U.S. Nuclear Regulatory Commission
Operations Center
Event Reports For
10/18/2002 - 10/21/2002
** EVENT NUMBERS **
39285 39289 39290 39293 39301 39302 39303 39304 39305
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|General Information or Other |Event Number: 39285 |
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| REP ORG: TEXAS DEPARTMENT OF HEALTH |NOTIFICATION DATE: 10/15/2002|
|LICENSEE: BAYLOR ALL SAINTS MED CENTER, MEDI-PH|NOTIFICATION TIME: 11:35[EDT]|
| CITY: FORT WORTH, DALLAS REGION: 4 |EVENT DATE: 09/25/2002|
| COUNTY: STATE: TX |EVENT TIME: 11:30[CDT]|
|LICENSE#: L2212, L05529 AGREEMENT: Y |LAST UPDATE DATE: 10/15/2002|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |GREG PICK R4 |
| |WAYNE HODGES NMSS |
+------------------------------------------------+ |
| NRC NOTIFIED BY: HELEN WATKINS | |
| HQ OPS OFFICER: MIKE RIPLEY | |
+------------------------------------------------+ |
|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|NAGR AGREEMENT STATE | |
| | |
| | |
| | |
| | |
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EVENT TEXT
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| PERSONNEL CONTAMINATION AND EXCESSIVE PACKAGE LEVELS AT NUCLEAR MEDICINE |
| FACILITIES |
| |
| "A 300 millicurie multidose glass vial of technetium-99m was dropped on the |
| floor at about 11:30 am [September 25, 2002] in a hot lab area at Baylor by |
| a nuclear medicine technologist. About 40% of the vial contents spilled on |
| the tech's pants, legs, and shoes. The initial radiation reading on the |
| tech's clothing was 35.2 [millirem]/hr. An initial wipe test of the floor |
| gave a reading of 81,012 dpm. The floor was decontaminated using radiowash |
| until radiation wipe levels were at 366 dpm and the survey meter detected |
| 1.8 [millirem]/hr. The tech's clothing were placed in storage for decay. |
| |
| "An outgoing nuclear medicine ammo box was about three feet from the spill. |
| The box was labeled and had been surveyed and was ready for pickup by the |
| nuclear pharmacy, Medi-Physics. The technologist did not believe the spill |
| had contaminated the ammo box and did not perform an additional survey of |
| it. The ammo box was picked up by a courier for the nuclear pharmacy. The |
| courier picked up the ammo box by using the keypad lock to access the |
| unoccupied hot lab as was his normal routine. |
| |
| "At around 1:00pm, as the courier was leaving the Medi-Physics facility, he |
| surveyed his hands and noticed radiation readings. Both palms were |
| contaminated and so was his shirt and pants. The hands gave readings of 8340 |
| cpm's. The courier was decontaminated to approximate background levels. The |
| only package picked up and transported by the courier was the ammo box from |
| Baylor. The nuclear pharmacy contacted Baylor and notified the State. |
| |
| "The ammo box radiation readings were 2,664,800 cpm's and the main area of |
| contamination read 150 [millirem]/hr. The courier vehicle showed |
| contamination on the door handle, radio knob, steering wheel, and gear |
| shift. Radiation readings were in the range of 81,649 cpm's. The ammo box |
| was placed in storage for decay. The vehicle was quarantined, decontaminated |
| to background revels, and returned to service the following day. |
| |
| "Additional information will be provided to the Agency in the Licensee's |
| written report. An onsite investigation by the Texas Department of Health |
| Bureau of Radiation Control identified items of noncompliance with Agency |
| regulations." |
| |
| Texas Incident No. I-7938 |
| |
| Medi-Physics, Inc (doing business as Amersham Health of Dallas) Dallas, TX |
| - License No. L05529 |
| BaylorAll Saints Med Center, Ft. Worth, TX - License No. L02212 |
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|General Information or Other |Event Number: 39289 |
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| REP ORG: ARIZONA RADIATION REGULATORY AGENCY |NOTIFICATION DATE: 10/15/2002|
|LICENSEE: CONSTRUCTION INSPECTION AND TESTING |NOTIFICATION TIME: 19:18[EDT]|
