Event Notification Report for June 08, 2023

EN Revision Imported Date: 6/8/2023

EN Revision Text: SAFE SHUTDOWN CAPABILITY AND ACCIDENT MITIGATION

The following information was provided by the licensee via email:

"Notification per 10 CFR 50.72 (b)(3)(v)(A) and (v)(D)

"At time 1630 CDT on 4/18/23, Comanche Peak Unit 1 entered TS (Technical Specification) 3.0.3 for 11 minutes due to declaring Train A component cooling water (CCW) inoperable in conjunction with a Train B centrifugal charging pump (CCP) inoperable for scheduled maintenance. This resulted in an event or condition that could have prevented fulfillment of a safety function, high head injection of the emergency core cooling system.

"CCP 1-02 and fan cooler were tagged out of service at 0400 CDT on 4/18/23 due to scheduled maintenance activities. Containment spray (CT) pump 1-03 seal oil cooler CCW leak was found by a watchstander at 0930 CDT on 4/18/23. Engineering determined that leakage was CCW from a pipe flange weld after insulation removal and could not [determine] operability and notified control room at 1630 CDT on 4/18/23. This placed unit 1 in a TS 3.0.3 condition from 1630 to 1641 CDT for approximately 11 minutes until CCP 1-02 was restored back to operable status. CCW was declared operable at 1912 after CT pump 1-03 seal oil cooler was isolated. CT pump 1-03 remained inoperable until weld repair completed. Train A CT pump 1-03 declared operable at 1211 CDT 4/19/23.

"ENS notification should have been made by 0030 CDT on 4/19/23. This report restores compliance."

The NRC Resident Inspector has been notified.

* * * RETRACTION ON 6/7/2023 AT 1000 EDT FROM CASEY DAVIES TO BILL GOTT * * *

The following information was provided by the licensee via phone and email:

"Although Comanche Peak Unit 1 conservatively entered a limiting condition for operation action statement and performed repairs immediately, further engineering inspection and evaluation concluded that the CCW system was fully able to provide the needed flow to the 1-03 CT pump seal coolers from the time of discovery (0930 CDT) until which time the piping was isolated for repairs. During this period, structural integrity of the joint was maintained, CCW inventory loss remained within acceptable limits, and CCW could perform its intended design and safety functions.

"Based on this revised operability determination, train A CCW was always operable, and TS 3.0.3 did not apply.

"Therefore, reportability requirements per 10 CFR 50.72 (b)(3)(v)(A) and (v)(D) did not apply, and a 60 day LER will not be submitted."

The licensee notified the NRC Resident Inspector.

Notified R4DO (Young)

AGREEMENT STATE - DAMAGED TROXLER GAUGE

The following information was provided by the Florida Department of Health Bureau of Radiation Control (BRC) via email:

"Universal Engineering Sciences Corporate Radiation Safety Officer (RSO) called the BRC Orlando [office] this morning to report one of their Troxler gauges was run over on a job site this morning. He stated the source rod was in the retracted and shielded position at the time of the accident. Unit apparently sustained housing damage. Local RSO was enroute with a radiation meter. A BRC inspector is also enroute."

The following additional information was obtained from the licensee in accordance with Headquarters Operations Officers Report Guidance:

The Troxler gauge involved contains nominal activity of 40 mCi of Am-241:Be and 8 mCi of Cs-137.

FL incident number: FL23-081

AGREEMENT STATE REPORT - MEDICAL EVENT - INCORRECT TARGET ORGAN

The following information was provided by the Florida Department of Health Bureau of Radiation Control (BRC) via email:

"The Radiation Safety Officer (RSO) for Santa Rosa Medical Center, called the BRC to report an incident which occurred on Sunday 5/28/23. A technician was performing a lung scan on a patient and accidentally grabbed the wrong dose. The patient received 4 mCi of Tc-99 before the technician realized her mistake; whole dose would have been 10 mCi. The radiologist and the patient were both made aware of the incident.

"Licensing and technology is being asked to further investigate this incident."

The following additional information was obtained from the RSO:

The prescribed dose was 10 mCi of Tc-99 tagged for lung scan while the administered dose of Tc-99 was tagged for the liver. The total body effective dose equivalent to the patient was 80 mrem.

Florida Incident Number: FL23-082

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 - MATERIAL IDENTIFIED IN INVENTORY NOT ON LICENSE

The following report was received by the Florida Bureau of Radiation Control (BRC):

"FSU [Florida State University] contacted BRC Radioactive Materials Licensing via written letter dated May 18th, 2023 regarding a request to add [Uranium] U-233, any form except aerosols, to their license #0032-10. BRC Tallahassee called BRC Orlando this morning at 0900 [EDT] to notify. During a recent inventory close-out process, they found approximately 1.71 mCi of U-233. After checking the U-233 against their license, it was noticed that the U-233 is currently not listed on their current license. After additional review of archival records, it was found that the listing of U-233 was a remnant of their license #0032-18. License #0032-18 was terminated in 2012. The material has not been used in decades. The U-233 will stay in their radioactive materials storage vault and will not be used for any research. The plan moving forward is to eventually transfer the U-233 to a new research laboratory at the Colorado School of Mines. An amendment to current license to add U-233 is needed for this transfer."

Florida Event Number: FL23-080

AGREEMENT STATE REPORT - LOST MEDICAL SOURCE

The following is a summary of an email received from the North Carolina Department of Health and Human Services:

The Breast Center of Greensboro reported one lost brachytherapy seed (Iodine-125 in a preloaded 7 cm syringe, initial activity 255 microcuries, final activity 176 microcuries, order number 202385558, lot number 85558, satisfactory leak test on April 4, 2023) to the North Carolina Department of Health and Human Services on May 12, 2023. The lost source was identified during an inventory performed on May 9, 2023. An extensive search was performed but the seed was not located. The seed was most likely thrown away in a sharps container and is not believed to be stolen. Each medical procedure performed with this specific seed lot was audited with no abnormalities noted. Corrective actions include identifying each seed with a unique tracking number, updating use procedures, designating waste containers for seed use only, daily seed tracking when seeds are used, and retraining for all seed technicians.

North Carolina Event Number: NC230009

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 - LOST IODINE LOCALIZATION SEED

The following was received by email from the Minnesota Department of Health:

"An Iodine-125 localization seed (approximately 270 microcuries) was lost following removal from the specimen. The seed is suspected to have been placed on a surgical towel and never put into the source vial. Prior to discovery of the missing seed, the pathology department linens were taken to a laundry facility where the towel was washed. The licensee surveyed the pathology department and the laundry facility and were not able to find the seed."

State event report number: MN230003

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

OFFSITE NOTIFICATION DUE TO ON-SITE FATALITY

The following information was provided by the licensee via email:

"At 0937 EDT on June 6, 2023, it was discovered that a site employee suffered a non-work-related fatality. The individual was found non-responsive outside the Radiological Controlled Area. This is a four-hour, non-emergency notification for which a notification to other government agencies has been made. This event is reportable in accordance with 10 CFR 50.72(b)(2)(xi). The NRC Region I inspector has been notified."

FITNESS-FOR-DUTY REPORT

The following information is summary provided by the licensee via email:

A non-licensed supervisor was found to have falsified fitness for duty reports for a period of two months. The employee's access to the plant has been terminated.

The NRC Resident Inspector has been notified.