Event Notification Report for May 27, 2025

AGREEMENT STATE REPORT - LOST TROXLER GAUGE

The following information was provided by the New Jersey Department of Environmental Protection via email:

"During a state prompted inventory for license renewal, the licensee discovered the loss of a portable gauge. The last confirmed possession of the gauge was December 15, 2017, when it was marked in their logbook to be sent for maintenance. No manufacturers or service providers contacted have any record of the gauge past 2017."

Gauge description: Troxler Electronic Labs. Inc. model 3411-B, serial number: 18670, containing sealed sources: Cs-137, 9 mCi (max), Am-241/Be, 44 mCi (max)

New Jersey Incident Number: 506950 - INV250001



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 SOURCES

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

"On 5/19/2025, at 0939 PDT, the Department was notified of missing or lost sources meeting the reporting criteria of WAC-246-221-240. During a routine inventory, the [licensee's] radiation safety officer (RSO) identified the following missing sources.

"The RSO believes that the sources may have been disposed of appropriately but not removed from the inventory list. A full report is required within 30 days."

Sources:
Am-241, 0.148177 microcuries
Am-241, 0.004437 microcuries
Pu-238, 0.003889 microcuries
Pu-239, 0.004149 microcuries
Th-230, 0.001101 microcuries

WA incident number: WA-25-07

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

MEDICAL EVENT

The following is a summary of information provided by the licensee via phone and email:

A patient was administered two Y-90 Therasphere treatments to the liver, each with its own written directive. The first treatment was administered without issue. The second treatment, which was a prescribed 1,382 Gy dose to the liver, resulted in no dose delivered due to a catheter malfunction. Post-administration, the activity level of the second Y-90 container was unchanged.

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 - EXTERNAL RADIATION LEVEL ON SHIPMENT EXCEEDED LIMITS

The following information was provided by the Utah Division of Waste Management and Radiation Control (the Division) via email:

"Shipment 9075-01-0074 arrived at EnergySolutions' Clive disposal facility on May 19, 2025. As Division inspectors were performing incoming waste shipment inspections, [Division] staff surveyed and observed a trailer that exhibited a dose rate of 10.5 mrem/hour at 2 meters from the outer plane of the conveyance. Upon this discovery, the [Division] inspector informed EnergySolutions' shipping and receiving staff of the discrepancy, [who] indicated that they were already aware of said discrepancy.

"The transport vehicle is a curtain-side, flatbed trailer."

Additional license number UT 2300478.

Utah event report ID: UT 25001

AGREEMENT STATE REPORT - DAMAGED PORTABLE GAUGE

The following information was provided by the South Carolina Department of Environmental Services (Department) via phone and email:

"The licensee informed the Department via phone on May 19, 2025, at approximately 1546 EDT, that one of their authorized users backed over a Humboldt Model 5001 EZ portable gauging device (Serial No. 5732), containing 11 millicuries of Cs-137 and 44 millicuries of Am-241:Be. The licensee reported that no immediate health and safety concerns had been identified.

"The on-call duty officer was dispatched to the construction site to investigate the event. The Humboldt Model 5001 EZ portable gauging device was crushed on one side of the device and the securing rod (depth rod) was transversely broken off. The source rod was intact, remained in the shielded position, and did not appear to be visibly damaged. Dose rate surveys at the surface of the gauge and at 1 meter indicated no elevated exposure. The Department performed swipe tests of the affected areas in addition to ambient dose rate surveys. All results were background. The licensee packaged the gauge within its transport case and a survey was performed to ensure compliance with Department of Transportation requirements (Transportation Index) prior to transporting it back to the licensee's facilities to await disposal.

"This event is still under investigation by the Department."

LOST TRITIUM EXIT SIGNS

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

Two tritium exit signs were reported lost or missing during a recent safety emergency lighting audit conducted on April 24, 2025. Despite a thorough internal review and inspection of storage, disposal, and installation records, the devices were unable to be located or disposition verified.

The licensee is in the process of updating all emergency exit signage and lighting. Additionally, they are removing the remaining six (6) self-luminous exit signs from their facility and will return them to lsolite for proper disposal in accordance with regulatory guidelines. To prevent any recurrence, the facility will no longer purchase or utilize self-luminous signage in the future.

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

There is no information of previous inventory records since the initial delivery around April 2016. Information about this event was previously reported to the NRC Region III office on May 12, 2025.

Maker: Isolite
Model Number: SLX-60
Serial Numbers: H56081 and H56088
Estimated Activity: 0.281 TBq tritium (H-3) or 7.59 Ci/ sign (TOTAL: 0.562 TBq or 15.18 Ci)
Date of Manufacture: March 2016

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 - DAMAGED GAUGE

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

"The Department received notification from the licensee that an Instrotek 3500 Xplorer nuclear moisture/density gauge was run over by a water truck on a construction site. The source rod was bent but the source was still in the shielded position. The gauge contains 10 millicuries of Cs-137 and 40 millicuries of Am-241:Be. The Department has requested additional information and continues to investigate the event.

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

DEGRADED RHR CHECK VALVE

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

"On May 22, 2025, at 2358 CDT, River Bend Station determined that a degraded condition existed following the performance of a VT-3 examination of E12-AOVF041A, Residual Heat Removal (RHR) 'A' injection line testable check valve. The cause of this event is currently being investigated. This examination was conducted following the plant shutdown, which was reported in Event Notification (EN) 57725.

"This event is being reported as an 8-hour reportable condition in accordance with 10 CFR 50.72(b)(3)(ii)(A) for the degraded condition of the pressure boundary.

"The NRC Resident Inspector has been notified."

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

This degraded condition resulted in a leakage rate of approximately 3.6 gallons per minute when at pressure. The plant is shutdown and depressurized which has caused the leakage to stop. No release is occurring or expected and possible corrective actions are being evaluated.