HomeMy WebLinkAbout23-361 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE RESULTED ❑ CASE 23-381 z
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F E: LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 0 5 2$
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cawsloN 01 - 09 - 2023 2357 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 77
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTU '�01 VEHtOCLEZ PEAL-CYMLE. El �ESAGE NHORE✓LD MET PHONE 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY TACOMA ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
DRIVERS
STATE SEX D - 328 LICENSE MMDYY❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 9❑ Pi ATE 14 BBU4583 STATE WA VIN# JTMBD33V185131720
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
rRLR. TRLR 1 5 33
12❑ vIN# VIN#
;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 34
13 2 2008 TOYT RAV4 SV DAMAGE YES vEs❑ NO
REGISTERED OWNER INFO CHAN PHON 1217 S 92ND ST TACOMA WA 98444 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE ' S 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ T.
6
MOTOR PEDAL- PEDESTRIAN ✓ :. PROPERTY DAM THR OLD MET PHONE
�NiT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:5096208205
16 2
LAST NAME PRIDEMORE FIRST NAME MIA MIDDLE E
INITIAL
17❑ STREET NEW ADOREss❑' 405 QUEEN ANNE BLVD CITY YAKIMA ST WA ZIP 98902 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK yEEst
III I I NOF YES
t l NO❑
19 DRIVE #'
ON DUTY STATUS 3 AIRBAG RESTR EJECT H EET 2 INJURY5 [NATURE OF INJURIES
CLASS INJURY TO LEFT LEG/RIGHT HIP/RIGHT ARM E 40
❑21❑ TATE LICENSE vIN1 41
`1
PLATE#
42
22❑ PIR TRAILER LATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED By Gov HI 44
L4 0 s DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED24996
COLLISION REPORT III III III III III 111
1591972 CASE# 23-361
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CARPING THOMAS M
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
612 N 6TH ST APT A YAKIMA WA 98901 5096206205 SEX M MMDDYyvv 08 - 20 - 1977
PASSENGER WITNESSUNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ �; POS. r USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) GRAY SPENCER A
ADDRESS&PHONE# D O B
14021 SE STARK APT 16 PORTLAND OR 97233 3609790585 SEX M MMDDYvvv 10 _ 25 _ 1989
PASSENGER []WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIRST,MIDDLE INITIAL) YAZDI KAVON J
ADDREss&PHONE# 2537377074 M M O6 13 _ 1995
SEX.
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ POS. USE CLASS
NARRATIVE'
On 01/09/2023 at 2358 hours I was dispatched to a vehicle versus pedestrian hit and run collision at
77 Rainier Ave S. When I arrived, I located the pedestrian victim on the East side of the roadway.
Pedestrian 1 said that she was attempting to cross across Rainier Ave S near the 77 block when she
observed a vehicle traveling Northbound in the number 1 lane. Pedestrian 1 stated that she stopped
walking in the Southbound number 1 lane to avoid being hit. Pedestrian 1 then said that she was hit
by a Vehicle 1 when she stopped in the roadway. Pedestrian 1 stated that she was unsure of how fast
Vehicle 1 was going but stated it "was going pretty fast.". Witness 1 that was on foot with Pedestrian 1
stated that he saw the incident happen as described by Pedestrian 1, and when he went to the
Vehicle 1 he observed an Asian male in the driver seat who then fled Southbound on Rainier Ave S.
Witness 1 was able to provide a license plate for Vehicle 1. 1 was later approached by another
witness after the scene was cleared who advised that he saw Vehicle 1 make contact with Pedestrian
1 and came back to the scene to provide a written statement.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 01-10-23 12:58 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 111512023 2:06:07 AM
BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED' 11:58 PM TIME POLICE ARRIVED'12:01 AM
PART I PAGE IT]OF 3�
REPORT NO. ED24996 CASE# 23-361 DATE AND TIME 01/09/23 23:57
OF COLLISION
—NOT TO SCALE—
77 block
3
i
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