| CITY: TEMPE REGION: 4 |EVENT DATE: 10/15/2002|
| COUNTY: STATE: AZ |EVENT TIME: 15:25[MST]|
|LICENSE#: 7-98 AGREEMENT: Y |LAST UPDATE DATE: 10/15/2002|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |GREG PICK R4 |
| |M. WAYNE HODGES NMSS |
+------------------------------------------------+ |
| NRC NOTIFIED BY: AZ RAD REGULATORY AGENCY | |
| HQ OPS OFFICER: GERRY WAIG | |
+------------------------------------------------+ |
|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|NAGR AGREEMENT STATE | |
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EVENT TEXT
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| AGREEMENT STATE - LOST OR STOLEN TROXLER MOISTURE DENSITY GAUGE |
| |
| "Description of event: The licensee reported the loss of a Troxler |
| moisture/density gauge sometime between 1030 and 1115 on 15 October after |
| the technician left a job site in the vicinity of Cactus and 151st Ave. The |
| gauge had been in the back of a pickup with the tailgate down. The gauge did |
| not have a handle lock. A search of his route for several hours failed to |
| turn up the gauge. The gauge is a Troxler Model 3400 series, serial number |
| 29519. It contains approximately 10 millicuries of cesium 137 and |
| approximately 50 millicuries of americium-beryllium. The company is offering |
| a $250 reward for information leading to the return of the gauge and truck. |
| |
| "The U.S. NRC, FBI, Mexico, and the states of Colorado, Nevada, Utah, New |
| Mexico and California are being informed of this incident." |
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|General Information or Other |Event Number: 39290 |
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| REP ORG: COLORADO DEPT OF HEALTH |NOTIFICATION DATE: 10/15/2002|
|LICENSEE: MIDWEST INSPECTION SERVICES |NOTIFICATION TIME: 19:15[EDT]|
| CITY: DENVER REGION: 4 |EVENT DATE: 10/14/2002|
| COUNTY: STATE: CO |EVENT TIME: [MDT]|
|LICENSE#: CO 902-01 AGREEMENT: Y |LAST UPDATE DATE: 10/15/2002|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |GREG PICK R4 |
| |M. WAYNE HODGES NMSS |
+------------------------------------------------+ |
| NRC NOTIFIED BY: TIM BONZER (VIA FAX) | |
| HQ OPS OFFICER: STEVE SANDIN | |
+------------------------------------------------+ |
|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|NAGR AGREEMENT STATE | |
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EVENT TEXT
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| AGREEMENT STATE REPORT INVOLVING INDUSTRIAL RADIOGRAPHY INCIDENT |
| |
| The following information was documented as a telecon "to file" received by |
| State of Colorado staff: |
| |
| "Received phone notification today from Jeff Conners at Midwest Inspection |
| Services concerning a source disconnect incident that happened yesterday, |
| 10/14/02. Mr. Conners reported a radiography crew, working at a field site |
| north of Denver, was unable to retract an Iridium-192 radiography source |
| back into the camera. The radiographers called Mr. Conners, who is the |
| assistant Radiation Safety Officer, for help. Mr. Conners reported that he |
| responded to the scene and was successful in connecting the source assembly |
| to the drive cable and retracting it back into the radiography camera. He |
| also responded that there were no overexposures to the radiography crew or |
| members of the public. Mr. Conners estimated his exposure for the recovery |
| operation to be about 500 millirem, based on his pocket dosimeter readings. |
| He stated that he would send a detailed written report to the Department |
| within 30 days. The corporate RSO, David Ezell, was also notified of the |
| incident." |
| |
| Contact the Headquarters Operations Officer for additional information. |
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|General Information or Other |Event Number: 39293 |
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| REP ORG: OR DEPT OF HEALTH RAD PROTECTION |NOTIFICATION DATE: 10/16/2002|
|LICENSEE: GEOCON NORTHWEST INC |NOTIFICATION TIME: 14:04[EDT]|
