U.S. Nuclear Regulatory Commission
Operations Center
Event Reports For
03/18/2003 - 03/19/2003
** EVENT NUMBERS **
39666 39671 39676 39677 39678
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|General Information or Other |Event Number: 39666 |
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| REP ORG: NEW MEXICO RAD CONTROL PROGRAM |NOTIFICATION DATE: 03/13/2003|
|LICENSEE: CARDINAL HEALTH |NOTIFICATION TIME: 15:00[EST]|
| CITY: ALBUQUERQUE REGION: 4 |EVENT DATE: 03/03/2003|
| COUNTY: STATE: NM |EVENT TIME: [MST]|
|LICENSE#: AGREEMENT: Y |LAST UPDATE DATE: 03/13/2003|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |MARK SHAFFER R4 |
| |THOMAS ESSIG NMSS |
+------------------------------------------------+ |
| NRC NOTIFIED BY: BILL FLOYD | |
| HQ OPS OFFICER: RICH LAURA | |
+------------------------------------------------+ |
|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|NAGR AGREEMENT STATE | |
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| | |
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EVENT TEXT
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| NEW MEXICO AGREEMENT STATE REPORT ON LOST SOURCE |
| |
| "On March 3, 2003, Cardinal Health in Albuquerque shipped out an ammo-can, |
| via Federal Express Overnight, containing 1.251 Giga-Becquerel of I-131 in |
| an inorganic salt, solid state to the Cardinal Health facility in Amarillo, |
| TX. for delivery on 03/04/03. The Amarillo facility called on Tuesday, |
| 03/04/03, to state they never received it. [DELETED ] placed a call with |
| Federal Express immediately to trace the package. She continued to place |
| calls with Federal Express on 03/05/03 and 03/06/03 to check on the status |
| of the package. On each occasion, Federal Express stated they had yet to |
| locate the package. On Friday 03/07/03 I called [DELETED ] at our Quality |
| and Regulatory Dept. to notify them of the missing package. He, in turn, |
| placed a call with the New Mexico Environment Dept. On Monday, 03/10/03, I |
| called Federal Express and spoke with [DELETED ] of the Amarillo office. She |
| stated that they had done a thorough search of the Amarillo office and could |
| not find the package. She also stated that there was to be a search of the |
| Memphis location and that they would hopefully know something by Tuesday |
| 03/11/03. I notified [DELETED ] of my conversation with Federal Express. We |
| did not hear anything from FedEx on Tuesday. On Wednesday 03/12/03, I called |
| FedEx again and spoke with a representative by the name of [DELETED]. She |
| confirmed that the package had still not been located. I then contacted |
| [DELETED ] again to report the information. I also left a message with the |
| New Mexico Environment Dept. regarding the current state of the matter. We |
| will continue to monitor the situation. The tracking number for the package |
| is [DELETED]." |
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|General Information or Other |Event Number: 39671 |
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| REP ORG: ILLINOIS DEPT OF NUCLEAR SAFETY |NOTIFICATION DATE: 03/14/2003|
|LICENSEE: COOK COUNTY HOSPITAL |NOTIFICATION TIME: 17:13[EST]|
| CITY: CHICAGO REGION: 3 |EVENT DATE: 03/14/2003|
| COUNTY: STATE: IL |EVENT TIME: [CST]|
|LICENSE#: IL-01768-01 AGREEMENT: Y |LAST UPDATE DATE: 03/14/2003|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |KENNETH O'BRIEN R3 |
| |THOMAS ESSIG NMSS |
+------------------------------------------------+ |
| NRC NOTIFIED BY: JILL CLINGER | |
| HQ OPS OFFICER: RICH LAURA | |
+------------------------------------------------+ |
|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|NAGR AGREEMENT STATE | |
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EVENT TEXT
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| ILLINOIS AGREEMENT STATE REPORT ON LOST SOURCE |
| |
| "On March 13, 2003 the RSO of Cook County Hospital called the Illinois |
| Northern Regional office to report that an Sr-90 eye applicator source was |
