Headquarters Daily report MARCH 17, 1995 *************************************************************************** REPORT NEGATIVE NO INPUT ATTACHED INPUT RECEIVED RECEIVED HEADQUARTERS X REGION I X REGION II X REGION III X REGION IV X *************************************************************************** PRIORITY ATTENTION REQUIRED MORNING REPORT - REGION I MARCH 17, 1995 Licensee/Facility: Notification: Consolidated Edison Co. Of N.Y. MR Number: 1-95-0038 New York Power Authority Date: 03/17/95 Indian Point 2 3 SRI/PC Buchanan,New York Dockets: 50-247,50-286 PWR/W-4-LP,PWR/W-4-LP Subject: Potential Failure of Dresser Pacific Safety Injection Pumps Reportable Event Number: N/A Discussion: Indian Point 2 (Con Edison) and Indian Point 3 (NYPA), each recently identified loose safety injection pump shaft lock nuts on Dresser Pacific ten stage centrifugal pumps. The lock nuts, one located at each end of the pump shaft, hold the rotating impellers in position. Without the lock nuts, the impellers are free to move axially on the shaft. Movement of the impellers can cause them to contact the stationary diffusers or the pump casing, which could lead to pump failure. The shaft lock nuts are designed to be self locking with right hand threads on one end of the shaft and left hand threads on the other. The lock nuts are not torqued, but require only hand tightening. Some applications of these pumps have set screws installed in the lock nuts to further guard against loosening. The use of set screws was recommended by the manufacturer for applications that are subject to back flow when idle. The configuration at both sites, i.e., the use of a discharge check valve to prevent back flow, was considered by the licensee to be adequate to not require setscrews. On February 19, 1995, the #33 safety injection pump at Indian Point 3 seized. The failure occurred during pump coast down after replacing a leaking seal. Maintenance personnel noted the seized shaft while attempting to rotate the shaft for seal adjustments. Inspection of the pump internals revealed that the outboard shaft lock nut had backed off about a quarter of an inch. This resulted in the tenth stage impeller contacting the pump casing. NYPA also discovered that the sixth stage impeller was damaged due to axial movement caused by the loose lock nut. Preliminary review of previous vibration data indicates that the sixth stage problem occurred between March and August of 1993. As a result of the problems identified at Indian Point 3, Con Edison inspected the Dresser Pacific safety injection pumps at Indian Point 2. Inspection of the #23 pump indicated that the lock nut was finger tight, not hand tight, potentially allowing movement of the impellers upon further loosening. Previous routine testing had not identified problems with this pump. During the inspection with the pump vendor representative onsite, indications of overheating (not currently thought to be related to the lock nut) caused Con Edison to replace this pump. Con Edison is continuing with inspections of the other pumps. NYPA and Con Edison are still investigating the cause of the loosening shaft lock nuts. The Dresser Pacific vendor representative was not aware of any other customers reporting loose lock nuts. Dresser Pacific is currently investigating whether this problem had been reported in the past. Reverse rotation is suspected as the cause, but both licensees have not been able to determine when or why the reverse rotation occurred. Both utilities monitor idle pumps for reverse rotation during pump runs and none has been previously identified. NYPA has modified the shaft lock nuts to install set screws to positively lock the nuts in place. Regional Action: The resident inspectors at both sites are following licensee actions. Contact: Richard Rasmussen (914)739-8565 Barry Westreich (914)739-9360 PRIORITY ATTENTION REQUIRED MORNING REPORT - REGION II MARCH 17, 1995 Licensee/Facility: Notification: MR Number: 2-95-0032 Rockingham Memorial Hospital Date: 03/17/95 Harrisonburg,Virginia Dockets: 03003320 License No: 45-05594-01 Subject: CONTAMINATED RADIOPHARAMACEUTICAL PACKAGE Reportable Event Number: N/A Discussion: On March 16, 1995, a Licensee representative notified Region II that a radiopharmaceutical package containing four millicuries of strontium 89 had been received with minor external removable contamination, and significant internal contamination. Initial external removable contamination levels were approximately 3000 disintegrations per minute (dpm) over the entire box surface (about 1000 square centimeters). The shipping box seal was unbroken, but the plastic sleeve around the shield baton in the shipping box was broken, the baton shield was opened, and the cap was on the needle. Removable contamination levels on the inside surface of the box were approximately 0.8 million dpm. The syringe surface had about 1.2 million dpm removable contamination. The syringe contained 4.2 milliliters when shipped from the supplier, Medi-Physics, Silver Spring, MD. The licensee estimates the syringe now contains approximately 3 milliliters. No personnel contamination occurred. The Only contamination to the facility was minor contamination to a cart used to carry