💾 Archived View for federal.cx › nukenews.gmi captured on 2023-03-20 at 17:46:45. Gemini links have been rewritten to link to archived content
⬅️ Previous capture (2023-01-29)
-=-=-=-=-=-=-
8b,dPPYba, ,adPPYba, 8b db d8 ,adPPYba, 88P' `"8a a8P_____88 `8b d88b d8' I8[ "" 88 88 8PP""""""" `8b d8'`8b d8' `"Y8ba, 88 88 "8b, ,aa `8bd8' `8bd8' aa ]8I 88 88 `"Ybbd8"' YP YP `"YbbdP"'
Site Name - City Name State Cd
Report Date Notification Dt Notification Time
Event Date Event Dt Event Time
Event Text
--------------------
Texas Dept of State Health Services - Round Rock TX
Report Date 06/13/2022 17:48:00
Event Date 06/13/2022 0:00:00
EN Revision Imported Date: 2/23/2023
EN Revision Text: AGREEMENT STATE REPRT - STOLEN TRUCK CONTAINING A MOISTURE DENSITY GAUGE
The following was reported by the Texas Department of State Health Services (the Agency) via email:
"On June 13, 2022, the licensee notified the Agency that on Friday, June 10, 2022, a truck containing a Insto Tek 3500 moisture density gauge was stolen. The gauge contained a 44 millicurie americium-241 source, and an 11 millicurie cesium-137 source. The licensee reported that the technician had stopped at a convenience store to buy some items and when they came back out the truck was missing. The licensee stated the gauge was locked in the back of the truck but was unsure if the keys to the locks were also taken. The licensee stated the gauge has an old [Global Positioning System] (GPS) tracking device that was inactive. The licensee stated they had contacted the GPS service company to see if the tracking device was still active and the gauge tracked that way. The licensee stated it would take up to 24 hours to determine if the tracking device could be used. The licensee stated the local police was notified of the theft. The individual who contacted the Agency stated they had not interviewed the technician about the event so some of the information requested by the Agency was unknown. Additional information will be provided as it is received in accordance with SA-300."
Texas Incident Number: 9934
"On June 13, 2022, the licensee notified the Agency that a pickup truck with a Instro Tek 3500 moisture/density gauge had been stolen on June 10, 2022, when the technician left the truck running with the doors locked. The secured gauge in the back of the truck contained a 10 millicurie cesium-137 source and a 40 millicurie americium-241/beryllium source. The truck was recovered and was partially stripped for parts. The gauge was missing. The source was locked, however, the keys to the gauge were in the pickup truck. The licensee conducted training on security of the gauge and not leaving trucks running even if the gauge is properly secured. The company is purchasing GPS tracking units to install on the gauges. On Feb 21, 2023, the licensee reported to the Agency that the gauge was found on February 20, 2023, in the back of a stolen U-Haul truck. The licensee has the gauge in their possession and the gauge is in good condition."
Notified R4DO (Roldan-Otero), NMSS Events Notification, and ILTAB 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
--------------------
Texas Dept of State Health Services - Humble TX
Report Date 07/12/2022 16:10:00
Event Date 07/12/2022 12:30:00
EN Revision Imported Date: 2/10/2023
EN Revision Text: AGREEMENT STATE REPORT - STOLEN MOISTURE DENSITY GAUGE
The following information was provided via email:
"On July 12, 2022, the licensee notified the Agency that around 1230 CDT, a Humboldt 5001EZ Moisture Density Gauge containing a 40 milliCurie Americium-241 source and a 10 milliCurie Cesium-137 source was stolen out of the back of a company truck. The licensee reported that the technician returned to the site office, he unlocked the moisture density gauge transit case. He then got distracted and went into the office. When he went back outside the case was still chained to the truck but when he opened the case the gauge was missing. The gauge was unlocked. LLE [Local Law Enforcement] was notified. Additional information will be provided as it is received in accordance with SA-300."
Texas Incident number: 9939
"On July 12, 2022, the licensee notified the Agency that a Humboldt 5001EZ moisture density gauge, serial number 3716, was stolen out of the transport case in the back of a pickup at the licensee's site office. The gauge contained an 10 millicurie cesium-137 source and a 40 millicurie americium-241/beryllium source. The technician had unlocked the transport case, got distracted and went into the office. When he came back outside the gauge was no longer in the case. The investigation was completed on August 17, 2022, and two violations were cited. On February 2, 2023, the Agency was notified by the NRC that a Moisture Density Gauge was posted for sale on eBay. The Agency contacted the seller and determined that it was the stolen gauge and the licensee retrieved the gauge on February 8, 2023. The seller found the gauge in a dumpster behind a retail store. The gauge was inspected and a leak test was conducted. The gauge operates properly."
Notified R4DO (Gaddy), NMSS Events Notification, ILTAB, and CNSNS (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
--------------------
Fermi - Newport MI
Report Date 08/31/2022 11:56:00
Event Date 08/31/2022 0:30:00
EN Revision Imported Date: 2/15/2023
EN Revision Text: FITNESS FOR DUTY REPORT
A contract supervisor refused to provide a specimen during a fitness-for-duty test. The employee's access to the plant has been terminated.
The licensee notified the NRC Resident Inspector.
--------------------
Curtiss-Wright Nuclear Division - Cincinnati OH
Report Date 11/30/2022 13:53:00
Event Date 11/22/2022 0:00:00
EN Revision Imported Date: 2/7/2023
EN Revision Text: PART 21 REPORT - INTERIM REPORT FOR EATON TRM5 TIMING RELAYS
The following is a summary of information provided by the Curtiss-Wright Nuclear Division via email:
QualTech NP discovered the presence of a programmable logic device (a flash-based CMOS (complementary metal-oxide-semiconductor) microcontroller) in the timing relays that was not previously identified for this family of relays. The only affected facility is Perry Nuclear Plant. This could potentially lead to unevaluated electromagnetic interference or radiofrequency interference issues when installed in the plant.
For questions concerning this potential 10 CFR 21 issue, please contact: Tim Franchuk Quality Assurance Director QualTech NP, Curtiss-Wright Nuclear Division (513) 528-7900, ext. 176
QualTech NP provided an update identifying other facilities that are affected by the Eaton TMR5 timing relays. The other affected facilities are Calvert Cliffs, Beaver Valley, Diablo Canyon, Arkansas Nuclear One, and Comanche Peak.
Notified R1DO (Cahill), R4DO (Gaddy), R3DO (Szwarc) via phone and the Part 21 group via email.
--------------------
SC Dept of Health & Env Control - Jackson SC
Report Date 01/05/2023 15:08:00
Event Date 12/07/2022 16:36:00
EN Revision Imported Date: 3/1/2023
EN Revision Text: AGREEMENT STATE REPORT - STUCK SHUTTER AND INDICATOR FAILURE
The following information was provided by the South Carolina Department of Health and Environmental Control (the Department) via email:
"The South Carolina Department of Health and Environmental Control was notified via email at 1636 [EST] on 12/7/2022, that during a routine shutter check, a general licensed fixed gauging device was stuck in the closed position (fail-safe). The licensee reported that the general licensed fixed gauge device is a Kr-85 Thermo EGS Gauging Model SCL-77A (housing serial number 65675-2), with an activity of 37 gigabecquerels (1000 millicuries). Department inspectors were dispatched to the facility on 12/21/2022 to perform an on-site investigation. At the time of the visit, the licensee had already taken action by contacting a licensed vendor to repair the fixed gauge, and the gauge was placed back in service. The licensee also indicated that for the duration that the gauging device was stuck in the closed position, the production line was shut down, and the device was removed from service. Dose rate surveys of the fixed gauging device were performed by Department inspectors and indicated readings below the external radiation levels outlined in the sealed source and device registry.
"The South Carolina Department of Health and Environmental Control was also notified on 01/04/2023, that a separate general licensed fixed gauge device indicator had failed on 09/26/2022. The licensee reported that the general licensed fixed gauge device is a Sr-90 NDC Technologies Model 301 (housing serial number 8778), with an activity of 0.37 gigabecquerels (10 millicuries). The licensee reported the device has been repaired."