| CITY: BEAVERTON REGION: 4 |EVENT DATE: 10/16/2002|
| COUNTY: STATE: OR |EVENT TIME: [PDT]|
|LICENSE#: ORE-90921 AGREEMENT: Y |LAST UPDATE DATE: 10/16/2002|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |GREG PICK R4 |
| |THOMAS ESSIG NMSS |
+------------------------------------------------+ |
| NRC NOTIFIED BY: TERRY LINDSEY | |
| HQ OPS OFFICER: GERRY WAIG | |
+------------------------------------------------+ |
|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|NAGR AGREEMENT STATE | |
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| | |
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EVENT TEXT
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| STOLEN VEHICLE AND TROXLER MOISTURE DENSITY GAUGE |
| |
| On the evening 10/15/02 or the early morning of 10/16/02 a 1987 red Toyota 4 |
| Runner storing a Troxler moisture density gauge was stolen from the |
| residence of an authorized user. The local police were notified of the theft |
| at approximately 0800 PDT and the Oregon Radiation Protection Services at |
| 0855 PDT on 10/16/02. The gauge is a Troxler model 3440 serial number 26707 |
| and contains an 8 millicurie Cs-137 source, serial number 75-9841, and a 40 |
| millicurie Am-241:Be source, serial number 47-23181. The licensee is GEOCON |
| Northwest Inc., 8380 Southwest Ave., Beaverton, OR 97008. Oregon Radiation |
| Protection Services will notify NRC Region 4 and plans to make a press |
| release for this event. The Oregon event number for this incident is 020041. |
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|Fuel Cycle Facility |Event Number: 39301 |
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| FACILITY: PADUCAH GASEOUS DIFFUSION PLANT |NOTIFICATION DATE: 10/17/2002|
| RXTYPE: URANIUM ENRICHMENT FACILITY |NOTIFICATION TIME: 23:30[EDT]|
| COMMENTS: 2 DEMOCRACY CENTER |EVENT DATE: 10/17/2002|
| 6903 ROCKLEDGE DRIVE |EVENT TIME: 16:40[CDT]|
| BETHESDA, MD 20817 (301)564-3200 |LAST UPDATE DATE: 10/18/2002|
| CITY: PADUCAH REGION: 3 +-----------------------------+
| COUNTY: McCRACKEN STATE: KY |PERSON ORGANIZATION |
|LICENSE#: GDP-1 AGREEMENT: Y |THOMAS KOZAK R3 |
| DOCKET: 0707001 |M. WAYNE HODGES NMSS |
+------------------------------------------------+NADER MAMISH IRO |
| NRC NOTIFIED BY: K. A. BEASLEY | |
| HQ OPS OFFICER: ARLON COSTA | |
+------------------------------------------------+ |
|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|NBNL RESPONSE-BULLETIN | |
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EVENT TEXT
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| 24-HOUR 91-01 BULLETIN RESPONSE NOTIFICATION |
| |
| "At 1708 on 10-17-02, the Plant Shift Superintendent (PSS) was notified that |
| potentially fissile (PF) waste had been discovered improperly stored at the |
| Wet Air Pump station in the C-333 building. A pile of used absorbent pads |
| was found in the floor at the West Air station. The absorbent pads are used |
| to soak up oil that has leaked from the pumps. These pads should have been |
| placed in an AQ-NCS approved 5.5 gallon drum and controlled as PF waste as |
| they were picked up. This is a violation of the requirements of NCSA |
| GEN-15. |
| |
| "The NRC Resident inspector has been notified of this event. |
| |
| "SAFETY SIGNIFICANCE OF EVENTS: The used absorbent pads were accumulated |
| incorrectly; however the uranium concentration for heterogeneous waste is |
| low and a large quantity of heterogeneous fissile material would be required |
| for a criticality to occur. |
| |
| "PATHWAYS INVOLVED: In order for a criticality to be possible, the |
| interaction process condition would also have to be violated. However, the |
| interaction control was maintained and therefore a criticality was not |
| possible. |
| |
| "CONTROLLED PARAMETERS: The two process conditions relied upon for double |
| contingency for this scenario are interaction and geometry. |
| |
| "NUCLEAR CRITICALITY SAFETY CONTROL(S) OR CONTROL SYSTEMS(S) AND DESCRIPTION |
