366B Licensee Event Report

NRC FORM 366B

U.S. NUCLEAR REGULATORY COMMISSION

(M-YYYY)

LICENSEE EVENT REPORT (LER)
FAILURE CONTINUATION
1. FACILITY NAME

2. DOCKET

6. LER NUMBER
SEQUENTIAL
NUMBER

YEAR

05000

-

3. PAGE
REV
NO.

-

OF

13. COMPLETE ONE LINE FOR EACH COMPONENT FAILURE DESCRIBED IN THIS REORT
CAUSE

SYSTEM

NRC FORM 366B (M-YYYY)

COMPONENT

MANUFACTURER

REPORTABLE
TO EPIX

CAUSE

SYSTEM

COMPONENT

MANUFACTURER

REPORTABLE
TO EPIX