South Carolina Event Report ID No: EN 56297
The following update was provided by the Department via email:
"The information for the sealed source housed in the Thermo EGS Gauging device model SCL-77A, serial number 65675-2, is as follows: Kr-85, Amersham Model No. KAC.D1 (serial number RH443). (NMED Item No. 230011)
"The indicator was repaired on the same day of the discovery of the failure by Pactiv Corporation. In order to complete the record, the Department has sent a request for additional information to the registrant to obtain the model and serial numbers for the sealed source housed in the Sr-90 NDC Technologies, Model 301 gauging device (serial number 8778). (NMED Item No. 230012)
"At this time, both [NMED] events are considered still under investigation."
Notified R1DO (Lally) and NMSS Events Notification via email.
* * * UPDATE ON FEBRUARY 28, 2023, AT 1517 EST FROM K. KOCI TO E. WEST * * *
"(NMED Item No. 230012) The model number of the Sr-90 sealed source housed in the NDC Technologies Model 301 gauging device is AEA Technology model number SIF.D1 (serial number NC406).
"Both events (NMED Item No. 230011 and NMED Item No. 230012) are now considered closed."
Notified R1DO (Bickett) and NMSS Events Notification via email.
--------------------
Illinois Emergency Mgmt. Agency - Waukegan IL
Report Date 01/05/2023 16:35:00
Event Date 09/30/2022 0:00:00
EN Revision Imported Date: 2/16/2023
EN Revision Text: AGREEMENT STATE REPORT - POTENTIAL OVEREXPOSURE
The following information was provided by the Illinois Emergency Management Agency (the Agency) via email:
"On December 28, 2022, the [Radiation Safety Officer] RSO for Vista Medical Center East (RML IL-01076-01, Waukegan IL) emailed a letter to the Agency indicating a nuclear medicine technologist received a whole body dose of approximately 11,307 millirem over the third quarter of 2022. The licensee initiated an investigation and does not believe the exposures indicated on the employee's badge represent a true dose to the nuclear medicine technologist. However, no clear evidence has been provided to the Agency that yet substantiates the licensee's position. As such, the Agency is currently treating this as a reportable occupational exposure. Based on the information available, this exposure does not appear to be related to contamination events, exposure to radiation-producing machines, or a single static exposure to a stationary source. The employee, reportedly, is not working at other licensed facilities. The last seven years of dosimetry for this employee consistently show total annual occupational exposures at or near 10% of the annual limits. Job duties have reportedly not changed.
"Agency inspectors will conduct a reactionary inspection on Monday, January 9, 2023. Inspectors will pursue any additional data which may support the licensee's claims that this was not an overexposure incident. The appropriateness of the technologists continued duties under the license, and sustained occupational exposures, will then be reviewed. Finally, inspectors will review noncompliance with Agency rules for timely reporting (32 Ill. Adm. Code 340.1230)."
Illinois Report Item Number: IL230001
"Agency inspectors conducted a reactionary inspection on January 9, 2023, to pursue any additional data which may support the licensee's claims that this was not an overexposure incident and to review the appropriateness of the technologists continued duties under the license and sustained occupational exposures. Inspectors also reviewed noncompliance with Agency rules for timely reporting (32 Ill. Adm. Code 340.1230).
"Expressed concerns of potential tampering and/or intentional exposure of badges were investigated. However, no evidence could be provided and the licensee elected not to make a formal allegation. No additional information to support the licensee's claims that the exposure was not valid were obtained during the 1/9/2023, reactionary inspection or through additional documentation provided to the Agency. As such the exposures will remain on the individual's exposure record as reported. Inspectors initiated dialogue with the dosimetry processor to determine root cause. Contamination seems unlikely as the dosimeters are screened for gamma radiation upon intake, however, the processor believes the badges were exposed to angular, shielded or collimated radiation. Re-analysis supported the initial exposure reports. The licensee was cited for failing to report timely, failing to limit occupational doses to 5 rem, failing to restrict the employee's additional occupational exposures for the remainder of the year, and failure of the RSO to initiate timely investigation. Required written report received 1/27/23. Pending satisfactory address of the Notice of Violation, this matter may be considered closed."
Notified R3DO (Dickson) and NMSS Events Notification via email
--------------------
Hartford Hospital - Hartford CT
Report Date 01/20/2023 9:18:00
Event Date 01/19/2023 10:00:00
EN Revision Imported Date: 2/2/2023
EN Revision Text: POTENTIAL MEDICAL EVENT
The following is a summary of information provided by the licensee via email and phone:
A patient, accompanied by her daughter who is the patient's preferred translator, was receiving the first of four Lutathera infusions. The physician, registered nurse, nuclear medicine personnel and radiological safety team members were present for the infusion. The Lutathera infusion was performed per protocol without any issue. Post infusion it was determined through the patient's daughter that the patient had had a lanreotide injection last week on 1/12/23. Per protocol Lutathera is to be given four weeks after a lanreotide/octreotide injection has been administered.
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.
The following information was provided by the licensee via telephone:
Further review from hospital staff in coordination with NRC Medical Health Team determined this is not a medical event.
Notified R1DO (Lally) and NMSS (email).
--------------------
California Radiation Control Prgm - San Diego CA
Report Date 01/25/2023 16:15:00
Event Date 12/23/2022 0:00:00
AGREEMENT STATE REPORT - LOST/STOLEN TROXLER GAUGE
The following information was provided by the California Department of Public Health - Radiation Health Branch (RHB) via email:
"On December 23, 2022, an authorized user of Nova Services, Inc. completed his use of radioactive Troxler 3430 gauge, serial number-32415 and returned it to the temporary storage location [Redacted] in Marina Del Rey, CA. The radioactive gauge was stored until the next time needed for for a work project in Marina Del Rey on January 24, 2023, at which time the authorized user discovered that the radioactive gauge was not in the storage unit, and reported the loss/theft to his Field Supervisor. The Field Supervisor reported the theft to an Inspector from the [Radiologic Health Branch - Radioactive Materials Inspection, Investigation, Compliance, and Enforcement Section] RHB-ICE Brea Regional office. The investigation is ongoing to determine the status of the radioactive gauge and will be reported to the local law enforcement agency, as well as contacting local newspapers in an attempt to retrieve the stolen radioactive gauge, and notifying local servicing vendors of radioactive gauges to be alert for the serial number of the stolen gauge in case it turns up for service. The gauge has not been recovered.
"California 5010 Number: 012423"
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
--------------------
Mississippi Div of Rad Health - Hamilton MS
Report Date 01/26/2023 13:20:00
Event Date 01/23/2023 0:00:00
AGREEMENT STATE REPORT - STUCK SHUTTER The following information was provided by the Mississippi Division of Radiological Health via email:
"During routine preventive maintenance on 1/23/2023, Tronox, LLC, discovered a stuck shutter on their Ohmart SHF-1-0, serial number 2641GK, 10mCi Cs-137. The shutter is stuck in its normal operating position.
"Using a Ludlum model 2241-2, serial number 313844 with a Ludlum Model 44-2 detector, the licensee measured 150 microrem/hr at 1 meter from the source and 1.4 millirem/hr at the surface.
"The gauge is mounted on an elevated platform in a process area. The area is not a routinely occupied work area and restrictions have been posted. The stuck shutter appears to be caused by corrosion. The licensee is working on a timeline for the repair.
"Mississippi Event Number: MS-230001"
--------------------
Louisiana DEQ - Lafayette LA
Report Date 01/31/2023 17:14:00
Event Date 10/26/2022 0:00:00
AGREEMENT STATE REPORT - OVEREXPOSURE TO THE FETUS
The following report was received by the Louisiana Department of Environmental Quality [the Department]:
"On January 31, 2023, University Hospital & Clinics, Inc. notified the Department of a Nuclear Medicine Event. A patient back on October 26, 2022, was being treated with thyroid ablation with isotope I-131 with an activity of 30 mCi. The patient was found out to be pregnant at eleven weeks at the time of treatment. The physicist determined that the fetus received 5 rads."