| missing from its storage location along with some exempt quantity |
| calibration and reference sources and some associated records. A thorough |
| survey of the facility had been conducted the previous two days with no |
| success. This hospital is going through the process of relocating to new |
| facilities immediately adjacent to the existing site. At first it was |
| thought that these sources had been moved with other brachytherapy sources |
| and had been merely overlooked in the transition. Further inspection showed |
| that was not the case. Apparently the source has been mistakenly removed |
| during efforts to clean and prepare the area for occupancy by another |
| hospital department. This probably occurred at the end of January 2003 based |
| on interviews with several associated individuals. The room where the source |
| cabinet had been stored had been cleaned and its contents sent for disposal |
| or relocation to the new oncology department on January 30 and 31. The |
| Department sent an inspector to the facility the next morning, 14 March, to |
| conduct interviews, perform monitoring, verify the extent of the search |
| efforts undertaken to this point and make an independent evaluation of the |
| reported fate of the device. Surveys of several areas with a variety of |
| appropriate rate meters and probes including old and new storage locations, |
| oncology departments, shipping and receiving docks, waste handling locations |
| and nuclear medicine departments were unsuccessful in recovery of the |
| applicator. Interviews with the RSO, facility medical director, radiation |
| oncologist, supervisory radiation technician and individuals who performed |
| the clean out work do not provide any additional information as to the fate |
| of the source as all state that they did not remove the source from its |
| storage cabinet. The source was initially 35 milliCuries in 1955 and has |
| since decayed to approximately 11 millicuries to date. The source does not |
| appear in the NRC SSDR due to its age. The manufacturer is listed as |
| TRAUSLAT with model number RA-1 and a serial number of 183. Given the |
| situational circumstances, the existing presence of nearby brachytherapy |
| sources of Cs-137 and a teletherapy source in the area, the limited access |
| to the room, control of keys, and the disappearance of records along with |
| check sources leads the RSO as well as the Department inspector to believe |
| that the eye applicator and exempt quantity reference sources were |
| inadvertently disposed as waste back in late January 2003. There is a slight |
| potential that the material may be discovered in the hospital as the various |
| departments continue their relocation to new facilities. The licensee will |
| file the required report and the department will take appropriate action |
| based on additional information received. Event reported to NRC Operations |
| Center on at 1713 ET 14 March 2003 and assigned event number 39671." |
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|Other Nuclear Material |Event Number: 39676 |
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| REP ORG: DEFENSE DISTRIBUTION DEPOT |NOTIFICATION DATE: 03/18/2003|
|LICENSEE: DEFENSE DISTRIBUTION DEPOT |NOTIFICATION TIME: 08:06[EST]|
| CITY: NEW CANTERBURY REGION: 1 |EVENT DATE: 02/24/2003|
| COUNTY: STATE: PA |EVENT TIME: [EST]|
|LICENSE#: 37-30062-01 AGREEMENT: N |LAST UPDATE DATE: 03/18/2003|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |PETE ESELGROTH R1 |
| |DAVID AYRES R2 |
+------------------------------------------------+THOMAS ESSIG NMSS |
| NRC NOTIFIED BY: DAVID MACK | |
| HQ OPS OFFICER: HOWIE CROUCH | |
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|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|BLO1 20.2201(a)(1)(i) LOST/STOLEN LNM>1000X | |
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EVENT TEXT
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| LOST AMERICIUM-241 SEALED SOURCES |
| |
