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HomeMy WebLinkAbout24-6236 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE94138 170 27 COLLISION REP FIT 1591971 CASE 24-6236 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28 UNITS RESERVATION I I STRUCK z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ CtLLISION' 06 - 1-- 2024 1715 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ RAINIER AVE S BLOCK NO. e✓ 700 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 1 2 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/NO D:2062808469 0 11 30 6❑ LAST NAME SHINEMAN FIRSTNAME JEFFREY MIDDLE S 1 1 2 31 INITIAL STREET ❑, PO BOX 1838 CITY SHELTON ST WA Zlp' 98584 z NEW ADDRESS ]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID LOB 10 1- 08 - 1986 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑ 3 LICENSE CJU5656 sTArI WAVIN# 183ES56C23D106804 10 F91 PI ATE# TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FR.. ro TRLR. TRLR 7 5 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 $ 34 13 3 2003 DODO NEON SD DAMAGE YES NO YES❑ NO REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 IN EEC 14� LIABILITY INSURANCE❑ INSURANCE CO M EFFECT &POLICY#E CHARGE5 36 veLEIF"GAL YES❑NO CITATION# 15❑ STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066839478 LAST NAME SPELLMAN FIRST NAME TIYA MIDDLE M INITIAL 17 NEW STREETR 7' 10915 SE 222ND ST CITY' KENT ST WA ZIP 98031 37 18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 DRIVER'S STATE WA ]SEX IF D.O.B. 04 16 _ 1983 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS I AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 ❑21❑ PLATE# BGJ8359 TArE WA VIN# 2(BKFLUEK1H6255766 41 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. N#. 43 RLR 'I GI VEH D YEAR 2017 MAKE GMC MODEL TERRAIN STYLE PK AMAGE TOWED ES NOO✓ BLIN TOWED BY ovyES NO 1/ 44 H 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO STATEFARM 499 75 88 CO747IN 9TOP 5 VEHICLE ❑ ,.I—I CITATION# CHARGE 25 i o BOTTOM LEGALLY YES N ' a 7m"1'c' S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 BATTLE 12049 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT No. EE94138 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6236 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME (LAST FIRST,MIDDLE INITIAL)_ ADDRESS&PHONE# SEX D.O.B. - - MMDDYYYY. PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# D D B SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS R PHONE# SEX D.O.B. MMDDYYYY. - PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit 1 (U1) was identified as Jeffery S Shineman (10/8/86, verified by WADL) who was driving WA- CJU5656. Unit 2 (U2) was identified as Tiya M. Spellman (4/16/83, verified by WADL) who was driving WA- BGJ8359. U2 stated he was pulling out of the Speedway Gas station to travel southbound on Rainier Ave S when U1 struck his front driver side. U2 stated she was driving southbound on Rainier Ave S in the inside lane, when U1 pulled into the roadway in front of her causing her to strike U 1 with her front passenger side. U2 also oversteered and when over the center median into oncoming traffic. No obvious or reported injuries, however the involved were evaluated on scene. U1 was cited with improper merging and no insurance. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MICAH BATTLE 07-06-24 09:36 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1 7/9/2024 1:25:31 PM BADGE OR ID# 12049 OR]#' WA0171300 TIME POLICE DISPATCHED; 5:16 PM TIME POLICE ARRIVED',5:23 PM PART Ei PAGE IT]OF REPORT NO. EE94138 CASE# ' 24-6236 DATE AND TIME 06/13/24 17:15 OF COLLISION ti Not drawn to scale i i k My t lil� t PAGE 3 OF 3