Louisiana Event Report Number: LA20230001
--------------------
Clinton - Clinton IL
Report Date 02/01/2023 1:40:00
Event Date 01/31/2023 23:43:00
AUTOMATIC SCRAM DUE TO TURBINE TRIP
The following information was provided by the licensee via fax and telephone:
"Generator trip due to power load unbalance which caused a turbine trip and subsequent reactor scram. Experienced a trip on circulating water pump A.
"NRC Resident Inspector notified."
The following additional information was obtained from the licensee in accordance with Headquarters Operations Officers Report Guidance:
Off-site power available and unaffected. Decay heat removal via main steam line and drains to condenser. Plant is stable in mode 3.
--------------------
Farley - Ashford AL
Report Date 02/01/2023 13:40:00
Event Date 02/01/2023 9:56:00
EN Revision Imported Date: 2/3/2023
EN Revision Text: AUTOMATIC REACTOR TRIP DUE AND AUTOMATIC ACTUATION OF AUXILIARY FEEDWATER SYSTEM
The following information was provided by the licensee via email:
"At 0956 CST with Unit 1 in Mode 1 at 100 percent power, the reactor automatically tripped due to a turbine trip. The trip was not complex with all safety related systems responding normally post-trip. During the trip, the non safety related '1A' 4160V bus lost power resulting in the loss of one Reactor Coolant Pump (RCP-1A). Operations responded and stabilized the plant. The '1A' 4160V bus was re-energized at 1031 CST. Decay heat is being removed by steam dumps to the main condenser. Farley Unit 2 is not affected.
"An automatic actuation of [Auxiliary Feedwater] AFW also occurred, which is an expected response from the reactor trip.
"Due to the Reactor Protection System actuation while critical, this event is being reported as a four-hour, non-emergency notification per 10 CFR 50.72(b)(2)(iv)(B) and an eight-hour report per 10 CFR 50.72(b)(3)(iv)(A) as an event that results in a valid actuation of the Auxiliary Feedwater System.
"There was no impact on the health and safety of the public or plant personnel. The NRC Resident Inspector has been notified."
--------------------
Utah Division of Radiation Control - Murray UT
Report Date 02/01/2023 14:23:00
Event Date 01/31/2023 14:45:00
AGREEMENT STATE REPORT - LIQUID RADIOACTIVE CONTAMINATION
The following information was provided by Utah Department of Environmental Quality, Division of Waste Management [the Division] and Radiation Control, via email:
"On January 31, 2023 at 1600 MST, the Intermountain Heart Institute, Cardiac Molecular Imaging Coordinator reported to the RSO [Radiation Safety Officer] that at 1445 MST a technologist, removing a Rb-82 (rubidium-82) generator from service, found liquid radioactive contamination in the bottom of the well chamber of the Infusion System. A syringe was used to remove the saline from the well of the Infusion System and the liquid was placed in the liquid radioactive liquid waste storage. Decontamination procedures were followed. The Infusion System well was wiped dry with paper towel(s). All radioactive waste was placed in approved radioactive waste storage. Wipe test(s) were performed.
"This incident has no impact on patient treatment. All Quality Control procedures passed while the generator was in use which verifies that patient treatments were within all requirements.
"The manufacturer was contacted for assistance and it is planned that the generator will be shipped back for investigation. We will follow the manufacturer's instructions for the shipment. A new generator has been placed in the Infusion System so that patient care can continue today.
"The Division will investigate this matter and update the record upon completion of the investigation."
Utah Event Report ID No.: UT23-0002
--------------------
Univ Of California Davis Mcclellan (CALD) - Sacramento CA
Report Date 02/01/2023 16:51:00
Event Date 01/31/2023 0:00:00
LIMITING CONDITION OF OPERATION NOT MET
The following information was provided by the licensee via email:
"[University of California, Davis McClellan Nuclear Research Center] MNRC received its new 20 year operating license from the NRC on November 21, 2022. As part of the new license, several new conditions in the technical specification were added for consistency with other non-power reactors and to give greater assurances of public safety beyond the previous technical specifications.
"The license condition involved in this event is Technical Specification 3.3 specification 4 concerning the maximum allowable activity of radionuclides in MNRC's primary cooling water with half-lives greater than 24 hours. The specific requirement is that these radionuclide concentrations shall be less than the 10 CFR 20 Appendix B table 3 values for the reactor to be operated. When agreeing to this new technical specification, MNRC staff looked at the historical values for all non-tritium nuclides having half-lives greater than 24 hours. These nuclides are assayed at MNRC via high resolution gamma-ray spectroscopy. For these nuclides MNRC is able to meet the new [limiting condition of operation] LCO limit easily. Separately, MNRC staff evaluated the tritium activity that was provided to MNRC via a 3rd party laboratory. The latest result from the 3rd party laboratory appeared to confirm that MNRC would meet the new tritium limit of 0.01 uCi/ml by having a tritium concentration of approximately 1/40th of this value.
"On January 31, 2023, during the planning for the required surveillance of technical specification 3.3 item 4, it was discovered that the 3rd party laboratory result was incorrect and they mistakenly underreported tritium concentrations by a factor of 100. At approximately 1600 (PST) on the same day, it was verified that MNRC's primary water tritium concentration was approximately 2.5 times the new technical specification limit given in section 3.3 item 4, resulting in not being able to meet an LCO. A more thorough data review shows that historical concentrations of the tritium in MNRC's primary coolant are very constant (except for the misreported data used to evaluation MNRC's ability to meet the new technical specification 3.3 item 4). Therefore, failing to meet this LCO is a condition that has likely existed since the issuing of the new license on November 21, 2022. MNRC was not operating at the time of this discovery and has not resumed reactor operations.
"There has likely been no increase in the amount of tritium in MNRC's primary cooling water nor has any primary cooling water been released from the reactor tank since the new technical specification took effect. There are no safety or security concerns generated as a result of this event.
"The facility license holder (level 1 management), the chair of the MNRC safety committee, MNRC's NRC program manager, assistant program manager, and inspector have been notified of this event. The ultimate resolution of this issue will need to be a license amendment increasing the permissible tritium concentration in the primary cooling water as a condition for reactor operation as it is physically impossible to lower the tritium concentration in order to meet the LCO."
--------------------
Iowa Department of Public Health - Shellsburg IA
Report Date 02/01/2023 19:56:00
Event Date 01/31/2023 0:00:00
AGREEMENT STATE REPORT - STOLEN GAUGE
The following information was provided by the Iowa Department of Public Health (Iowa HHS) via email:
"During the night or early morning of January 31, 2023 - February 1, 2023, a Troxler portable nuclear gauge (model 3430, containing 9 millicuries Cs-137 and 44 millicuries Am-241:Be) was stolen from the truck of a licensee in Shellsburg, Iowa. It was reported that the employee had an early morning nuclear job on the day of February 1, 2023, in which he took the device home. Upon the early morning of February 1, 23, when the employee went to leave for the job, he discovered that the truck had been broken into. Items in the cab and all materials' testing equipment in the bed of the truck had been stolen, including the licensed portable nuclear gauge.
"The cause is still under investigation. Corrective actions will be determined.
"The Licensee notified the local sheriff's office. Iowa HHS will follow-up to support the response and provide assistance as needed and will update this event as they investigate."
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
--------------------
Minnesota Department of Health - Oronoco MN
Report Date 02/02/2023 13:10:00
Event Date 12/16/2022 0:00:00
AGREEMENT STATE REPORT - LOST SOURCE
The following information was received from the Minnesota Department [the Department] of Health via email:
"The Department was notified on January 13, 2023, of a lost 1.59 GBq (43 mCi) W-181 [tungsten-181] source in a Check-Cap C-scan colorectal cancer screening device. The Check-Cap C-scan was administered to a patient with the expectation the patient would recover the device at home when it exited the body. The device was not recovered and instead flushed down the toilet at the patient's residence."
