Event Notification Report for March 06, 2025

EN Revision Imported Date: 3/24/2025

EN Revision Text: AGREEMENT STATE REPORT - LOST/FOUND GAUGE

The following information was received from the Washington State Department of Health (the Department) via email:

"On March 7, 2025, at 1613 PDT, the Department was notified that a portable gauge (Troxler 3411-B) had fallen from a vehicle. This notification initially came from the Washington State Emergency Operations Officer of the Washington Military Department. The notification stated that the licensee had submitted a police report and was actively searching for the source.

"At 1633, the Department Emergency Response Duty Officer (ERDO) forwarded the notification to the Radioactive Materials Section Manager. At 1711, the Materials Section Manager contacted the licensee by phone to determine the scope of response necessary. The licensee informed the Department that the gauge was contained in a locked box and was believed to be lost or stolen. The licensee called back at 1716, informing the Department that the gauge had been found with the box locked, intact, and no signs of damage to the source contained within the shielded gauge. The gauge was found along the side of the road, in a ditch and away from any pedestrian traffic. No exposure is believed to have occurred to the public when considering the source was in a shielded position and inside of a locked Troxler class A container.

"The source was verified to be intact and sealed. Operational verifications of the gauge were performed, and the gauge is functioning normally. The gauge is in the possession of the licensee.

"A final report will be submitted to the NRC after the licensee has responded with corrective actions."

Washington Incident Number: WA-25-005

* * * UPDATE ON 3/21/2025 AT 1947 EDT FROM DANE BLAKINGER TO TENISHA MEADOWS * * *

The following information was received from the Washington State Department of Health (the Department) via email:

"The licensee corrective actions include mandatory retraining of gauge handling and locking procedures for all gauge users at Terra Associates Inc., an increased [frequency] of user audits of locking procedures from every 6 months to every 3 months, and GPS trackers installed on all gauge transportation boxes. The Department will review corrective actions during future inspections, to include a review of this report and ensure licensee is demonstrating compliance with proposed corrective actions."

Notified R4DO (Bywater) and NMSS Events Notification (email)

AGREEMENT STATE REPORT - POTENTIAL OVEREXPOSURE

The following information was received from the New York State Department of Health (NYSDOH) via phone and email:

"New York State Department of Health (NYSDOH) received an email on the morning of 3/20/2025, from the Chief Operating Officer of NRD, LLC to report a potential overexposure of a production worker.

"On 3/7/2025, a production worker had received an acid burn on his forearm resulting in a first-degree burn where the skin was reddened but not visually broken. The chemical agent causing this burn is suspected to be nitric acid with Am-241 contamination used in routine production activities for Am-241 foils. The exact nature of the work being performed, cause of this burn/contamination, and personal protective equipment (PPE) worn by the affected individual is unknown at this time. The initial skin contamination was 8,900 disintegrations per minute (dpm) according to NRD. After 7 hours of decontamination, using water and mild soap, NRD states that they were able to successfully decontaminate some of the areas on the individual's forearm, however, 5,900 dpm remained on the skin. Nasal swabs and whole-body surveys returned as below background levels according to NRD. NRD, LLC stated that only this one worker had been contaminated from this event.

"NRD states that they believed that this contamination was localized to skin contamination with no evidence of internal uptake. However, this individual has been removed from work and a series of bioassays were performed (24-hour composite urine collection) on 3/8/2025, 3/11/2025, and 3/16/2025 and sent to GEL Laboratories for rush analysis. The 3/8/2025 result showed 22.9 picocuries per liter of Am-241, further confirmed via gamma spectroscopy. This preliminary report was provided to NRD on 3/19/2025.

"NRD states that they performed dose reconstruction from this event using the baseline bioassay, last monthly routine bioassay (collected on 3/5/2025), and the singular reactionary bioassay result available from the collection on 3/8/2025 (reported to NRD on 3/19). NRD, LLC used the integrated modules for bioassay (IMBA) using an ingestion-specific intake model, which indicates 5.47 rem committed effective dose equivalent (CEDE) and 128 rem committed dose equivalent (CDE) to the bone surfaces. These doses are not confirmed as official, but estimates provided the information available at this time. Given the nature of intake and the suspected pathways for intake (e.g., dermal absorption), NYSDOH is awaiting clarification for the assumptions and rationale used in estimating this intake as well as seeking additional information on the nasal samples collected/analyzed and the whole-body surveys performed pre-, during and post-decontamination.

"Prior to reporting this event to NYSDOH, NRD, LLC contacted Radiation Emergency Assistance Center/Training Site (REAC/TS) on the evening of 3/19/2025. NRD, LLC informed NYSDOH that REAC/TS was notified and did not recommend any medical intervention. NYSDOH called REAC/TS independently on March 20, 2025, and spoke to the medical team that spoke to NRD. It was noted that REAC/TS did not have enough information at the point of discussion with NRD to determine if any intervention was necessary and requested NRD, LLC to provide additional information on this event. NYSDOH shared information on this event reported by NRD with REAC/TS following this call. NYSDOH immediately recommended to NRD, LLC that they continue timely follow-up with REAC/TS to determine if medical intervention may be necessary per their clinical recommendation, particularly since two additional bioassay samples (3/11/2025 and 3/16/2025; collection dates) were being analyzed and may strengthen the confidence in performing dose reconstruction. If medical intervention is deemed clinically necessary, the timeliness of medical intervention may directly impact the amount of dose received by the affected worker. Because of this, NYSDOH strongly recommended to NRD that they prioritize resolving any information needed for REAC/TS to make this determination.

