Event Notification Report for November 08, 2023

AGREEMENT STATE - DOOR INTERLOCK FAILURE

The following information was provided by the Wisconsin Department of Health Services (the Department) email:

"On Wednesday, November 8, 2023, the licensee was treating an individual in their high dose rate (HDR) suite. During the treatment, while the Ir-192 source was exposed, it was noticed that the door to the suite was ajar. The treatment was immediately paused, and the physicist confirmed that the door was open and that the door interlock was not functioning as required. The staff closed the door, put up caution tape, and maintained constant visual surveillance to ensure no one entered. Treatment was reinitiated and completed according to the written directive.

"On Friday, November 10, 2023, the interlock had not yet been repaired, and the licensee performed another HDR treatment utilizing caution tape and constant surveillance.

"The licensee reported the event to the Department by phone on November 14, 2023.

"The licensee performed an event reconstruction and surveyed at the open door with the Ir-192 source exposed. The highest dose rate of 0.3 mR/hr indicates that no member of the public would have received a dose exceeding public dose limits from this event.

"The patients were unaffected.

"The Department will be performing a reactive inspection on November 20, 2023."

WI Event Report ID Number: WI230022

AGREEMENT STATE REPORT - LOST RADIOACTIVE MATERIAL

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

"On November 9, 2023, the Department was notified by the licensee that a shipment of 960 millicuries of iridium - 192 Zero Wash had not arrived at its Alice, Texas, location. The licensee stated the shipment was scheduled to arrive in Alice, Texas on October 31, 2023. The licensee stated that the carrier used often misses the arrival date by as much as a week, so they did not start looking for the shipment until November 7, 2023. The licensee contacted the shipping company and the last know location of the shipment is Abilene, Texas. The shipper is searching that location for the material. The licensee stated the material was shipped inside a 55 gallon drum. It is currently believed that it is not likely that any individual would exceed any exposure limits. Additional information will be provided as it is received in accordance with SA-300."

Texas Incident Number 10065

Texas NMED Number: TX230051

* * * UPDATE ON 11/9/23 AT 1529 EST FROM ART TUCKER TO KERBY SCALES * * *

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

"On November 9, 2023, the licensee reported they had located the missing shipment of 960 millicuries of iridium - 192 Zero Wash. The licensee had placed two orders for the materials for two separate locations and the shipping company had inadvertently delivered both shipments to the same location."

Notified R4DO (Warnick), and NMSS Event Notifications, ILTAB, and CSNS Mexico via email.

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 EXIT SIGN

The following information was obtained and summarized from the Colorado Department of Public Health and Environment in accordance with Headquarters Operations Officers Report Guidance:

On November 8, 2023, Five Rivers Cattle Feeding (Lamar) reported to the Colorado Department of Public Health and Environment one lost exit sign (Manufacturer: Isolite Corporation; Model #: SLX60; Isotope & activity: H-3, 6.2 Ci).

Event Report ID No.: CO230041

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

ALERT - SEISMIC EVENT FELT ONSITE

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

"An Alert has been declared at Urenco USA. An Alert is the official designation for an emergency which is contained on the URENCO USA site. No public protective actions are recommended at this time. A seismic event was detected near the facility and felt inside the control room. A release of hazardous material has not occurred."

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

On 11/08/2023 at 0337 MST, Urenco USA declared an Alert (EAL 5.1A) due to a seismic event felt onsite. The Headquarters Operations Officer was notified of the Alert at 0559 EST (0359 MST). No radioactive release has occurred. A 5.2 magnitude earthquake occurred in western Texas with an epicenter 36.7 km west-southwest of Mentone, Texas. Plant personnel are conducting walkdowns of the site.

The State and local authorities have been notified.

Notified DHS SWO, FEMA Ops Center, USDA Ops Center, HHS Ops Center, DOE Ops Center, CISA Central Watch Officer, EPA EOC, FDA EOC (email), FEMA NWC (email), DHS Nuclear SSA (email), DHS NRCC (email), FEMA NRCC SASC (email), FERC (email)

* * * UPDATE ON 11/8/2023 AT 1153 EST FROM JIM RICKMAN TO SAMUEL COLVARD * * *

TERMINATION OF SEISMIC EVENT ALERT

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

"The earthquake of 5.2 magnitude in western Texas was felt in the control room. No release of UF6 was detected. Building inspections have been completed with no damage identified. This event has been terminated at 0937 MST and has entered into the recovery process. The State and local authorities have been notified."

Notified DHS SWO, FEMA Ops Center, USDA Ops Center, HHS Ops Center, DOE Ops Center, CISA Central Watch Officer, EPA EOC, FDA EOC (email), FEMA NWC (email), DHS Nuclear SSA (email), DHS NRCC (email), FEMA NRCC SASC (email), FERC (email), R2DO (Miller), NMSS (Brenneman), IRMOC (Grant), OPA (Burnell).


The following additional information was obtained in accordance with Headquarters Operations Officers Report Guidance:
US Geological Survey (USGS) updated the seismic event to 5.3 magnitude at 10:27 on 11/08/23.

MANUAL ACTUATION OF AUXILIARY FEEDWATER SYSTEM (AFW)

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

"At 0645 EST, on November 8, 2023, with Unit 2 in Mode 3 at zero percent power, a manual actuation of the auxiliary feedwater system (AFW) occurred during a planned plant cooldown. The reason for the AFW manual-start was a trip of the 22 steam generator feed pump due to a high casing level. The 23 AFW motor driven pump was manually started in accordance with implementation of AOP-3G, Malfunction of Main Feedwater System to restore steam generator levels.

"There was no impact to Unit 1. This event is being reported in accordance with 10 CFR 50.72(b)(3)(iv)(A) as an event that results in a valid actuation of the AFW system. There was no impact on the health and safety of the public or plant personnel.

"The NRC Resident Inspector has been notified."

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

No other systems were affected. No other compensatory or mitigation strategies implemented. Plant cooldown was the only significant evolution in progress. No impact to other technical specifications or limiting conditions for operation. All systems functioned as required. The electric plant is being supplied by offsite power with all diesel generators available. No significant increase in plant risk. There was nothing unusual or not understood.