event Number: 56393
Rep Org: Wisconsin Radiation Protection
Licensee: Meriter Hospital, Inc.
Region: 3
City: Madison   State: WI
County:
License #: 025-1179-01
Agreement: Y
Docket:
NRC Notified By: Micheal Costello
HQ OPS Officer: Thomas Herrity
Notification Date: 03/07/2023
Notification Time: 17:41 [ET]
Event Date: 02/02/2023
Event Time: 00:00 [CST]
Last Update Date: 03/07/2023
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
Person (Organization):
Ruiz, Robert (R3DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
MacDonald, Mark (ILTAB)
CNSC (Canada), - (FAX)
Event Text
AGREEMENT STATE REPORT - LOST SOURCE

The following information was received from the Wisconsin Department of Health Services (the Department) via email:

"On February 7, 2023, the Department was notified by phone call from a physics consultant for the licensee that a package containing radioactive material being shipped by a common carrier from Wisconsin to Burbank, California on December 24, 2022, did not arrive at its destination. The package contained an Eckert & Ziegler Model HEGL-0133 sealed line source (s/n T1-924). The source contained 10 millicuries of Gd-153 on manufacturer's assay date of October 1, 2020. The licensee calculated the activity at the time of shipment to be 0.972 millicuries on December 24, 2022. The courier was contacted by the licensee on February 2, 2023, and the courier's last record for the package shows it located in Memphis, TN on December 24, 2022. The current location of the package is unknown. A lost shipment claim has been made with the courier."

Event Report ID Number: WI230002



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: 56394
Rep Org: California Radiation Control Prgm
Licensee: Krazan and Associates, Inc.
Region: 4
City: Lancaster   State: CA
County:
License #: 8277-19
Agreement: Y
Docket:
NRC Notified By: Donald Oesterle
HQ OPS Officer: Thomas Herrity
Notification Date: 03/07/2023
Notification Time: 18:36 [ET]
Event Date: 03/07/2023
Event Time: 00:00 [PST]
Last Update Date: 03/07/2023
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
Person (Organization):
Gepford, Heather (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
MacDonald, Mark (ILTAB)
CNSNS (Mexico), - (EMAIL)
Event Text
AGREEMENT STATE REPORT - THEFT OF MOISTURE DENSITY GAUGE

The following was received from the California Department of Public Health, Radiologic Health Branch via email:

"On Tuesday, March 7, 2023, the Krazan and Associates, Inc. Radiation Safety Officer (RSO) reported the theft of a moisture density gauge, CPN MC-3 (M351208119) containing sealed sources of Cs-137 (10 mCi) and Am-241:Be (50 mCi), Cal OES control number: 23-1630. The theft occurred overnight between Monday and Tuesday, March 6-7, 2023, at the office's equipment storage container located within their fenced in property. The RSO stated that the thief cut a hole in the back fence that borders an open dirt area behind their lot and then cut the lock off of the storage container and opened the doors. This theft was reviewed on security camera footage. They had several gauges in the storage container and other construction equipment, but only this one gauge was stolen. The other equipment was assumed to be too heavy for the thief. The CPN nuclear gauge handle was locked to prevent operation. The gauge was locked in its transport case, and the company had contact information on the gauge and case. Lancaster police were notified. An investigation will be conducted, and a report will be provided when available. The licensee was advised to submit a reward ad in the local paper to aid in the recovery effort. Further information will be provided as it becomes available."

California Event Number: 030723

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


Non-Agreement State
Event Number: 56395
Rep Org: Ascension Providence Rochester Hospital
Licensee: Ascension Providence Rochester Hospital
Region: 3
City: Rochester   State: MI
County:
License #: 21-13562-01
Agreement: N
Docket:
NRC Notified By: Michelle Kritzman
HQ OPS Officer: Thomas Herrity
Notification Date: 03/08/2023
Notification Time: 12:14 [ET]
Event Date: 03/07/2023
Event Time: 00:00 [EST]
Last Update Date: 03/10/2023
Emergency Class: Non Emergency
10 CFR Section:
20.2201(a)(1)(i) - Lost/Stolen LNM>1000x
Person (Organization):
Ruiz, Robert (R3DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
MacDonald, Mark (ILTAB)
CNSC (Canada), - (FAX)
Event Text
LOST SOURCE

