| Type of Incident: | Injury |
| Match Number: | |
| Date of Incident: | 2013-12-15 |
| Time of Incident: | 03:15:00 |
| Location of Incident: | Chaboya Middle School Large (3276 Cortona Dr San Jose, CA 95 |
| Competition: | 2013_SOR_FALL_ |
| Home Team: | Evergreen United Earthquakes - 01B Blue |
| Visiting Team: | SASC Fury 01 White |
| Age Group and Gender: | U12B |
| Team Affiliation of Individual Committing Incident: | |
| Incident Summary: | TBD |
| Comments: | Evergreen referee coordinator was informed of the concerns and a send off report was also filed and PAD made a ruling on one sent off report that was submitted. |
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