Minnesota Event Number: MN230001
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
--------------------
Texas Dept of State Health Services - Houston TX
Report Date 02/03/2023 11:28:00
Event Date 02/03/2023 7:00:00
AGREEMENT STATE REPORT - STOLEN GAUGE
The following report was received via email from the Texas Department of State Health Services [the Agency]:
"On February 3, 2023, the licensee notified the Agency of a stolen moisture density gauge. The gauge was left chained to the back of a truck at a [Borger, TX] hotel overnight. At around 0700 CST, the technician found the chains cut. The incident was reported to the local police department [and the State and local emergency management coordinators]. The licensee reported that the gauge was in the safe position within a Type A Package which had both sides of the package locked. The licensee reported that the gauge is a CPN-MC1-DR model that contains 50 millicuries of americium-241 and 10 millicuries of cesium-137. The serial [number] for the gauge and the two sources was reported to be MD40301932. Further information will be provided per SA-300 when obtained."
Texas Incident No: I-9985 Texas NMED No.: TX230003
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
--------------------
Illinois Emergency Mgmt. Agency - Sauget IL
Report Date 02/03/2023 14:39:00
Event Date 09/26/2022 0:00:00
AGREEMENT STATE REPORT - SEALED SOURCE GAUGES INVOLVED IN A FIRE
The following information was provided by the Illinois Emergency Management Agency (the Agency) via email:
"The Agency was contacted on February 3, 2023, by Jiva Resources in Sauget, IL to advise that five Cs-137 gauges had been impacted by a fire in September 2022. A Jiva Resources representative called and initially reported the five radioactive gauges as stolen 'in the last week.' When Agency staff returned his call that same morning, the devices had been located but were identified as having been involved in a fire back in September 2022. While the container (sealed drum) holding the gauges was impacted by the fire, it is unclear if there was any impact to the gauges. The devices include two Ohmart model SH-F1 gauges (serial numbers 2879GK and 1652GK) and three Vega model SR-A gauges (serial numbers 2174GK, 2878GK, and 63008). All contain 20 millicuries of Cs-137 except for serial number 63008 which contains 30 millicuries of Cs-137. It should be noted the SH-F1 housings are identified in the Sealed Source and Device Registry as being fireproof (rated above 800 degrees Celsius for 30 minutes) while the SR-A housings are lead-filled cylindrical steel shells, which are noted for retaining the source should the lead shielding melt out. Exposure rates should be less than 5 mR/hr at one foot - which will be confirmed by Agency staff. Leak tests will be conducted and source security assessed. Additional regulatory requirements regarding proper disposal, storage, leak testing and reporting will be investigated as well."
The following information was provided by the Illinois Emergency Management Agency (the Agency) via email:
"Agency staff attempted to perform a reactionary inspection the morning of February 6, 2023, to inspect the condition of the five radioactive gauges identified above. This effort confirmed that the registrant did in fact lose accountability of the gauges as it appears they were stolen at some point in the last four months. The last known location was in Sauget, IL in September 2022 when that storage location was involved in a fire. Since that time, the building has reportedly been accessible to looters. Local scrap yards and public safety partners will be notified."
Illinois Incident Number: IL230002
Notified: R3DO (Szwarc) and NMSS Events Notification, ILTAB 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
--------------------
Saint Louis University - St. Louis MO
Report Date 02/03/2023 19:35:00
Event Date 02/02/2023 14:00:00
NON-AGREEMENT STATE REPORT - LOST MEDICAL DOSE
The following information was provided by the licensee via telephone:
On February 1, 2023, a clinical dose of radium (Ra-223) dichloride (146 microcuries) was delivered by courier to the hospital hot lab. At approximately 1400 CST on February 2, 2023, a technician identified that the dose was missing while attempting to retrieve it in preparation to administer it to a patient.
The licensee performed a search for the missing dose and suspects that the package with the dose was thrown away during cleanup of the hot lab on the afternoon of February 1, 2023.
The licensee stated that they did not believe that an exposure to a member of the public would result from the dose because Ra-223 is an alpha emitter with a very low gamma yield. In addition, the radioisotope was enclosed in a syringe and external packaging.
The Radiation Safety Officer is still investigating the events of the lost medical isotope.
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
--------------------
Constellation Energy Corporation -
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 6:30:00
EN Revision Imported Date: 2/15/2023
EN Revision Text: LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by the licensee via email: "On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752. "During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
The effected plants are Braidwood (EN 56352), Byron (EN 56354), Calvert Cliffs (EN 56355), Clinton (EN 56356), Dresden (EN 56361), FitzPatrick (EN 56362), Ginna (EN 56363), LaSalle (EN 56364), Limerick (EN 56360), Nine Mile Point (EN 56359), Peach Bottom (EN 56358), and Quad Cities (EN 56357).
--------------------
Louisiana Radiation Protection Div - Baton Rouge LA
Report Date 02/06/2023 14:59:00
Event Date 02/06/2023 10:25:00
EN Revision Imported Date: 2/8/2023
EN Revision Text: AGREEMENT STATE REPORT - EXCESSIVE EXPOSURE
The following information was provided by the Louisiana Department of Environmental Quality (LDEQ) via email:
"LDEQ was notified by the Acuren Inspection Radiation Safety Officer (RSO) via the DEQ Radiation Hotline at approximately 1240 EST on February 6, 2023, concerning a possible industrial radiography camera excessive exposure. According to the RSO, at approximately 1025 at the Shell Norco Refinery, a possible excessive exposure occurred. Two radiographers did not crank the Ir-192 source completely back in the camera. The first radiographer had his hand close to where the source was located for approximately 10 seconds. The estimated whole-body exposure for both radiographers is 448 mR and the worst-case exposure to the hand for one of the radiographers is 96.86 R. The licensee is currently doing a reenactment to have a better idea of the potential exposures. The licensee is sending the radiographers for a blood count. The camera is a QSA Global 880 Delta (s/n D13733) with 41 curies of Ir-192 (s/n 54759)."
LA Event Report ID No.: LA 20230002
--------------------
Texas Dept of State Health Services - Amarillo TX
Report Date 02/06/2023 17:53:00
Event Date 01/18/2023 0:00:00
AGREEMENT STATE REPORT - MISSING GAUGE
The following report was received via email from the Texas Department of State Health Services [the Agency]:
"On February 6, 2023, the Agency received information from the licensee that a Peco Controls Gamma 101P device, which was believed to have been removed from a machine and placed into storage on-site [in Hereford, TX] in 2020, was determined on or about January 18, 2023, to be lost/missing. The licensee has confirmed the device is not on any of its premises. The licensee is investigating with its metal waste vendor to see if they can determine if it was disposed of with them. An investigation into this event is ongoing. The licensee holds a General License Acknowledgment from the Agency for this device. More information will be provided as it is obtained in accordance with SA-300."
Device: Peco Controls Gamma 101P (SN: G030860749) Source: Am-241 100 millicuries (SN: 3904LV)
Texas Incident No: I-9986 Texas NMED No.: TX230004
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
--------------------
Illinois Emergency Mgmt. Agency - Carol Stream IL
Report Date 02/07/2023 11:45:00
Event Date 02/06/2023 0:00:00
EN Revision Imported Date: 2/16/2023
EN Revision Text: AGREEMENT STATE REPORT - LOST BRACHYTHERAPY SEEDS
The following information was provided by the Illinois Emergency Management Agency, Division of Nuclear Safety, Radioactive Material Branch (DNS-RAM) via email:
"DNS-RAM was notified on 2/6/23, by Bard Brachytherapy (IL-02062-01) that a package of radioactive brachytherapy seeds was lost while in the care of a common carrier. The package was shipped on 2/3/2023, from the licensee's facility in Carol Stream, IL to Centrum Radiotherapie in Kortrijk, Belgium. Total package activity at the time of shipment was 65.62 millicuries of I-125 (ninety STM-1251 seeds, each at 0.430 millicuries). DNS-RAM is currently seeking updated information on the last reported location of the package - which is believed to have been in South Africa. This does not represent a significant public safety hazard and there is no indication of intentional theft or diversion.
"Updates will be provided as they become available."
Illinois Event Number: IL230003
The following information was provided by the Illinois Emergency Management Agency, Division of Nuclear Safety, Radioactive Material Branch (DNS-RAM) via email:
"Licensee advised this morning that the package has been located. Updates will be provided as they become available."