| OF THE FAILURES OR DEFICIENCIES: The first leg of double contingency is |
| based on a minimum 2 ft. edge-to-edge spacing requirement to ensure double |
| contingency for spacing violations involving waste drums end other items |
| containing fissile/potentially fissile material. This control was not |
| violated. |
| |
| "The second leg of double contingency is based on geometry controls of the |
| waste when it is placed into an AQ-NCS approved waste drum and the secondary |
| containment pans used to store the drums. Since the waste was accumulated on |
| the floor and not into the NCS-approved container, this control was |
| violated. The process condition was not maintained and double contingency |
| was not maintained |
| |
| "Since the used absorbent pads were not generated into an AQ-NCS approved |
| waste container, the process condition for waste accumulation was not |
| maintained. Therefore, double contingency was not maintained. |
| |
| "CORRECTIVE ACTIONS: A buffer area has been established to control movement |
| of fissile material within the area. A remediation guide will be prepared by |
| NCS prior to removal of the used absorbent pads. |
| |
| *****UPDATE ON 10/18/02 AT 2120 FROM BEASLEY TO LAURA***** |
| |
| "As a result of continued evaluation, it was discovered that the pile of |
| absorbent pads was with 2 feet of the 4 inch diameter wet air header. |
| Therefore the minimum 2-foot spacing control has also been violated. Even |
| though the spacing control was violated, the existing configuration is |
| bounded by analysis, and it is acceptable to continue to use the header |
| piping within 2-feet of the pile of absorbent pads. |
| |
| "While approved analysis does exist to safely bound the current violation |
| configuration, both controls relied upon for the safe generation and |
| handling of potentially fissile waste material were violated. |
| |
| "In order for a criticality to be possible, an additional violation would |
| have to occur resulting in an unsafe mass of fissile material accumulating |
| in an unsafe geometry. |
| |
| "Approved analysis exists which bounds the existing configuration and |
| demonstrates it is subcritical. However, the process conditions for waste |
| accumulation were not maintained. Therefore, double contingency was not |
| maintained." |
| |
| Notified NMSS (HODGES). |
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|Other Nuclear Material |Event Number: 39302 |
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| REP ORG: US ARMY |NOTIFICATION DATE: 10/18/2002|
|LICENSEE: US ARMY |NOTIFICATION TIME: 09:52[EDT]|
| CITY: FT BRAGG REGION: 2 |EVENT DATE: 10/17/2002|
| COUNTY: STATE: NC |EVENT TIME: [EDT]|
|LICENSE#: 19-30563-01 AGREEMENT: Y |LAST UPDATE DATE: 10/18/2002|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |KEN BARR R2 |
| | |
+------------------------------------------------+ |
| NRC NOTIFIED BY: KUYKENDALL | |
| HQ OPS OFFICER: CHAUNCEY GOULD | |
+------------------------------------------------+ |
|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|BLO2 20.2201(a)(1)(ii) LOST/STOLEN LNM>10X | |
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EVENT TEXT
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| POSSIBLE LOST/STOLEN CHEMICAL AGENT DETECTOR |
| |
| The licensee is investigating the circumstances involving a chemical agent |
| detector being turned in to the Military Police (MP's) by the spouse of a |
| serviceman stationed at Fort Bragg NC. The CAD, containing 15 millicuries |
| of Ni-63, was being kept at the serviceman's home. The Army is trying to |
| determine if the device was stolen . |
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|Power Reactor |Event Number: 39303 |
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| FACILITY: QUAD CITIES REGION: 3 |NOTIFICATION DATE: 10/19/2002|
| UNIT: [1] [] [] STATE: IL |NOTIFICATION TIME: 05:27[EDT]|
| RXTYPE: [1] GE-3,[2] GE-3 |EVENT DATE: 10/18/2002|
+------------------------------------------------+EVENT TIME: 21:30[CDT]|