"NYSDOH has requested a significant amount of additional information and documentation on this event including, but not limited to, the modeled pathways and methods for dose reconstruction, the extent of personnel and area contamination, immediate protective actions, and causes and corrective actions from this event. NYSDOH has also identified several suspected items of noncompliance pertaining to this event and will follow up on these observations.

"It is not suspected that there is any risk to public health or the environment from this event. NYSDOH is monitoring this event and has assigned NYSDOH Incident Number 1523 to internally track this event. NYSDOH will provide an update to this notification once additional information is available."

NMED Event Report ID Number: NY-25-04

AGREEMENT STATE REPORT - DAMAGED MOISTURE DENSITY GAUGE

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

"On March 7, 2025, at approximately 1700 CST, the Department was notified by the licensee that a Troxler 3440 moisture density gauge containing an 8 mCi Cesium-137 source (original strength) and a 40 mCi (original strength) Am-241/Be source were damaged by being run over by construction equipment at a job site in Melissa, Texas. The radiation safety officer (RSO) was onsite, the sources were intact, but the gauge was damaged to an extent that the cesium source could not be retracted into a safe position. The RSO, in coordination with the Department, removed the gauge from the accident site, and made the device safe by placing it in a container filled with sand. The damaged gauge was then secured to the container, the container was secured to the licensee's vehicle, and the damaged gauge was transported to their vault which was less than 1 mile away. The manufacturer, who has a local repair facility, was already closed for the weekend so the damaged device was placed in the vault at the licensee's facility for transport to the manufacturer on Monday. The RSO performed several surveys at the accident site, with the gauge in the truck, and at the licensee's vault. All readings were well within normal limits. No overexposure occurred as the only time the source was exposed was when the RSO transferred it from the ground to the sand filled container. Additional information will be provided in accordance with SA-300."

Texas Incident Number: I-10181
Texas NMED Number: TX250018

EN Revision Imported Date: 5/16/2025

EN Revision Text: PART 21 - CIRCUIT BREAKER DEFECT

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

"On March 7, 2025, General Electric Hitachi (GEH) issued 10 CFR Part 21 Communication SC 25-01 for a molded case circuity breaker (MCCB), in accordance with 10 CFR 21.21(b). Testing performed by GEH identified a deviation in two (2) breakers; specifically, GEH part number DD148C6151P004 (Asea Brown Boveri (ABB) part number: TB13030BWE05). These MCCBs failed to instantaneously trip at the designated current and time.

"James A. FitzPatrick Nuclear Power Plant (JAF) completed an evaluation of this deviation in accordance with 10 CFR 21.21(a)(1) on May 6, 2025, and concluded this condition is a defect which could create a substantial safety hazard. The instantaneous trip function of this component protects safety-related buses from tripping on an overcurrent condition.

"JAF was listed as the only affected plant. It was determined that the defect does not exist in any installed plant equipment because bench testing performed prior to installation includes overcurrent trip testing and would have identified this defect. The components affected by this defect have been restricted to prevent them from being installed pending corrective action resolution.

"This letter is submitted as a non-emergency notification in accordance with 10 CFR 21.21(d)(3)(i). Additional details will be provided in a written report within 30 days, in accordance with 10 CFR 21.21(d)(3)(ii).

"There are no new regulatory commitments contained in this letter. The NRC Senior Resident Inspector at JAF has been notified. Should you have any questions regarding this submittal, please contact Mark Hawes, Regulatory Assurance, at (315) 349-6659."

Known affected power plants:
James A. FitzPatrick

FITNESS FOR DUTY

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

A non-licensed employee brought an illegal substance into the protected area. The employee's access to the plant has been terminated.

The NRC Resident Inspector has been notified.

EN Revision Imported Date: 3/14/2025

EN Revision Text: AGREEMENT STATE REPORT - LOST RADIOGRAPHY CAMERA

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

"On March 6, 2025, the Department received a call from the licensee's radiation safety officer (RSO). He reported that at around 1600 hours a radiography crew reported losing a SPEC 150 exposure device containing a 95.4 curie iridium-192 source. The RSO stated that the source was in the fully shielded position. The RSO stated that the radiographers had completed an exposure on a pipeline and the radiographer trainer told the trainee to store the exposure device. [The radiographer trainer] then went to the cab of the truck to do some paperwork. The trainee set the exposure device on the back of the truck with the guide tube removed but the 35-foot crank outs still attached. The trainee failed to secure the device in the truck. The radiographers drove [toward] the next site. The RSO stated that they traveled about a mile and realized the exposure device was no longer on the back of the truck. The radiographers turned around and retraced the path they had traveled. They did not find the device. The RSO stated that while looking for the device [the radiographers] passed two trucks, which they stopped and asked if anyone had seen the device. Both said they had not seen it. The RSO stated that they have 4 radiography crews searching in the area for the device. The operations manager is also in the area searching for the device. The RSO stated that he has tried to contact the sheriff for the area and has not been able to do so. He stated he will continue to call them until he reaches someone. The radiographers were working approximately 10 miles east of Mentone, Texas, north of state highway 302. The RSO said he would provide GPS coordinates as soon as he received them.

