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HomeMy WebLinkAboutMINUTES - 03182003 - C39 4. What particular act or omission on the part of aunty or district officers, servants, or employees caused the injury or damage? The driver of the bus negligently ran a red light, which is a violation of the California Vehicle Cade. The driver of the� bus is an employee of the County. 5. What are the names of county or district officers,servants, or employees causing the damage or injury? Dollie Ann Reed, AC Transit. 6. What damage or injuries do you claim resulted?(Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) _ Extensive property damage to my Infinity 130T in excess of $14 ,000. Extent of physical injuries still unknown - experiencing headaches, sore back and neck. 7. Hove was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) Physical injuries still unknown. To date, I have incurred $1 ,869. 30 in medical costs and $34,642,49 in the repair of auto damage caused by accident. ' S. Names and addresses of witnesses,doctors, and hospitals. San Ramon Medical Center P. 0. Box 2517, Santa Ana, Ca. 92707 San 'Ramon Emergency Physicians, P. U. Box 2267, Chatsworth, Ca. 91313 Danville Medical Group, 903 San Ramon Valley .Blvd. , # 122, Danville, Ca. f`fili es in Im in in P p. B 111%, LaFayette, Ca. 94549 9. List€ ie expen' res you mal on`�ecc fit of this accident or injury. ]DATE TUVWAIVi.£1I��NT To date I have incurred $1. ,69. 30 in medical costs and. $14 ,642. 49 in the ',repair of auto damage caused by accident. ) Gov. Code Sec:910.2 provides"The claim must be ) signed by the claimant or by some person on his behalf:" SEND NOnCES TO: LAUQn= Hume and Address of Attorney ) JEFFREY NADRICH:, ESQ. NADRICH & ASSOCIATES ) ( mant's Signature) 1 Blvd. Fifteenth Floor . NADRICH & ASSOCIATES Los Angeles, Ca. 90025 � " ` Fifteenm Floor Telephone No. 310 826-8082 OS rageles UA UV 02 0-1 )Telephone No. %_t,o 2 4^ o fi 2 *****��*«***#******:**��►****w**s+**�****s#****s*s�►t*sss***s#t*�***�*:s*****s****:***�***** NoncE Section 72:of the Penal Code ptuuides. Evoy person who.with intent to defraud,pants*for allowanoe or the paynieent to any state board or officar,or to any wwy,city,or district board or offic a,authorized to allow or pay the same if genuine,any false or fraaudulew claim,bill,amt, voucher,or writing,is punishableeidw by imptisomnent in tb e,m linty jail for a period of no more than enc year,by a fine of m exceeding one 9musand($1,000),or by bath such impisoment and fie,or by impr soninew in the state prison,by a fine of not exceeding in thousand dollars($10,0W),or by both such imp6sonmeat and fins:. STA, C tCALWORNIA TRAFFIC COLLISION REPORT 64 Q,.