Notified R3DO (Szwarc), NMSS Events Notification, and ILTAB (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
--------------------
Hatch - Baxley GA
Report Date 02/07/2023 21:10:00
Event Date 02/07/2023 17:38:00
EN Revision Imported Date: 2/8/2023
EN Revision Text: PRIMARY CONTAINMENT DEGRADED
The following information was provided by the licensee via email:
"At 1738 EST on 02/07/2023, while in mode 5 at 0 percent power, it was determined during local leak rate testing (LLRT) that the primary containment leakage rate exceeded the allowable limit defined in 10 CFR 50, Appendix J, 'Primary Reactor Containment Leakage Testing for Water-Cooled Power Reactors.' Both primary containment isolation valves in a penetration failed LLRT requirements which represents a failure to maintain primary containment integrity.
"This event is being reported as an eight-hour, non-emergency notification per 10 CFR 50.72(b)(3)(ii)(A). There was no impact on the health and safety of the public or plant personnel. The NRC Resident Inspector has been notified."
--------------------
NJ Dept of Environmental Protection - South Plainfield NJ
Report Date 02/08/2023 15:08:00
Event Date 02/07/2023 0:00:00
AGREEMENT STATE REPORT - SOURCE LOST IN TRANSIT
The following information was provided by the New Jersey Radiation Materials Program (RMP) via email:
"On 2/7/2023, RMP staff was notified via the radiation safety officer that a Cardiogen generator with 100 mCi of Sr-82 and 71 mCi of Sr-85 was considered lost in transit by the common carrier. On 1/31/2023, the licensee sent the generator to a customer via a common carrier. Due to delays, the licensee's logistics team contacted the common carrier for a status update on the generator. On 2/7/2023, it was declared lost and its last location was at the common carrier hub in Memphis, TN."
New Jersey Incident Number: TBD
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
--------------------
Virginia Rad Materials Program - Chantilly VA
Report Date 02/08/2023 19:13:00
Event Date 02/08/2023 11:15:00
AGREEMENT STATE REPORT - DAMAGED PORTABLE GAUGE
The following information was provided by the Virginia Radioactive Materials Program (VRMP) via email:
"On February 8, 2023, at approximately 1300 EST, the VRMP received a report via telephone from the licensee that a portable nuclear moisture/density gauge (Troxler Model 3440+, serial number 72924, containing 8 millicuries of cesium-137 and 40 millicuries of americium-241/beryllium) was damaged. At approximately 1115 EST on February 8, 2023, [the gauge] was hit by a 'Bobcat' compaction vehicle/machine on a temporary jobsite at a private residence. The source rod was not out at the time of the impact. The gauge is not functional as the housing and electronics sustained significant damage. The source appeared to remain intact within the safe position. The authorized user secured the area and immediately contacted his radiation safety officer (RSO) who was several hours away. The RSO then contacted the VRMP. The licensee was instructed to transport the gauge back to their storage facility in its transport container to expedite removal from the residential site before nightfall. At 1615 EST, the RSO confirmed the gauge had arrived at their office in Chantilly VA and was secured. The Virginia Office of Radiological Health will perform surveys of the gauge on February 9, 2023, and will conduct a reactive inspection to investigate the incident. This notification will be updated with additional information determined during the inspection.
"No members of the public have had close proximity to the gauge. Any potential exposure by the authorized user will be determined once surveys have been made."
Virginia Incident Number: VA230001
--------------------
McGuire - Cornelius NC
Report Date 02/09/2023 14:53:00
Event Date 01/01/2023 6:04:00
60-DAY OPTIONAL TELEPHONIC NOTIFICATION OF INVALID ACTUATION OF AUXILIARY FEEDWATER PUMP
The following information was provided by the licensee via email:
"This 60-day optional telephone notification is being made in lieu of a Licensee Event Report as allowed by 10 CFR 50.73(a)(1). This notification is made pursuant to 10 CFR 50.73(a)(2)(iv)(A) for an invalid system actuation.
"On January 1, 2023, at approximately 0604 EST, static inverter KXA failed causing a loss of power to shared 120-VAC auxiliary control panel board KXA. Operations entered the appropriate procedures to assist in diagnosing and responding to the event. As expected, the solenoid valves in the instrument lines to steam supply valves 1SA-48ABC and 1SA-49AB deenergized, causing 1SA-48ABC and 1SA-49AB to open and admit steam to the unit 1 turbine driven auxiliary feedwater pump (TDAFWP). Operations reduced turbine load to maintain reactor power less than 100 percent. At approximately 0641 EST, power was restored to the KXA panelboard and the TDAFWP was secured. All systems functioned as required.
"Actuation of the TDAFWP was not initiated in response to actual plant conditions or parameters satisfying the requirements for initiation of the system nor was the actuation due to an intentional manual initiation. Therefore, this actuation is considered an invalid actuation. The NRC Resident Inspector has been notified."
--------------------
Cooper - Brownville NE
Report Date 02/09/2023 15:15:00
Event Date 02/09/2023 10:06:00
FAILED FITNESS FOR DUTY TEST
The following information was provided by the licensee via fax:
"A licensed operator had a confirmed positive for alcohol during a for-cause fitness-for-duty test. The employee's access to the plant has been terminated."
The NRC Resident Inspector has been notified.
--------------------
Calvert Cliffs - Lusby MD
Report Date 02/09/2023 15:40:00
Event Date 12/25/2022 6:37:00
60-DAY OPTIONAL TELEPHONIC NOTIFICATION OF INVALID ACTUATION OF EMERGENCY DIESEL GENERATOR (EDG)
The following information was provided by the licensee via email:
"This 60-day optional telephone notification is being made in lieu of an LER [Licensee Event Report] submittal as allowed by 10 CFR 50.73(a)(1). This notification is made pursuant to the reporting requirements specified in 10 CFR 50.73(a)(2)(iv)(A) for an invalid actuation of one of the systems listed in 10 CFR 50.73(a)(2)(iv)(B). At approximately 0637 EST on December 25, 2022, the 2B EDG inadvertently started and ran unloaded without a valid undervoltage or safety injection actuation signal. It was determined that this condition was caused by the failure of the emergency start button due to age-related degradation. The button is normally held depressed (closed) by the glass enclosure in standby. To start the EDG using the Emergency Start Button, the button is released (open) when the glass enclosure is broken, which sends a start signal to the EDG. During troubleshooting, the resistance across the button contacts was measured at zero volts DC, indicating the button had failed to an open state causing the EDG to start. The button fell apart when the glass enclosure was removed. The actuation was not initiated in response to actual plant conditions, it was not an intentional manual initiation, and there were no parameters satisfying the requirements for initiation of the emergency diesel generator."
The NRC Resident Inspector has been notified.
--------------------
SC Dept of Health & Env Control - Charleston SC
Report Date 02/10/2023 9:21:00
Event Date 02/09/2023 15:34:00
EN Revision Imported Date: 3/10/2023
EN Revision Text: AGREEMENT STATE REPORT - STUCK SHUTTER GAUGE
The following summary was obtained via phone and email from the South Carolina Department of Health & Environmental Control [the Department]:
On February 9, 2023, at 1534 EST, the Department was notified by WestRock Charleston Kraft, LLC of a shutter on an Ohmart SH-F1 gauging device (serial number 67584) containing 10 mCi of Cs-137 that was stuck in the open position. The shutter was found during the licensee's six month inventory and shutter check. The gauge is in an isolated area not heavily trafficked.
The vat that the gauge is attached to leaks directly onto the gauge, so it was previously recommended that the gauge be covered. The recommendation did not help. The contractor surveyed the gauge and got no higher than 2 mR/hr at a foot. The inspector concurred after using his [model] 14-C [detector] (serial number 99961). The numbers were approximately 4 mR/hr on the outside surface of the covering. It has been decided by the licensee that because it is in a very unobtainable location, they will leave it in the open and operating position until they remove the entire vat from service in March or April.
South Carolina Event Number: EN56348
Notified R1DO (Young), and NMSS Events Notification (via email).
