| Type of Incident: | Referee |
| Match Number: | 1434 |
| Date of Incident: | 2021-06-19 |
| Time of Incident: | 05:00:00 |
| Location of Incident: | Shorty Garcia Field #2 |
| Competition: | 2021_SOR_SUMMER_ |
| Home Team: | UNION CITY PREMIER BLACK 04B |
| Visiting Team: | SAN JOSE RUSH 03B |
| Age Group and Gender: | U18B |
| Team Affiliation of Individual Committing Incident: | UNION CITY PREMIER BLACK 04B |
| Incident Summary: | Allegation that the referee failed to file a send-off report. |
| Comments: | See Incident 3997 for the PAD Committee's recommendation that Union City Premier not be permitted to host home games until they engage a certified referee assignor. |
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