| Type of Incident: | Other — Do not use if a team, player, coach, or spectator is involved. Use only if the incident cannot be classified as any other Type of Incident above. |
| Match Number: | 48 |
| Date of Incident: | 2017-04-15 |
| Time of Incident: | 02:00:00 |
| Location of Incident: | Ceres Soccer Complex |
| Competition: | 2017_SOR_NCSC_ |
| Home Team: | Ceres Earthquake FC Warriors Jrs. |
| Visiting Team: | Placer United 03B Gold |
| Age Group and Gender: | U14B |
| Team Affiliation of Individual Committing Incident: | Placer United 03B Gold |
| Incident Summary: | Field Reimbursement. |
| Comments: | Please contact the Event Coordinator. This is not a PAD issue. |
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