�i��C CHP 555 PA90 1{Rev, i- ?};OPJ 042 SPEOAL CONDITIONS : Nuta%R MYt.Ruk CITY Ptgi r%{ ' Imi"to €itow 3UO=AL DISTRICT LOCAL REPORT42UM£ER upz aLMs� %o T Rom 'COUNTY REPORTING DISTRICT SEAT COLLISION OCCt1RRED ON MO. DAY YEAR 'TtME a4m NCIG K OFFICER W. 5 7" I ; MILEPOST INFORMATION /04, i !!�tdz DAY OF WEERTOW•WhY PHOTOGRAPN39Y: ,() : FEET,'MItEB OF S IN "T t+J 'lE^aEl NO AT INTERSECTION WITH '�Y/r / � G.,' !v✓ 'STATE hN Y REL OR: : FECTRMLES OP YES . NO + �+Fa� PARTY DRIVER'LICENSE NUMBER STATE CL433 SAFETY VEIL TEAR 'MAt E AtOggLOR :. ,,.Z. LICENSE NUMBER// 4SNER NAME{FIRS T;MtdOIE;.LAST) . i 4� — G L.� _ V`< t oW aER S nuME •.['"FRAME AS DRIVER v aI`E STREET f ADORE (J =•;RXE I crWIfER9AQDRE58 . '4(Nt�%"E4 GtYYiBTATFIZ:P ME AS DRIVER �.J kIf DISPOS4TR3N OP VEltlGLe ON ORDIREOF: 0t%ri SEX HAIR EYES HE OHT WEIGHT B RTP%MTE PACO OFFICER DRIVER U OTHER LYt6T 1Lt !}}L Mo. DSY YS2c j P.tDRMECNANI FEC78: NONE APPARENT REFER TO NARRATIVE CTNJA SOW"ONE �}/3 6 3 J IBL ,SS t i V" L GGT{ CHP UNTIP-mLy-N NUMB'SRt J I£ CHP ti$E YiNLY DESCRIBE VEHkCLE DAMAGE SHADE W dAMAGEb AREA t ;HCARRfER POLICY NUMBER DItCYNUMBERV€HtGlETYPI (`1.UNK .NONE ]MINOR �! Se--7 OERO � �.., OtR OF TRAVEL ON STREET OR HIGHVYAY SPEED LIMtT _/�,,,. t 5` CA OOT I�"T j �.J CAL�7 „i7GPJPCC APARTY ORWER'S LICEN NjUMMER(�,,r} ;STATE CLASS WE7Y VEH YEAR MMCElfAOOE1ICOLOR LiCFN3E NUMBER 'STATE Cl- . MM4 NAME IPMST:Af1DDLP,LAST) .._. --_---_ - �,L1 ���-- I t - - � E hJ �,.'!r✓. OWNE . .NAME Y� SAMEASDR4VER 3^� STREE XDQR}ES9 1 ,r WE ; Afr SAME AS DRDRNER Pti%ED CITYMIATW4r Ia Ytslt%lE �/yJ ��,, E..A 01500VTIONOF VE31s4;LE ON ORDERS OF. �OFfICER,�.DRIVER ®OTHER u%r• SEX HAIR EYES HVCHY Y4,B04T RiRTHOA�E RACE t�—� PRK1R MECHANICAL OEFEG73 NONEAPPAREi3T REF.R TO NARRATIVE ants HOME PHON'L' s$U6II#38 PHONE VEHICLE IDENTIFICATION NUMBER: CHPUS91ONLY DESCRIBE VEHICLE CAMAG£ SHADE 1.4 DAMAOED AREA INSURANCE CARRIER PrXtCr P#iM3ER AmwAE 7YPE ©4JNiCNONEMINOR 11 T~` DCI. D MAJOR El ROLL-OYER DfR O/F: �VEL ON STREET OR H16 I.BPE£Q LlM1T_,,.r+ T.. .YG�.—i :CANT .,... _TCPA-SC 1111_.,..,,,,_,,.,.,,.,,,., PARTY DR7VER5 WCENSE NtJMflPlt ISTATE11CLASS SAFETY -VEH.YEAR NAK&NODELICOLOR •LICENSE NUMBER STATE aARDDLF.LA&TJ -------- ---------- - -� O 3 HAW � SAME AS DRIVER MAN B,TtiEETi•DDRE96 TPIAY OWNERS ADDRESS El SAME AS DRIVER PAW D CITI'jSTA7E2tP : ie,i - rL.Jt =POSITION sR VIEWC11 ONORDERS OF: u OFFICER DRIVER Fj OTHER EiCY• SFX HAIR (EXES HE4GNT 'W£tGkT EtRTHGATE ItiACE tt,IST t7j Mo, OST Yief IE..M34 PRIOR USCHM ICAL DEFECTS; NONE APPARENT RIFER TO NARRATIVE OrHIA :HOME PHONE. BUSWESa PHONE