--------------------
Wisconsin Radiation Protection - Madison WI
Report Date 02/10/2023 16:33:00
Event Date 02/10/2023 0:00:00
AGREEMENT STATE REPORT - PATIENT UNDERDOSE
The following information was provided by the Wisconsin Radiation Protection Section via email:
"On February 10, 2023, the licensee reported a medical event which had occurred the previous day. A patient was being treated with a high dose rate remote after loader unit and the fraction required 17 needles. After the first 15 needles had been treated, the licensee noticed that the patient's needles had been pulled out approximately 2 cm from where they had been placed due to unexpected movement of the patient's bed. The licensee has not yet determined how the patient's bed moved, as the patient was sedated during treatment. Needles 16 and 17 were re-inserted and the dose to those needles was delivered as intended. The authorized user had prescribed 13.5 Gy to the treatment site for this fraction, and the licensee estimates that only 30 percent of the treatment volume received the prescribed dose. The referring physician and the patient's family have been notified."
Event Report ID No: WI230001
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.
--------------------
Beaver Valley - Shippingport PA
Report Date 02/12/2023 14:41:00
Event Date 02/12/2023 8:00:00
EN Revision Imported Date: 3/17/2023
EN Revision Text: CONTROL ROOM EMERGENCY VENTILATION SYSTEM INOPERABLE
The following information was provided by the licensee via phone call and email:
"At 0800 on February 12, 2023, it was discovered that both trains of control room emergency ventilation system were simultaneously inoperable due to a safety injection relief valve discharging to a Unit 1 sump. This leakage in conjunction with design basis loss of coolant accident may result in radiological dose exceeding limits to the exclusion area boundary and to the control room, which is common to both Unit 1 and Unit 2. Therefore, this condition is being reported as an eight-hour, nonemergency notification per 10 CFR 50.72(b)(3)(ii)(B) and 10 CFR 50.72(b)(3)(v)(D) as an 'Unanalyzed Condition and a Condition that Could Have Prevented Fulfillment of a Safety Function.'
"There was no impact on the health and safety of the public or plant personnel.
"The NRC Resident Inspector has been notified."
"Retraction of EN56350, Control Room Emergency Ventilation System Inoperable:
"Based on subsequent evaluation, it was determined that the control room emergency ventilation system remained operable due to the maximum measured leak rate being within the bounds of the analysis. The maximum measured leak rate of 32,594 cc/hr from the safety injection system did not challenge the calculated maximum engineered safety features leak rate of 45,600 cc/hr and remained within the current dose analysis limits. As such, this was not an unanalyzed condition and did not prevent the fulfillment of a safety function to mitigate the consequences of an accident.
"The NRC Resident Inspector has been notified."
Notified R1DO (Bickett).
--------------------
Arkansas Nuclear - Russellville AR
Report Date 02/14/2023 14:40:00
Event Date 02/14/2023 11:03:00
EN Revision Imported Date: 2/15/2023
EN Revision Text: AUTOMATIC REACTOR TRIP DUE TO TWO REACTOR COOLANT PUMPS TRIPPING
The following information was provided by the licensee via email:
"On February 14, 2023 at 1103 CST, Arkansas Nuclear One, Unit 1, (ANO-1) automatically tripped on reactor protection system actuation due to two reactor coolant pumps tripping.
"ANO-1 is currently stable in MODE 3 (Hot Standby) maintaining reactor coolant system pressure and temperature with main feedwater and steaming to the condenser.
"No additional safety system actuations occurred. All immediate actions were completed satisfactorily. "There are no indications of a radiological release on either unit as a result of this event.
"This report satisfies the reporting criteria of 10 CFR 50.72(b)(2)(iv)(B) and 10 CFR 50.72(b)(3)(iv)(A) for the reactor protection system actuation.
"The NRC Senior Resident Inspector has been notified.
"Unit 2 was not affected."
The following additional information was obtained from the licensee in accordance with Headquarters Operations Officers Report Guidance:
The licensee is investigating the cause of the two reactor coolant pump trips.
--------------------
Braidwood - Braceville IL
Report Date 02/16/2023 13:26:00
Event Date 02/06/2023 5:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES The following information was provided by the licensee via email: "On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752. "During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Texas Dept of State Health Services - San Antonio TX
Report Date 02/14/2023 16:06:00
Event Date 02/13/2023 0:00:00
AGREEMENT STATE REPORT - DOSE DELIVERED TO THE WRONG TREATMENT SITE
The following information was provided by the Texas Department of State Health Services (the Agency) via email:
"On February 13, 2023, the Agency was notified that a patient was prescribed to receive 35.74 mCi (1.32 GBq) of Y-90 microspheres to the right lobe of the liver. The dose was given to the left lobe (wrong lobe) of a patient during treatment on February 13, 2023. The dose delivered (36.48 mCi (1.35 GBq)) to the left lobe was within 20 percent of the prescribed dose. The dose that was delivered to the left lobe is also within 20 percent of the dose that would have been prescribed for the left lobe in 2 weeks according to the physician. The treatment was clinically insignificant to the patient as both lobes were to be treated with a pending remapping of the second lobe to confirm the dosage but both have similar tumor volumes. More information will be provided as it is obtained in accordance with SA-300.
NMED National Number: TX230005
Texas Incident Number: 9889
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.
--------------------
Byron - Byron IL
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 5:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email: "On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752. "During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Calvert Cliffs - Lusby MD
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 6:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email: "On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752. "During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Clinton - Clinton IL
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 5:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email: "On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752. "During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Quad Cities - Cordova IL
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 5:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email:
"On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752.
"During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Peach Bottom - Philadelphia PA
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 6:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email:
"On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752.
"During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Nine Mile Point - Syracuse NY
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 6:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email:
"On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752.
"During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Limerick - Philadelphia PA
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 6:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email:
"On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752.
"During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Dresden - Morris IL
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 5:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email:
"On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752.
"During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
FitzPatrick - Lycoming NY
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 6:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email:
"On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752.
"During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Ginna - Ontario NY
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 6:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email:
"On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752.
"During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
LaSalle - Marseilles IL
Report Date 02/06/2023 13:26:00
Event Date 02/06/2023 5:30:00
LOSS OF COMMUNICATIONS AND ASSESSMENT CAPABILITIES
The following information was provided by Constellation via email:
"On 02/06/2023 at 0416 EST, the Constellation Emergency Response Organization (ERO) Notification Database System uploaded data files into the Mass Notification System (Everbridge) which is used to notify ERO personnel when activated. At 0630, the individual reviewing the uploaded files discovered that the data files did not upload properly and that Everbridge may not notify all ERO individuals within the required 10 minutes of system initiation. Constellation resolved the issue by 0752.
"During the time period of 0416 to 0752, control room operators would have been unaware that the ERO notification was not successful. Therefore, this issue constitutes a loss of offsite communications capability and is reportable under 10 CFR 50.72(b)(3)(xiii), 'The licensee shall notify the NRC as soon as practical and in all cases within eight hours of the occurrence of any event that results in a major loss of emergency assessment capability, offsite response capability, or offsite communications capability (e.g., significant portion of control room indication, Emergency Notification System, or offsite notification system).' This loss of offsite communications capability affected all Constellation nuclear stations.
"There was no impact on the health and safety of the public or plant personnel. Each affected station NRC Resident Inspectors have been or will be notified."
--------------------
Arkansas Department of Health - Liittle Rock AR
Report Date 07/05/2022 18:50:00
Event Date 04/25/2022 0:00:00
AGREEMENT STATE REPORT - DOSE LIMIT EXCEEDED FOR GENERAL PUBLIC
The following information was received from the state of Arkansas via email:
"UAMS (University of Arkansas for Medical Sciences) reported to Arkansas Radiation Control Program on May 27, 2022, that three (3) persons (radiation workers), acting under verbal orders, volunteered to be injected as test subjects for the evaluation of two (2) different PET/CT scanners with F-18 FDG.
"As part of an investigation, radiation exposure calculations were performed, and results submitted for review. It has been determined that the limit for public dose as defined in 10 CFR 20.1003 and stated in RH-1208.a., was exceeded.
"Reporting Requirement: Arkansas State Board of Health Rules for Control of Sources of Ionizing Radiation RH-1504.a.2.d and 10 CFR Part 20.2203(a)(2)(iv).
