Event Notification Report for September 21, 2023

AGREEMENT STATE - LOST STATIC ELIMINATORS

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

"On July 13, 2023, the Department was contacted by the Biomeric's quality assurance scientist, who stated she could not find two generally licensed devices. The devices are P-2024-1000 static eliminators. The devices were used to remove static electricity on small plastic parts. The devices were discovered missing during an inventory of devices that were to be replaced. The company stated the devices did not pose a risk of exposure to any individual. The company searched for the devices, but was unable to locate them. The company has implemented a monthly inventory program to keep better track of the devices. The devices will be centrally located when in storage from now on."

Texas Incident Number: 10039

Texas NMED Number: TX230034

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 - STUCK OPEN SHUTTER

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

"On September 13, 2023, the Department was notified by Braskem Inc. that during routine testing, the shutter on two Vega model SH-F2 gauges failed to close. Shutters in the open position is the normal operating position. Both gauges contain 200 millicuries of Cesium-137. There is no risk of additional radiation exposure to members of the general public or radiation workers due to this event. Additional information has been requested of the licensee. Additional information will be provided in accordance with SA-300."

Texas Incident Number: 10050

AGREEMENT STATE REPORT - STOLEN MOISTURE DENSITY GAUGE

The following was reported by the Florida Bureau of Radiation Control (BRC) via email:

"[The branch administrator and vice president] of Ardaman & Associates, called the BRC at 1030 EDT to report a stolen moisture density gauge. Their technician was at a job site where he says there are two entrances, but not much security to check who comes and goes. Before doing his readings, he noticed a truck parked close by but did not make anything of it since there are other workers on site. After he was done he went to the trailer to get his reports and left the gauge outside. A few minutes later he says someone came to notify him they saw an individual from the truck take possession of the gauge and drive off the site. They called the police to report the stolen Troxler gauge, serial number 36530 model 3430. Police report number to follow."

Florida Incident Number: FL23-143


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 - STOLEN MOISTURE DENSITY GAUGE

The following was reported by the California Department of Public Health, Radiologic Health Branch (RHB) via email:

"On 09/12/2023, RHB received a call from [the] Principal Engineer, and President of A3GEO, Inc., regarding the loss of their moisture density gauge. They stated that on 09/12/2023 at 1445 PDT, the radiation safety officer (RSO) of A3GEO parked his 2001 Dodge Dakota Pickup Truck, containing InstroTek Model 3500 Xplorer with serial number 503 moisture density gauge, at the corner of Ridge Road and Euclid Avenue in Berkeley, CA. The RSO went into the corner market, and as he was exiting the corner store, he saw a man driving away his truck. He tried to stop him by running behind the truck, but he was unable to stop him from driving off. He immediately reported the incident to the Berkeley Police Department. RHB advised the licensee to place an ad in a local Berkeley newspaper offering a reward for return of the stolen gauge."

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
The following information was provided by the licensee via email:
"On 9/18/2023 at 2007 CDT, Clinton reported to the Illinois Emergency Management Agency, National Response Center and DeWitt County a hazardous substance release of 1300 gallons of Sodium Bisulphite. The release was at the site's flume discharge building due to a crack on a fitting inside the building. This release did not exceed any NRC regulations or reporting criteria. 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."

CONCURRENT REPORT - HIGH CHLORINE LEVEL IN OUTFALL POND

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

"The Ohio Environmental Protection Agency was notified at approximately 1402 EDT on 09-19-2023, that the [National Pollutant Database] limit for chlorine at Outfall 012 (X-2230M Holding Pond) of 0.019 mg/L was exceeded on 09-18-2023, with a result of 0.109 mg/L with the elevated level being confirmed by a sample on the morning of 09-19-2023.

"Centrus American Centrifuge Operating is currently investigating to determine the cause of the exceedance."

NRC Region 2 was notified.

Centrus event number: CN 11437.

AGREEMENT STATE REPORT - POTENTIAL OVEREXPOSURE

The following information was received from the New Jersey Department of Environmental Protection (NJDEP) via email:

"On 9/15/2023, NJDEP staff was notified of a potential overexposure of an authorized user (AU) at a radiopharmacy. This licensee states that a whole body badge from June was submitted late and results were just received. This AU's June badge results were 4632 mrem. The badge was processed twice to ensure the reading was correct. This brings the AU's annual readings to 5351 mrem. As a result, the licensee has been put on work restrictions while an investigation is done. The licensee has also requested Landauer reprocess the badge. Staff was also told that the ring badges had the exact same reading as the whole body badge. Records of instant read out dosimeters are kept by this licensee and all recorded readings were no higher than 2 mR per day for June and July. More information to follow as the licensee's investigation is completed."

New Jersey Event Number: To Be Determined

AGREEMENT STATE - PATIENT UNDERDOSE

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

"During the course of a routine inspection at the licensee's facility on 9/14/23, inspectors discovered an underdose of a TheraSphere Y-90 treatment performed on 4/14/2023. A patient was receiving treatment for two different liver segments. The first TheraSphere dose to liver segment 3 was prescribed at 200 Gy and the patient only received 150 Gy (75 percent of the intended dose). A second written directive for segment two was successfully delivered (200 Gy prescribed and 194 Gy delivered). At the bottom of the segment 3 written directive an AMP [accredited medical practitioner] wrote 'Due to possible air in tubing, dose to segment 3 was slightly underdosed. Cumulative dose to both segments is 86 percent of [prescribed]'. Inspectors informed the licensee that each written directive is a stand alone document and that this would qualify as a medical event.

"On 9/15/23, the authorized user [AU] physician advised there was no adverse impact to the patient. The licensee advised the referring physician and was working to contact the patient. The AU determined the dose was medically sufficient. The licensee is aware of the 15 day reporting requirement and a written report is pending."

Illinois Item Number: IL230026

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 - STUCK SOURCE

The following information was provided by Alabama Radiation Control via email:

"The licensee's representative called an Alabama Radiation Control staff member to report that an RT [radiographic testing] crew working at Alabama River Cellulose in Perdue Hill, AL, called to advise that a radiography source could not be retracted. The call was received by the radiation control staff member at about 1715 CDT on 9/14/23. The representative did not have many details, and was preparing to leave the ATS [Applied Technical Services] office in Marietta, Georgia to respond.

"Alabama Radiation Control received a report from the licensee's representative between very late on 9/14/23, to very early on 9/15/23, that the source was able to be retracted. The representative stated that a wire in the crank was apparently damaged.

"Alabama Radiation Control will provide more information as the investigation continues."

Alabama Incident Number: To Be Determined

FITNESS-FOR-DUTY REPORT

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

"A licensed operator had a confirmed positive test for alcohol during another entity's pre-access fitness-for-duty screening for unescorted access authorization. The individual's unescorted access at Peach Bottom Atomic Power Station has been denied.

"The NRC Resident Inspector has been notified."