HomeMy WebLinkAbout26-4732 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EH2O983 170
27
COLLISION REP FIT 1591971
CASE 26-4732 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 06 - 1-- 2026 1705 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e✓ ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a LIND AVE SW
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2069541177 0 11
30
6� LAST NAME LEI FIRSTNAME CHUYANG MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 11630 RENTON AVE S CITy SEATTLE ST WA ZIP 981783044 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 7 [NATURE OF INJURIES
COMPLAINT OF NECK PAIN z❑
3
10[1Pi ATNES# CUT4538 sTAr WAv N# JTMBCAEBXTJ000294
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 1 7 33
12 3 5 VIN#' VIN#
ROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 1 5 34
13 4 2026 TOYT BZ UT DAMAGE YES NO �MEYER YES❑ NO✓
REGISTERED OWNER INFO CHUYANG LEI 11630 RENTONAVE S SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO FARMERS 187753473 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069543065
16 a
LAST NAME TAN FIRST NAME KHIM MIDDLE N
INITIAL
17 STREET❑ NEW ADDRESS❑' 23848 125TH PL SE CITY KENT ST WA ZIP 980313754 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO
�
19 D IVERI # STATE WA SEX M MMDDYy 03 _ 10 _ 1966 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS COMPLAIN NECK PAIN
LICENSE I ❑21❑ PLA E# D22992A TArE 41
WA VIN 1 3TYSZSAN3NT084765 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE TOYT MODEL TACOMA STYLE PK VEHICLETOWED TO BLIN TOWED eY GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO KHIM TAN 23848125TH PL SE KENT WA 98031 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO AMICA MUTUAL INSURANCE 96024622KP STOP 5
IN EFFECT
VEHICLE ❑ ,.I—I CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEV/N PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH2O983
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4732
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 FIRST 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'
I was dispatched to a vehicle collision on 06/17/26 at the intersection of SW Grady Way and Lind Ave
SW, in the city of Renton, King County WA.
Unit 1 CUT4538 Driver: Chuyand Lei (DOB 10/03/1964)
Unit 2 D22992A Driver: Khim Tan (DOB 03/10/1966)
Upon arriving I spoke with Unit 2 who told me that he was traveling South in the far right lane on Lind
Ave SW approaching the intersection of SW Grady Way and Lind Ave SW. As Unit 2 went to go
through the intersection Unit 1 pulled out in front of him colliding with him. He told me that Unit 1 was
facing south on Lind Ave SW in the left turning lane when he then turned right across both lanes to go
West.
I spoke to Unit 1 who told me that he was at the light on SW Grady Way and Lind Ave SW in the left
turn lane facing south. He then attempted to turn right onto SW Grady Way to go right when he
collided with Unit 2.
Both Units were seen by Renton Fire Department and both drivers complained of neck soreness.
An information exchange with the case number was given to all involved parties
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 06/17/2026, 2354 hours at Renton,
WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 06-17-26 11:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 1 7/15/2026 11:00:50 PM
BADGE OR ID# ` 12808 OR]# WA0171300 TIME POLICE DISPATCHED', 5:05 PM TIME POLICE ARRIVED'5:08 PM
PART I PAGE IT]OF 3�
REPORT NO. EH2O983 CASE# ' 26-4732 DATE AND TIME 06/17/26 17:05
OF COLLISION
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