HomeMy WebLinkAbout23-9582 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-9582 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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# ❑
COLLISION: OS - 1-- 2023 1329 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE 192ND ST BLOCK NO. e✓ 10200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 102ND AVE SE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:2534864607 0 11
30
6� LAST NAME TURNER FIRSTNAME THOMAS MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 2616 ALPINE PL SE CITY AUBURN ST I WA 2jp, 98002 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CES0538 sTArr WAurN# 1G1FZ6S02N4109830
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 1 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TJ�,�pt�p Y GOVT.VEHICLE 3 ] 34
13 2 2022 CHEV BOLT 4H DAMAGE vE5 0NO f la gkS vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO pEMCO CA763615 3 4
IN EFFECT &POLICY# 9TOP
15❑ LE
vEGALLY HICLE 5 36
YES�No D CITATION# 3A0629774 CHARGE FAIL YIELD LEFT TURN io sorrow
STANDING 8 7 6
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT ❑✓ ❑ PEDESTRIAN ❑ ❑ D:2064884118
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME WASAN FIRST NAME NINO MIDDLE P
INITIAL
17❑ STREET ❑', 18631 131 ST AVE SE CITY RENTON ST WA ZIP 98058 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YES❑NO� INTERLOCK vEs❑NOF YES
❑NOF,/
19 LDIIVEW # STATE WA SEX M M .C.B. 01 16 _ 1994 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BTR0624 TAre WA YIN# 1(B1FH1R77L0100893
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED By Gov HI 44
VEH YEAR 2020 MAKE CHEV MODEL CAMARO STYLE CP DAMAGE TOWED✓ NOO BLIN MEYERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO pROGRESSIVE 938031519IN STOP 5
vEwGLE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES FINE]
25 s 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED93777
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9582
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
PM 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 Turner turning from eastbound SE 192nd St to northbound 102nd Ave SE. Unit 2 Wasan
traveling west on SE 192nd St. Turner entered turn in front of Wasan (fail to yield right of way), front
end of Wasan's car into right front of Turner's.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 08-20-23 03:04 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS solo 1 812112023 3:15:56 PM
BADGE OR ID# 5738 OR]#' WA0171300 TIME POLICE DISPATCHED 1:31 PM TIME POLICE ARRIVED]1:39 PM
PART I PAGE IT]OF 3�
REPORT NO. EU93777 CASE# 23-0582 DATE AND TIME 08/20/2313:20