the package. The licensee stated that the material will not be used for patient injection. The carrier, Federal Express, was notified by the licensee and the courier and vehicle returned to the hospital, were surveyed and found not to be contaminated. Medi-Physics has also been contacted by the licensee. Regional Action: Region II has notified Region I and the Commonwealth of Virginia. Contact: C. Hosey (404)331-5614 PRIORITY ATTENTION REQUIRED MORNING REPORT - REGION III MARCH 17, 1995 Licensee/Facility: Notification: City Incinerator MR Number: 3-95-0037 City Incinerator Date: 03/16/95 Indianapolis,Indiana TELECON FROM STATE OF IN RCP License No: NON-LICENSEE Subject: RADIATION ALARM ON INCOMING WASTE SHIPMENTS Reportable Event Number: N/A Discussion: Region III was informed by representatives of the State of Indiana that within the last 2 weeks, three trucks containing primarily residential waste caused the radiation monitoring system to alarm at the city incinerator located in Indianapolis, Indiana on March 7, March 15 and March 16, 1995. The incinerator is operated by Ogden-Martin, Inc. The waste, which was hauled by trucks operated by BFI and the Indianapolis Department of Public Works, was rejected by the incinerator staff and subsequently transported to a facility operated by the Department of Public Works. The trucks are segregated and roped off. Representatives of the State of Indiana Radiation Control Program responded to each of the alarms using gm survey instrumentation and a portable gamma spectrometer. Maximum radiation levels near the surface of the trucks ranged from 250 microR/hr to 2 mR/hr. The contaminant in the two Public Works Department trucks has been identified as iodine-131. Liquid drops leaking from one of the trucks appears to be contaminated with nanocurie levels of iodine-131. The State placed absorbent material and plastic on the ground to contain the leakage. The contaminant in the BFI truck has not been identified, but it appears to be a relatively low energy gamma emitter with an energy peak of 90 kev. Since the waste has not been traced to a specific NRC licensee, Region III referred the State to the EPA, in accordance with the draft Federal Radiological Emergency Response Plan. Regional Action: Region III contacted the Region V office of EPA (Chicago) and confirmed that its Radiation Program Manager had been notified by the State. Region III also informed NMSS of the incidents. Contact: B.J. HOLT (708)829-9836 PRIORITY ATTENTION REQUIRED MORNING REPORT - REGION IV MARCH 17, 1995 Licensee/Facility: Notification: Southern California Edison & San MR Number: 4-95-0035 Diego Gas & Electric Co. Date: 03/17/95 San Onofre 2 Telephone Call from Resident San Clemente,California Dockets: 50-361 PWR/CE Subject: IMPROPERLY SIZED LUGS IN SAFETY-RELATED SWITCHGEAR Reportable Event Number: N/A Discussion: On March 15, 1995, the licensee discovered that the wrong size lugs were connected to wires for incoming and outgoing DC control power to various Unit 2 safety-related circuit breakers. The affected circuit breakers were located in the Train B Class 1E 4.16 KV switchgear and in the Train B Class 1E 480 volt switchgear. The licensee made the discovery while the switchgear was deenergized during the Unit 2 current refueling outage. The lugs were color-coded yellow with three black stripes, which should have been 14/16-gauge, per the vendor catalogue. The lugs were actually 10/12-gauge and were installed on 14-gauge wire. Consequently, the lugs were too large for the application and could separate from the wire more easily than a properly sized lug. The lugs were manufactured by Amp Incorporated, of Harrisburg, PA, and the switchgear was provided by ITE Imperial, now owned by ABB/Combustion Engineering. The lugs are a part of the switchgear and have been in place since construction in the early 1980s. The licensee contacted Amp, Incorporated and the company is researching color coding requirements for lug size during the time in which the switchgear was provided. The licensee is evaluating the reportability of this occurrence under 10 CFR Part 21. The licensee plans to replace the improper lugs prior to declaring the switchgear operable. The licensee also plans to inspect the other Class 1E 4.16 KV and 480 Volt switchgear (Unit 2 Train A and both trains in Unit 3) at the next opportunity. The inspection requires removing wires from terminals and reading the inscribed lug size. The inspection cannot be accomplished with DC control power energized. The licensee's preliminary risk evaluation of having lugs too large was that the risk was small, as there was no evidence of separation of the wires from the lugs. The licensee found that most lugs were tightly connected to the wires. Previous work to replace DC circuit breakers had not identified any loose connections. In addition, a control room alarm will occur to indicate a problem with DC control power if a lug separated from a wire. San Onofre Unit 2 is currently in Mode 6 during a refueling outage, and Unit 3 is operating at full power. Regional Action: The resident inspectors will monitor the licensee's activities to inspect and replace the lugs. Contact: H. Wong (510)975-0296 J. Russell (714)492-2641