| NRC NOTIFIED BY: JOHN LECHMAIER |LAST UPDATE DATE: 10/19/2002|
| HQ OPS OFFICER: MIKE NORRIS +-----------------------------+
+------------------------------------------------+PERSON ORGANIZATION |
|EMERGENCY CLASS: NON EMERGENCY |THOMAS KOZAK R3 |
|10 CFR SECTION: | |
|AIND 50.72(b)(3)(v)(D) ACCIDENT MITIGATION | |
| | |
| | |
| | |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|1 N Y 100 Power Operation |100 Power Operation |
| | |
| | |
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EVENT TEXT
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| RCIC HIGH STEAM FLOW ISOLATION INSTRUMENTATION INOPERABLE DUE TO BEING OUT |
| OF TOLERANCE |
| |
| "At 2130 hours CDT on 10/18/2002, the U1 RCIC High Steam Flow Isolation |
| Instrumentation was determined to have been inoperable. Both U1 RCIC High |
| Steam Flow switches were found to be outside their Technical Specification |
| Allowable Value during a calibration surveillance. Both U1 RCIC High Steam |
| Flow switches were subsequently recalibrated back to within their Technical |
| Specification Allowable Value. |
| |
| "This notification is being made in accordance with 10CFR50.72(b)(3)." |
| |
| The NRC Resident Inspector has been notified. |
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|Power Reactor |Event Number: 39304 |
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| FACILITY: FERMI REGION: 3 |NOTIFICATION DATE: 10/19/2002|
| UNIT: [2] [] [] STATE: MI |NOTIFICATION TIME: 11:55[EDT]|
| RXTYPE: [2] GE-4 |EVENT DATE: 10/19/2002|
+------------------------------------------------+EVENT TIME: 10:15[EDT]|
| NRC NOTIFIED BY: JEFF GROFF |LAST UPDATE DATE: 10/19/2002|
| HQ OPS OFFICER: MIKE NORRIS +-----------------------------+
+------------------------------------------------+PERSON ORGANIZATION |
|EMERGENCY CLASS: NON EMERGENCY |THOMAS KOZAK R3 |
|10 CFR SECTION: | |
|ACOM 50.72(b)(3)(xiii) LOSS COMM/ASMT/RESPONSE| |
| | |
| | |
| | |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|2 N Y 100 Power Operation |100 Power Operation |
| | |
| | |
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EVENT TEXT
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| LOSS OF ENS AND COMMERCIAL TELECOMMUNICATIONS |
| |
| "At 10:15 on 10/19/02, the ENS and commercial telecommunications capability |
| to dial offsite was found to be non-functioning. Communications to outside |
| agencies have been verified using the microwave lines (RERP lines). The |
| cause of the problem is not yet determined, however, the local |
| telecommunications company is investigating." |
| |
| The NRC Resident Inspector was notified. |
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|Power Reactor |Event Number: 39305 |
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| FACILITY: MILLSTONE REGION: 1 |NOTIFICATION DATE: 10/19/2002|
| UNIT: [] [2] [] STATE: CT |NOTIFICATION TIME: 14:14[EDT]|
| RXTYPE: [1] GE-3,[2] CE,[3] W-4-LP |EVENT DATE: 10/19/2002|
+------------------------------------------------+EVENT TIME: 13:47[EDT]|
| NRC NOTIFIED BY: BARRY DOE |LAST UPDATE DATE: 10/19/2002|
| HQ OPS OFFICER: ARLON COSTA +-----------------------------+
+------------------------------------------------+PERSON ORGANIZATION |
|EMERGENCY CLASS: NON EMERGENCY |KENNETH JENISON R1 |
|10 CFR SECTION: | |
|ASHU 50.72(b)(2)(i) PLANT S/D REQD BY TS | |
| | |
| | |
| | |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE |
+-----+----------+-------+--------+-----------------+--------+-----------------+
| | |
|2 N Y 100 Power Operation |99 Power Operation |
| | |
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EVENT TEXT
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| TECH SPEC REQUIRED SHUTDOWN |
| |
| "Millstone U2 Initiation of plant shutdown as required by Technical |
| Specifications 10CFR50(b)(2)(i)" |
| |
| Power supply to the Engineering Safeguards Activation System was replaced |
| and tested satisfactory. Unit will subsequently return back to full power. |
| |
| The licensee notified the NRC Resident Inspector. |
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