exhibit 13 - exhibit list accession #ml003734092 - pkg. … · 2012-11-17 · c8pq-1q-flf 1wpn...
TRANSCRIPT
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4. ACR SiGnMeance Uvet r_] A [313 P C E] 0 [3 W* S. Causal Factor
CW*s: ftiluteMo"Codo(s) FallwoGnum Coda(*) HUranPaton=rA*/Programmxticcwj"cocws)
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rmaki9e; Facie Ge&wmm- S*ppment -*CA d=.d lad*-krg kiftW owww 13 DxNW - dw -*wft Of Wl I TwW21128"t B !jet w0able ImmompUem
Distributlon List pftimmev"Ibn rmtmftl Pow-clasov rmwnnw
Nam orilwanabn Lo"tion Cod* (we bebwl AM NunAw
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Distribution Acton Codes: A- "alanad Lead In.emilgatw - gWor ta AZT30M PEOUMT and L*od kymw6gater Asatunmont Shamt (Form PtP 4-4) 8, Oth*r Action A*xlWwwnt - Rater I* ACTION REQUEST C. Wormatm Only No action Yequired. FuU ACP docwneM pe ge
0n, ýMbxcn requIrsct Traftaftow Sh**t aftly-
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N )(rtbSZ Nder Adverse Condition Report ______
Lead Investigtor Assignent Sheet ACR#?fo
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0 Apwflcasa flr dan*~. SV i =M'~t. n* G 1 atsee awdrs~ n eiw
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C PUAlS MAaintmnwnca History -Sevch, the PMMS database for the affeted sWath. tuctare arid coh4Wrpowf (SSCs) and related SQSC. The seawch should go back rive years.
C NPRDS - Cortac a MaWenlanCe or I&C NPRDS cocrdtruator and request a NPRDS sew~cl lox similar or relaed
components.
C NPO Inform.tion - R.v,#m the INIPO an4 nduhstry operating weariioc. informatcct liste below.
Cm~tbwabon hetf 0I
9 onnaider mo boflowing potmnliarty toelaed issues or Owicationz. or other, considerrzons dwurin the investigation
Confitnuatin SheetS
C. Required evalNations to support kwe~stgastlon As lead hwestgator. you ar* requited to bflltet at cowrdinate (suhas In11 the case of operabl~tty an~d roportabltty deternlnattions) these mvauaftmos
ED Op.rabiwr Evaftution - Lead kgudiduat _____________
9l Repoflýll Determination - Load sndv~at _ ____________
o PSSH (NGP2.01). 9 HPES Emluation 0 £0 (NO 2.29) 0 Omec____ _ Nwae
D. Is an LSR or other written report to the NRC required or potenitlany required?
q No 9 Yes - Type of reo-t 9 LEA 9 Othes -___ Raqurre stotic date _____
Lead bndividuad icr report prsparatcr
L. Thet following budividiak I groups muml review thob causal factoirs and eonetls actin plan:
1. Managementr UP to and hncWdiNg the tct[OwinT.
o Manage riDepartrnont ?41a± _______3wet Sr.vP - ,UTsOn
2. Other inditviuais or groups;
3. Oversight reviw groups.
Ol PORC: E] MPI C5 MP2 5 MPS 03 N______ one
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Noth~mst Advers.0oncflton Report -
NiucisM* Enn.,V ti"u Fulc '-d C~4sU d.pwas
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FAY NO. R60 440 2091AFR-19-00 WED 02:51 PM
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c8PQ-1Q-flf 1wpn flQ:R I T(nrItI1CT Ine FAX NO. 860 i 0001
N&&saM toAdverse Conditon Report
Cast Fact"s ad Covemdn ACtio Pbs
ACR#710 I
~rImovstwn iped P-roc mmgemt wawt mad am ACt wa secn IN-t fpc w~dt Kcaemdyi pAew*miftnim ftftisac o t Mo~c atf
8Canal Gkt=r and correctiwe actions prepared by.
9. Acceptance oftcmzctve action responsibilities =6d planed camp kaon darm
Namn6Dcpfartmc D=
NamelDepatnext Dhrc
NameDepartmetc= Dow
10- Review of cauml fu vs, corrective actionts and planed comipletion dates.
Name/tridle: 4D4-0
Name/ T itir D=
S. Other required indlivxduals (refer to Form RP 4-6 Block E2)
Nazne/ TitLe- Due:
Name/ Tidle: Date:
C. Assigned Events Analysis Coordinator (refer wo Form P.P 4-5):
Name:-ýo%-*\D- N
1), Oversight Review Groups (refer to Farm RP 4-6 Block E.3):
PORC-Unit I Meeting Number Dar
PORC-Unit / Meeting Numb=r Deu:
flrhtr- Mtrting, Nnmhrr fare:
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p nQAPR-19-00 WED 02:52 PM NUCLEAR LICENSING SVCS, ~ O 804029
QttbastNacur dverse Condition Repot A R N 01 Fo~~~m ~Initiation Form A RN 01
Rtr.O0fa at Ict
Appro~ved& 4 t('". SORC: qs',EW . 2 -q
Provide U* folUowing IrdnTad~on to the bee tit yoix abfy. Provide eonogh Infam~nn so Use hmna cm~ be
understood by thers whowia rwwLuu3 .e oI~cln p~ ~~~# a
Usept uporvlsacrb ine ow l0aiu Rmv dhft4F.