"Additional information will be provided as it is received in accordance with SA-300."

Texas Incident Number: 10179
NMED Number: TX250016

Notified: DHS SWO, FEMA Ops Center, USDA Ops Center, HHS Ops Center, DOE Ops Center, DHS CISA Central, EPA EOC, FEMA NWC, FDA EOC (email), Nuclear SSA (email), CWMD Watch Desk (email), CNSNS (Mexico) email.

* * * UPDATE ON 03/13/2025 AT 1843 EDT FROM ART TUCKER TO ROBERT THOMPSON * * *

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

"On March 13, 2025, the licensee contacted the Department and stated they had received a phone call from an individual who stated they had found its exposure device. The individual stated they found it on March 13, 2025, where the licensee believed it had been lost. The individual stated they had taken it to their home in Pecos, Texas. They stated this was their first day back at work since they found the device and saw the posting about the device. They agreed to meet at the individual's home at 1700 CDT. The licensee's radiation safety officer, corporate safety officer, the local sheriff, and two deputies arrived at the individual's home at 1715 CDT. The individual took them to a small shed behind their house. The shed was locked. The individual stated the gauge remained in the locked shed from the time they brought it to their home until then. The exposure device was found on the floor in the shed. The crank outs were still attached, and the dust cover was still on the front of the device. Both the exposure device and the crank outs appeared to be undamaged. The individual stated they had not attempted to operate the device. The licensee took the device to their vehicle to transport it back to its normal storage location. The licensee stated that dose rates off the device were normal and no individual would have received any significant exposure due to this event."

Internal notifications: R4DO (Warnick), NMSS (Silberfeld), ILTAB (Brown), IR MOC (Crouch), NMSS_EVENTS_NOTIFICATION (email), ILTAB, (email), INES National Officer (Smith), NMSS INES Coordinator (Allen).

External notifications: DHS SWO, FEMA Ops Center, USDA Ops Center, HHS Ops Center, DOE Ops Center, DHS CISA Central, EPA EOC, FEMA NWC, FDA EOC (email), Nuclear SSA (email), CWMD Watch Desk (email), CNSNS (Mexico) email.

THIS MATERIAL EVENT CONTAINS A 'Category 2' LEVEL OF RADIOACTIVE MATERIAL

Category 2 sources, if not safely managed or securely protected, could cause permanent injury to a person who handled them, or were otherwise in contact with them, for a short time (minutes to hours). It could possibly be fatal to be close to this amount of unshielded radioactive material for a period of hours to days. These sources are typically used in practices such as industrial gamma radiography, high dose rate brachytherapy and medium dose rate brachytherapy. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf

AGREEMENT STATE REPORT - IMPROPER SHIPMENT OF BYPRODUCT MATERIALS

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

"On March 6, 2025, the Department was contacted by Customs and Border Protection regarding a shipment that was passing through their checkpoint in the port of Houston, Texas. The shipment set off their radiation monitors and the radionuclides were identified as americium-241 and radium-226. When the Department contacted the shipper, the shipper stated that part of the shipment was smoke detectors. The shipper made arrangements for the shipment to be returned to the originating location in Farmers Branch, Texas. On March 14, 2025, a Department investigator went to the shipper's location and confirmed that the shipment contained two boxes with smoke detectors. On March 27, 2025, a Department investigator went back to the location to inspect the materials and perform radiological surveys. The investigator verified that the two boxes contained approximately 3,200 smoke detectors. The investigator noted that a large number of the americium-241 sources had been separated from the smoke detectors and were laying free inside the boxes. The investigator found that the dose rates on contact with the outside of the box were around 75 uR/hr. A gamma spectroscopy reading of the box determined the radionuclides to be americium-241 and radium-226. The investigator did not detect any loose surface contamination. The owner (shipper) of the package was directed to secure the packages containing the smoke detectors in a secure location. Based on the radiological surveys performed by the Department, no individual would have received a significant exposure as a result of this event. The owner of the material has agreed to impound all the sources and secure them in an area not easily accessible to an individual. The Department will assist the owner of the smoke detectors in finding a contractor to properly dispose of the material."

Texas incident number: 10185
NMED number: TX250020

There was no indication that any foils were separated from the shipping packages. The owner of the shipment does not have a Texas license for the possession of byproduct materials. The Department will continue to investigate this incident.