The following is a synopsis of information provided by the licensee via phone call:

A vendor was contracted to remove and dispose of outdated medical equipment. The licensee understood that the sources, 114 millicuries total of Gadolinium-153, had been removed from the equipment prior to its removal from the hospital on March 7, 2023. Upon realizing the sources had not been removed, the licensee contacted the vendor. The truck containing the removed equipment was located in Ohio. It is parked and secured in a warehouse. Arrangements were made to maintain a conservative exclusion zone. There is no indication that the sealed sources are damaged. It is believed the sources are safe and locked in the retracted position, but that has not been confirmed. Surface measurements on a similar unit at the licensee show 0.7 mR/hr at the surface.

The licensee has made arrangements for the truck to remain at its current location until the sources are retrieved. The retrieval is planned for March 9, 2023.

* * * UPDATE ON 03/10/2022 AT 1512 EST FROM THE MICHELLE KRITZMAN TO IAN HOWARD * * *

The following is a synopsis of information provided by the licensee via phone call:

At 1505 EST on 3/10/2023, the licensee received a notification that the sources were retrieved. The sources were in a safe and locked position and there was no indication of tampering with the sources. There was no additional exposure to the public or employees.

Notified: R3DO (Ruiz). Notified via email: NMSS Event Notification, ILTAB, and Canada.

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


Power Reactor
Event Number: 56409
Facility: Susquehanna
Region: 1     State: PA
Unit: [2] [] []
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: John Teck
HQ OPS Officer: Bill Gott
Notification Date: 03/14/2023
Notification Time: 15:52 [ET]
Event Date: 03/14/2023
Event Time: 10:00 [EDT]
Last Update Date: 03/14/2023
Emergency Class: Non Emergency
10 CFR Section:
50.72(b)(3)(v)(D) - Accident Mitigation
Person (Organization):
Bickett, Brice (R1DO)
Power Reactor Unit Info
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N Y 85 Power Operation 85 Power Operation
Event Text
HIGH PRESSURE CORE INJECTION INOPERABLE

The following information was provided by the licensee via email:

"At 1000 EDT on March 14, 2023, during valve diagnostic testing, the high pressure core injection (HPCI) lube oil cooling water supply isolation valve did not stroke open. This failure resulted in the Unit 2 HPCI system being inoperable.

"This is being reported as a loss of an entire safety function condition in accordance with 10CFR50.72(b)(3)(v)(D)."

The licensee notified the NRC Resident Inspector.


Power Reactor
Event Number: 56410
Facility: Yankee Rowe
Region: 1     State: MA
Unit: [] [] []
RX Type: Unit 1
NRC Notified By: Ian Lemay
HQ OPS Officer: Bill Gott
Notification Date: 03/14/2023
Notification Time: 22:50 [ET]
Event Date: 03/14/2023
Event Time: 20:00 [EDT]
Last Update Date: 03/14/2023
Emergency Class: Non Emergency
10 CFR Section:
50.72(b)(3)(xiii) - Loss Comm/Asmt/Response
Person (Organization):
Bickett, Brice (R1DO)
Power Reactor Unit Info
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
Event Text
LOSS OF RESPONSE CAPABILITIES

The following information was provided by the licensee via fax:

"On March 14, 2023, at 2000 EDT, in accordance with 10 CRFR 50.72(b)(3)(xiii). Yankee Nuclear Power Station Independent Spent Fuel Storage Installation (ISFSI) determined that the impacts of a severe winter storm have resulted in a major loss in off site response capability. Since approximately 0200, very heavy snow has fallen and greater than two feet has accumulated on site. All security related equipment has remained functional, and there have been no impacts to methods of offsite communications or emergency assessment capability. The concrete cask heat removal systems have remained operable in accordance with the NAC International multi-purpose container system (NAC-MPC) technical specifications. From approximately 0550 until 1840, offsite power was lost, and the site was powered by the security diesel generator. Periodically throughout the day, the Security Shift Supervisor was in contact with State and local police to ensure response capability. At the 2000 hours update, the law enforcement agencies reported that there were recent reports of trees and power lines being downed by the weight of the snowfall causing road closures and significantly impacting routes and response times to the site.

"The site remains fully staffed."