| Type of Incident: | Referee |
| Match Number: | 5432 |
| Date of Incident: | 2016-10-22 |
| Time of Incident: | 10:15:00 |
| Location of Incident: | Petaluma Sports Complex |
| Competition: | 2016_SOR_FALL_ |
| Home Team: | North Coast FC |
| Visiting Team: | Impact 99 Boys |
| Age Group and Gender: | U19B |
| Team Affiliation of Individual Committing Incident: | North Coast FC |
| Incident Summary: | Allegation filed by a Team Assistant Manager |
| Comments: | PAD only reviews Incident Reports filed by Club Presidents and DOCs. |
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