"The NRC HOO was notified by email of this discovery on July 5, 2022."
"The University of Arkansas for Medical Sciences (UAMS) reported that three radiation workers volunteered to be injected with F-18 FDG (fluorodeoxyglucose) and scanned in order to compare the image quality of an existing and a new PET/CT scanner. The events occurred between 4/13/2022 and 4/15/2022. As part of the investigation, radiation exposure calculations were performed by a contractor of the licensee, and the results were submitted for Arkansas Department of Health review. The activities of F-18 FDG received by the three physicians were 408.85 MBq (11.05 mCi), 392.2 MBq (10.6 mCi), and 403.3 (10.9 mCi). TEDEs of 24.1 mSv (2,410 mrem), 25.1 mSv (2,510 mrem), and 20.1 mSv (2,010 mrem) were received from x-ray and F-18 FDG combined, respectively. The PET-only TEDEs were 6.1 mSv (610 mrem), 5.2 mSv (520 mrem), and 6.3 mSv (630 mrem), respectively. The estimated doses exceed the limits for an individual member of the public and are therefore considered a reportable event under RH-1504.a.2.D. [10 CFR 20.2203(a)(1)(iv)]."
NMED Number: 2203303
--------------------
McGuire - Cornelius NC
Report Date 02/16/2023 11:33:00
Event Date 02/16/2023 9:15:00
OFF-SITE NOTIFICATION OF AN ON-SITE FATALITY
The following information was provided by the licensee via email:
"On February 16, 2023 at 0859 EST, a contract worker at McGuire was transported off-site for treatment at an off-site medical facility. Upon arrival at the off-site medical facility, medical personnel declared the individual deceased at 0915 EST.
"The fatality was not work-related and the individual was inside the Radiologically Controlled Area. An on-site survey confirmed that neither the individual nor the individual's clothing were contaminated. A notification will be made to the Occupational Safety and Health Administration.
"This is a four-hour notification, non-emergency for an on-site fatality and notification of other government agency. This event is reportable in accordance with 10 CFR 50.72(b)(2)(xi). The NRC Resident Inspector has been notified."
--------------------
Vogtle 3/4 - Waynesboro GA
Report Date 02/16/2023 15:52:00
Event Date 02/16/2023 7:43:00
FAILED FITNESS FOR DUTY TEST
The following information was provided by the licensee via email:
At 0743 EST on February 16, 2023, it was determined that a contract supervisor failed a random fitness-for-duty (FFD) test. The individual's authorization for site access has been terminated.
The NRC Resident Inspector has been notified.
--------------------
Illinois Emergency Mgmt. Agency - Romeoville IL
Report Date 02/16/2023 15:55:00
Event Date 01/17/2023 0:00:00
EN Revision Imported Date: 3/7/2023
EN Revision Text: AGREEMENT STATE REPORT - OCCUPATIONAL DOSE LIMIT EXCEEDED
The following information was provided by the Illinois Emergency Management Agency (the Agency) via email:
"The Agency received written correspondence on February 16, 2023, indicating a worker at a Romeoville, IL nuclear pharmacy (Sofie, RML IL-02074-01) received a whole body dose that exceeded the occupational limits in 32 Ill. Adm. Code 340.210. The exposure occurred over the course of 2022 and no adverse health impacts are anticipated. Specifically, the information provided indicates a quality control production associate received 5,090 millirem over the course of 2022, exceeding the occupational limit of 5,000 millirem.
"The licensee has conducted an investigation and believes the cause is related to both a management deficiency and equipment issues. New duties assigned in July of 2022 resulted in increased exposure which was apparently not reviewed and/or assessed at a frequency sufficient to limit occupational dose. Additionally, dose delivery equipment reportedly failed at some point in 2022, resulting in the use of equipment with insufficient shielding. The licensee identified corrective action as more frequent dosimetry exchange, repair of equipment (timeline unspecified) and reassignment of duties.
"This is a reportable incident under 32 Ill. Adm. Code 340.1230 and was reported to NRC the same day (2/16/23). The licensee provided timely notification. In the next week, IEMA inspectors will perform a reactionary inspection to assess the adequacy of the licensee's investigation and corrective action, compliance with Agency regulations and root cause determination."
Illinois Event Number: IL230004
The following information was received via email:
"On March 3, 2023, Agency inspectors performed a reactionary inspection. The root cause of failing to provide adequate monitoring of occupational exposures was confirmed. This was compounded when delivery equipment failed and alternate procedures were utilized.
"The subject employee who exceeded the annual occupational dose of 5,000 mrem (5 rem) was reported as having received 5,090 mrem. However, during the inspection, inspectors discovered that from February 14, 2022, through April 25, 2022, the employee was wearing visitor dosimetry, which wasn't added to the individuals dosimetry report. It was added to her Form 5 by the RSO which was completed on February 20, 2023. The total exposure was 5,781 mrem for this individual.
"It was also noted that as a result of not adding the visitor badges to the individuals report the employee first exceeded the annual occupational dose at the end of October, 2022, having reached 5,057 mrem. Additional violations regarding employee dosimetry were noted and are being assessed at this time. However, they are not expected to result in another occupational exposure. The Agency has requested dosimetry records for all licensee staff working under the alternate procedures. Updates will be provided as they become available."
otified the R3DO (Havertape) and the NMSS Events Notification email group.
--------------------
PA Bureau of Radiation Protection - Wampum PA
Report Date 02/17/2023 12:59:00
Event Date 02/16/2023 0:00:00
AGREEMENT STATE REPORT - UNPLANNED CONTAMINATION EVENT
The following information was provided by the Pennsylvania Department of Environmental Protection (Department / DEP) via email:
"On February 16, 2023, the licensee informed the Department of a contamination event involving Cobalt 60. It is reportable as per 10 CFR 30.50(b)(1).
"On February 16, 2023, the licensee received an exclusive use shipment of boxes of equipment from Dresden Nuclear Station. Upon surveying the conveyance after unloading, the licensee found a small area of contamination approximately 2" x 2" in surface area on the bed of the trailer outside of where the boxes were positioned. The licensee isolated the trailer at its facility, decontaminated the area of contamination, resurveyed the trailer, and released it. The licensee informed their client, Dresden Nuclear Station, of the issue. The DEP is currently in contact with the licensee and will update this event as soon as more information is provided.
"The Department will perform a reactive inspection. More information will be provided as received."
Pennsylvania Event Number: PA230007
--------------------
Browns Ferry - Decatur AL
Report Date 02/18/2023 11:25:00
Event Date 02/18/2023 4:39:00
DEGRADED CONDITION
The following information was provided by the licensee via email:
"On February 17, 2023 during the planned U2R22 outage on Browns Ferry Nuclear Plant Unit 2, personnel entered the Unit 2 drywell for leak identification. Personnel discovered a cracked weld on the 2A recirculation pump discharge isolation valve drain line. At 0439 CST on February 18, 2023, following engineering evaluation, this drain line was determined to be ASME Code Class 1 piping.
"This constitutes an 8-hour NRC notification in accordance with 10 CFR 50.72(b)(3)(ii)(A) - Any event or condition that results in the condition of the nuclear power plant, including its principal safety barriers, being seriously degraded.
"The NRC Resident Inspector has been notified."
--------------------
FitzPatrick - Lycoming NY
Report Date 02/19/2023 8:56:00
Event Date 02/19/2023 1:05:00
SPECIFIED SYSTEM ACTUATION The following information was provided by the licensee via fax or email: "At 0105 EST on February 19, 2023, with the James A. FitzPatrick Nuclear Power Plant (JAF) at 100 percent power, a valid high main steam line radiation signal was received. An actuation of a fire protection foam system caused migration of high conductivity water into a low conductivity sump. Organic compounds were introduced into the primary coolant and resulted in a temporary increase in nitrogen-16 which was detected by main steam line radiation monitors and actuated primary containment isolation signals in more than one system. The reactor water recirculation sample system isolated. The signal also went to the normally isolated main steam line drain system and condenser air removal system. The event is reportable in accordance with 10 CFR 50.72(b)(3)(iv)(A). The elevated radiation condition no longer exists. Health and safety of the public was not impacted by this event."
