Once the air monitoring system goes into alarm, the most qualified control room operators should be controlling operations. Furthermore, even when plant personnel do not believe agent is in the system, when an agent-related alarm activates, the alarm should be considered valid until it can be proven false. Once the alarm is activated, the control room supervisor should make all decisions consistent with guidelines from the Contingency Procedure for Agent Detected in the Stack manual. The contingency procedures should be reviewed and updated to reflect this incident. Prior to the restart of plant agent operations, CDC recommends a careful review and evaluation of the entire system.
Intensified investigation is needed to identify and eliminate the source of false stack alarms.
All air monitors should be challenged and reviewed for quality assurance. An engineering evaluation of the location and operation of the flow meter should be conducted. The deactivation furnace feed chute and related gates should be evaluated to optimize proper functioning. Finally, all components of the deactivation furnace system including the pollution abatement systems need to be systematically examined to ensure proper functioning. Since there is some question regarding the notification policy during an agent release incident and the current policy is unclear, the procedure to ensure that Tooele County is informed in a timely manner of potential and confirmed agent released should be reviewed and clarified.