| On 3/18/2003, NRC Headquarters was informed by the master materials |
| licensee (located in New Cumberland, PA) that on 3/17/2003, it was |
| discovered by the licensee that two Americium-241 sealed sources were |
| unaccounted for. The sources were tracked to a shipment facility at Warner |
| Robbins Air Force Base on 2/24/03, but there is no record that the sources |
| were shipped out of the facility or where they might be stored. The |
| sources are contained in a laser transmitter/receiver and contain 4 |
| microcuries of Americium-241. |
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|Power Reactor |Event Number: 39677 |
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| FACILITY: PALO VERDE REGION: 4 |NOTIFICATION DATE: 03/18/2003|
| UNIT: [1] [2] [3] STATE: AZ |NOTIFICATION TIME: 15:15[EST]|
| RXTYPE: [1] CE,[2] CE,[3] CE |EVENT DATE: 03/18/2003|
+------------------------------------------------+EVENT TIME: 10:00[MST]|
| NRC NOTIFIED BY: DON STRAKA |LAST UPDATE DATE: 03/18/2003|
| HQ OPS OFFICER: MIKE RIPLEY +-----------------------------+
+------------------------------------------------+PERSON ORGANIZATION |
|EMERGENCY CLASS: NON EMERGENCY |CLAUDE JOHNSON R4 |
|10 CFR SECTION: | |
|APRE 50.72(b)(2)(xi) OFFSITE NOTIFICATION | |
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+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|1 N Y 100 Power Operation |100 Power Operation |
|2 N Y 100 Power Operation |100 Power Operation |
|3 N Y 100 Power Operation |100 Power Operation |
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EVENT TEXT
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| OFFSITE NOTIFICATION |
| |
| The Governor's Office of the State of Arizona issued a press release |
| regarding National Guard deployment at the Palo Verde Nuclear Generating |
| Station (PVNGS). The press release was issued at approximately 10:00 MST |
| 03/18/03. |
| |
| The Palo Verde Nuclear Generating Station has no plans to issue a press |
| release at this time. |
| |
| The licensee notified the NRC Resident Inspector. |
| |
| Notified R4DO (C. Johnson) |
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|Power Reactor |Event Number: 39678 |
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| FACILITY: PALISADES REGION: 3 |NOTIFICATION DATE: 03/18/2003|
| UNIT: [1] [] [] STATE: MI |NOTIFICATION TIME: 21:05[EST]|
| RXTYPE: [1] CE |EVENT DATE: 03/18/2003|
+------------------------------------------------+EVENT TIME: 20:47[EST]|
| NRC NOTIFIED BY: TROY POLHAMUS |LAST UPDATE DATE: 03/18/2003|
| HQ OPS OFFICER: MIKE RIPLEY +-----------------------------+
+------------------------------------------------+PERSON ORGANIZATION |
|EMERGENCY CLASS: ALERT |JAMES CREED R3 |
|10 CFR SECTION: |JIM DYER R3 |
|AAEC 50.72(a) (1) (i) EMERGENCY DECLARED |STUART RICHARDS NRR |
| |NADER MAMISH IRO |
| |ROY ZIMMERMAN NSIR |
| |M. DUNKER FEMA |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|1 N N 0 Refueling |0 Refueling |
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EVENT TEXT
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| ALERT DECLARED DUE TO FIRE IN CABLE SPREADING ROOM |
| |
| The licensee declared an alert at 2047 EST due to a fire in the cable |
| spreading room which started at 2037 EST. The fire was declared out by 2130 |
| EST in response to deenergizing 480 volt AC load center # 12. |
| Preliminarily, the fire appears to have occurred within the breaker |
| compartment on load center #12 supplying Charging Pump 55A . Plant |
| conditions remains stable with shutdown cooling continuing in service. |
| There were no releases or other offsite consequences. |
| |
| The licensee notified the NRC Resident Inspector. |
| |
| * * * * UPDATE RECEIVED FROM J. MIKSA BY M. RIPLEY AT 2326 EST 03/18/03 * * |
| * * |
| |
| The licensee terminated the alert at 2326 EST on 03/18/03. |
| |
| Notified R3DO (J. Creed), NRR EO (S. Richards), DIRO (N. Mamish), FEMA |
| (Watch Officer), DHS (S. Tull) |
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