The NRC Resident Inspector was notified.
--------------------
North Anna - Richmond VA
Report Date 02/20/2023 17:07:00
Event Date 02/20/2023 16:18:00
EN Revision Imported Date: 2/24/2023
EN Revision Text: OFFSITE NOTIFICATION TO STATE AGENCY
The following information was provided by the licensee via fax:
"At 1618 EST on February 20, 2023, North Anna Power Station notified the Virginia Department of Environmental Quality (DEQ) that water discharged into Lake Anna following hydrostatic testing of tanks associated with a new on-site sewage treatment plant had exceeded the project's general permit (VAG83) pH value.
"Hydrostatic test water discharge activities to Lake Anna began on February 20, 2023 at 0900 EST. A pH sample was collected at 0955 EST on February 20, 2023 and determined to have a pH of 9.1 which exceeded the maximum permit pH of 9.0. Discharge ceased after the reading was collected. Approximately 354 gallons were discharged to Lake Anna. A follow-up ambient pH sample result of 7.8 was collected on February 20, 2023 at 1401 EST from Lake Anna in the vicinity of the discharge pipe. No evidence of dead fish, foam, or other negative environmental impacts were observed.
"This event is reportable in accordance with 10 CFR 50.72(b)(2)(xi) for 'Any event or situation, related to the health and safety of the public or on-site personnel, or protection of the environment, for which a news release is planned or notification to other government agencies has been or will be made. Such an event may include an on-site fatality or inadvertent release of radioactively contaminated materials.'"
The following is a summary of information provided by the licensee via telephone:
The licensee called to correct the pH sample results from a pH of 9.1 to a pH of 9.93.
Notified R2DO (Miller) via phone
--------------------
Ohio Bureau of Radiation Protection - West Chester OH
Report Date 02/21/2023 13:57:00
Event Date 02/20/2023 0:00:00
AGREEMENT STATE REPORT - STUCK SOURCE
The following information was received from the state of Ohio via email:
"On Monday 2/20/2023, radiographers from the licensee's Akron, Ohio office experienced a source that would not retract. There were two radiographers working on the job site when they realized that their source was not locking into the safe position. They contacted management at 1013 [CST] and were instructed to move their boundaries out and use physical barriers to prevent unauthorized access. When the licensee's source retrieval team arrived on site, they discussed the situation with the crew and began to form a plan for locating the source.
"The retrieval team located the source in the collimator and then developed a plan for a way to shield and retract the source. The retrieval team made 16 moves to shield the source before attempting retrieval. The source was locked in the safe, shielded position inside the camera at 1510.
"The source retrieval team found that the drive cable connector had broken just above the crimp causing the source and pigtail to become disconnected from the cable. The licensee reports that the connector lot number is FW-21, and it was put into service on 12/18/2022."
Ohio Item Number: OH230001
--------------------
San Onofre - San Clemente CA
Report Date 02/21/2023 19:16:00
Event Date 02/21/2023 14:02:00
EN Revision Imported Date: 2/23/2023
EN Revision Text: OFFSITE NOTIFICATION TO LOCAL AGENCY
The following information was provided by the licensee via email:
"On 2/21/2023 at 1402 [PST] SONGS [San Onofre Nuclear Generating Station] notified San Diego Regional Water Quality Control Board (SDRWQCB) regarding the results of a quarterly monitoring report. The report indicated the 24-effluent toxicity sample resulted in a 'Fail.' The results prompted a 24 hour notification to the SDRWQCB in accordance with the NPDES [National Pollutant Discharge Elimination System] permit. There was no significant effect on the health and safety of the public or the environment.
"Action Taken: SCE [Southern California Edison] Environmental notified the SDRWQCB via telephone voice mail at 1402 on 2/21/2023 followed by an e-mail describing the reason for the notification."
The following is a summary of information provided by the licensee via email:
The licensee corrected the Unit from ISFSI to Unit 2 and the name of the quarterly test to note it was for the first quarter of 2023.
Notified R4DO (Roldan-Otero), and NMSS Events Notification via email.
--------------------
Texas Dept of State Health Services - Houston TX
Report Date 02/21/2023 21:35:00
Event Date 02/21/2023 0:00:00
EN Revision Imported Date: 3/1/2023
EN Revision Text: AGREEMENT STATE REPORT - STUCK SOURCE
The following information was provided by the Texas Department of State Health Services (the Group) via email:
"On February 21, 2023, the Group was notified by the licensee's radiation safety officer (RSO) that a cobalt-60 source was stuck in the unshielded position. The source is used in a teletherapy unit for non-human experimental irradiation. The source is pointed towards the floor. The RSO stated they contacted their service company and was told it is probably caused by low air pressure as air pressure is used to drive the source. The RSO stated the source/unit was located in the basement of the facility. The RSO stated they performed radiation surveys in adjoining rooms and the room above where the exposed source is located, and all dose rates were normal (less than 200 microrem/hr). The service provider will be at the licensee's location on February 23, 2023, to inspect the unit. The access door has been locked and 'Caution' tape has been placed on the door jam. No over exposures have occurred due to this event. Additional information will be provided as it is received in accordance with SA-300."
Texas Incident Number: I-9991
The following update was received from Texas Department of State Health Services (the Agency) via email:
"On February 22, 2023, the licensee's RSO notified the Agency that they had just talked with the service company that would retrieve the source and discussed the operation. The job is expected to start at 0830 CST on February 23, 2023. The RSO stated the individual will enter the room wearing a Personal Radiation Dosimeter (PRD), an OSL [Optically Stimulated Luminescence] dosimeter, and an Instadose for exposure monitoring. Alarms will be set on the PRD. The RSO stated they will have a pre-job safety briefing before the technician enters the room and will establish turnback values for the job. The technician will enter the room and rotate the source head to point the source away from them. They will then force the source back into the shield. The service company estimates the technician will receive 500 millirem for the job. The RSO stated the room has video surveillance and will also have audio capabilities. The RSO stated the job is anticipated to take less than 15 minutes. The RSO will notify the Agency when the technician enters the room for the first time and leaves the room when the job is completed. The Agency has requested additional information."
The following update was received from Texas Department of State Health Services (the Agency) via email:
"On February 23, 2023, the licensee notified the Agency that the service company was able to return the source to the fully shielded position by manipulating the systems air pressure. No individual received any significant radiation exposure from the operation. Additional information will be provided as it is received in accordance with SA-300."
Notified R4DO (Roldan-Otero) and NMSS Events Notification via email.
"The licensee's radiation safety officer provided the following additional information: `[The teletherapy unit that had a stuck source] is a Theratron 780C, and it was the Numatics Mark 8 solenoid valve that failed.'
"Additional information will be provided as it is received in accordance with SA-300."
Notified R4DO (Vossmar) and NMSS Events Notification via email.
--------------------
Utah Division of Radiation Control - Murray UT
Report Date 02/21/2023 22:25:00
Event Date 02/21/2023 17:00:00
AGREEMENT STATE REPORT - LEAKING EQUIPMENT
The following was provided by the Utah Division of Waste Management and Radiation Control:
"On 2/21/23, at 1700 [MST], the Intermountain Heart Institute, Cardiac Molecular Imaging (CMI) Coordinator reported to the RSO [Radiation Safety Officer] that around 1630 a technologist, removing a Rb-82 generator from service, found liquid radioactive contamination in the bottom of the well chamber of the infusion system.
"A syringe was used to remove the saline from the well of the infusion system and the liquid was placed in the liquid radioactive waste storage. Decontamination procedures were followed. The infusion system well was wiped dry with paper towel(s). All radioactive waste was placed in approved radioactive waste storage. Wipe test(s) were performed. This incident has no impact on patient treatment. All quality control procedures passed while the generator was in use which verifies that patient treatments were within all requirements.
"The manufacturer was contacted for assistance, and it is planned that the generator will be shipped back for investigation. We will follow the manufacturer's instructions for the shipment. A new generator has been placed in the infusion system so that patient care can continue today."
Utah Event Report Number: UT23-0003
--------------------