| Type of Incident: | Referee |
| Match Number: | |
| Date of Incident: | 2012-10-14 |
| Time of Incident: | 12:15:00 |
| Location of Incident: | Trione Field, santa rosa, ca |
| Competition: | 2012_SOR_FALL_ |
| Home Team: | SRU Napoli |
| Visiting Team: | Tahuichi FC boys 03 white |
| Age Group and Gender: | U09B |
| Team Affiliation of Individual Committing Incident: | |
| Incident Summary: | Incident occurring in game between SRU and Tahuichi |
| Comments: | Please see send off report in regards to the Tahuichi coach |
Español