Adverse Candition InforMaI~on hiI awwidteDok1-.P'ndltmtwz
1. Descrbe the adverue condliost (The bak Cd Ofts $WMl 5MS ty" at k*x~waOf Youh ihwd kxk"*)
~ýikL Aq- 0. F/A t STI P WKQ. WLý 0
3.What inktal clsWR taken as a resgit C4 *ae kkdn? se
4. W4Atdo ou nowor suspect was the cause of the adverso a fitlow? j
S.WaCRo o Revi mrew da Eonsrrce acll etnen nomto isryWdad ntay*insae£di~t
11.~~-ý Suevio Reie IatIih
6. Sytam Engby.- t Lit/?CPW~tbz jcmedd)QN ~•'s-N
1C. Supavisor AR .avlew d wit "atSnRSzettl
TV=medlstaly bLka a pivWinde othffactud ShftSupwvSkar(ui ) No * Fwuwd tothu EwuwtuAnaiskoiar qbuin
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*12. iniu tlathit supervisor Review (it ACA Want to SS):
Does ACR h&yS bl,V-W 5 EW. O Pcotho!flIaVif ~Of~t f ZW*,tV OP9Ub~tY~ r P~ OPereon2 g Ves- P1o. 'min FýOrm RP 44.
,Ma. Of ShM S4JP~rVWIeo/ /[, WA L-k•K ý Q- O NO- R.tan ACR bn Contrl R-J
D66*mf,6- %a*-6rw",-6w YJ6,-SWt Sdpft-60f P6&-0rW"W
FAX NO, 860 440 2091
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Which 0Mw am riot OPERABLE "n wIt.
Doscrbe actýns bouh9 taken to resolve w.Etaimy:
Load ir6NkiU2 fesponsbte to raw"~v: Ext. _____ Coftwawsn lest
4. Yes*AZ REOTBE RN Uncertain
RepwcateoT. A (po~nmda* - attach a coNr of Nuclear Incident Ropoit Form Repofl~~ Cavg)y o8 LER) c mur utwes) [I Fr-D (Poti; linwws) 0 Other ___
Why is the AC4I REPOFMABLE
Cc-rua~a sr~ l
Dascrbe acUofk bomg taken~ to resolve ucertain~y-.
Duty Officur' (afl ACRS%) Date/Time:
Other (sp"cl) ____________________ ate no:
7._____SS____Signature:__________ Datefrime:___ rave)______
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'-00 WED 02:52 PN NUCLEAR LICENSING SVCS, FAX NO. 850 440 2091 P.10
Adverse Condition Report AR Nortean Nwadar Shift Supervisor Review L ~
Ann. ,dkak7 4 .. SORCr 9 O -Wci 2& aI'?5s
Pr~vd W. tilowng I~t~tim t~h. est I~jar b'Bi. ftoh btwdom na In U back~ cot. 1h% .*P dwiso yawx twvlew you consie oddUsa kdoumtbt Is ripqubud receWe O WdNB or aee bividwaW raide 1.zo
i. Piact Ccwvdonw Mods; 6 ftg p0*04c % =STw0ffp. / OF R P= swft "-g
2. Atm hiftWm cmeOrvl sefloam su~fthint? eYw No - Di~scbo aVW edd4Un aon Iaken o-r requlr
Am mas ofa the affected suucurma, systma or ow*neponts (SBCS) sa .ry-e.4 or -avetd by TacnihcaZ SpOGlka"Mo
(TS) or to. Todwcwla Ruqukaefti MoNUW (M"? g]yes No - 0o0 Smctý 4
im AjU ca S~~ssc3Mad wo~a~ TS I TRM Swtirqs):
Am. Owes. sbdz1*dtrn. tMs or componefts OPERABLE? MYes 0 o u c-iup au
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Norheat uckar Adverse Condition Report AR i ~ EzNortes ula Management Review F PW Rey. Pag papI t1
Rater to b hCtlrnS oma the bm*J of this farm it daring your review you 8xksid r el ki a h~eon Is. rmqufrd ruqoemtatli neo opsvd ,poI y"My.I or meqest anussmnfom &M~w kiWbu&WvI:
1. Was UV.ACIA proceseed tmootw SMi $upWV*ottSS WiW&aFuaa~P3, E 4y-3V
N/A 00a 0 dawamur
LSW___AMO Co~oShea [3
The Events Analysi CoordkMor "cmpltes the folftwlnW A, Shoudti hs AC~tbe tevq*d byth*.SS? [3 No E] Yes - Takeoor provide ACA to Vie appropfiaf* SS(s) EL At r emmtaJonctive actios uftV 5~0~ Ye [] 5 N - DescRb. any a*MkXona adiln taken or required:
Coauiabon Sh"o
C, Should Me ACV4 be teviwed at a unit Morning mneeting? Q No EC Yes - Proces e=s kogi at hel morng e¶- nw.am
2. WtiR the ACR be closed f ollowing lbdtal reVIew? Ye m- ProvdO basis lto closure, then go to Block 6.No
L B"5 0 uelongs in another problem reponing syat-a IIFor 03 Low siga(canco. .au. . understood. corructive action camplaot, IM Mo gsnric irt~catons. ]Closure 0 Ote ruason (axplazy
3. What additional evaluations am requred durlrig the Investigation? E0 PSSi (NGP 2-01) E0 SPES Evaluation E] JC (XQP 2.29) 0-- O*.ri M__________
4. WMat adltkxnal reviews of the I wastigatin resuUi and corrective action ptan are requfred?
Omefc Op UP DS&9VP35 4 C3 te Nraon'iee
6. Comnpleted by: 7,R~-.~Otljn: 'i~''
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