VEHICLE VENTIFICA71ON NUMSER: J CMP Us&ONLY DESCRIBE VENCtE DAMAGE 4HA06 IN OVAA6CO MGA INSURANCE CA"I€R pOLaCY N49ASER VEHtGLE TYPE QLSNkNONE ®MINOR t E MOD. []MAJOR ROLL-OVER I Q1R OF YRAVEL ON 57REE7 OR HIGHWAY SPEED LIMIT CA DOT CAI•T 7CPR+SC MClM% (PREPARBA'S NAk£ DISPATCH NOTIFIED REVIEWER'S NAME TO r- WA,r �' ��--�+I •{. Age ck ,{• k,',YES L.]NO 1tern ...::: ........: _. t STATE O'CALIFORNIA TRAFFIC COLLISION CODING CHP 555 Page 2 Rev:8-97 OPI 042 DATE Of OOLOSION(MO. DAY YL'IRY:... TIME(+7+064 INC.N J o6Y�CER t.a NUMBER i ovnaEki`S.x+AnE oWNEI;S AOORSSS NOTWIfio PROPERTY s YES NO DAMAGE DFBCRIPPON Of DAMAGE SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTS L-AIR BAG'DEPLOYED M if C$$CYCLE-HELMET A A-N J $N FHICLE M-AIR BAG NOT`bEPLOYED C-NOT EJECTED / � B-UNKNOWN N-OTHER DRivER #-FULLY EJECTED C-LAP BELT USED P-NOT REQUIRED V-NO 2-PARTIALLY EJECTED D-LAP BELT NOT USED W-YES 3-UNKNOWN 1 2 3 t-DRIVER E-SHOULDER HARNESS USED 4 2 TO S-PASSENGERS F-SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER 7.STATION WAGON REAR G-LAP/SHOULDER HARNESS USED -INV MEM Mo X-Na S-REAR OCC--RK OR VAN H-LAPISHOULDER HARNESS NOT USED R-1N VEHICLE NOT USED Y-YES p-POSITION UNKNOWN d-PASSIVE RESTRAINT USED S-IN VEHICiE USE UNKNOWN 7 K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE!MPROPER USE 0-OTHER v-NONE.IN VEHICLE ITEMS MARKED BELOW FOLLOWED SY AN ASTERISK(')SHOULD BE EXPLA)NED IN 714E NARRATIVE, PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NU#BER 3 V QF¢ARTY AT FAULT TRAFFIC CONTROL DEVICES 1 2 3� TYPE OF VEHICLE 1 2 3 CY3L IS ae a:anon d;oWeo � A CONTROLS FUNCTIONING k I IA PASSENGER CAR t STATION WAGON f1 STOPPED i } E3 CONTROLS NOT FUNCTIONING:' 8 PASSENGER CAR W i TRAILER 8 PR CEEDI STRAIGHT CTHER$MPROPER DRIVING': C CONTROLS OBSCURED C MOTOt4CYCLE t SCOOTER I IC RAN OFf ROAO I Q..NO CONTROLS PRESENT r FACTOR* 0 PIC)WP OR PANEL TRUCK 10 MAKING RIGHT TURN a C OTHER THAN t)RtVER- TYPE OF COLLISION E PICKUP I PANEL TRUCK Wr TRAILER FBA KING LEFT TURN D StNKN_CiyNI' A HEAT}-aN ' TRUCK OR TRUCK TRAC7ttf2 FKING U xURN i 'ELL ASLEEP SIDE SWIPE IGT TRUCK I TRUCK TRACTOR WITRLR. I `GK,N' IC REAR END i H SCHOOL BUS #{ SLOWING i STOPPING WEATHER ARX T TO 2ITEMS RRaADSIDE OTHER BUS PASSING OTHER VEHICLE_ A CLEAR 1'E HIT OBJECT EMERGENCY VEHICLE li CH NGWG LANES $CLOUDY F OVERTURNED I KC HIGHWAY CONST.EQUIPMENT K< PARKIN MANEUVER !C RAtNIt10 Ca V€HICLE i PEDESTRIAN1 L BICYCLE I ENTERINGTRAF$ D SNOWING H OTHER^ OTHER VEHICLE MOTHER UNSAFE TURNING F FOO+v1-1-3141Y �_ FT. !N P£DE.STRIAN N )ONG INTO OPPOSING LAN. F O?HER' MOTOR VEHICLE INVOLVED WITH E}MOPED iO PARKED W_m I AA�-NON-COLLISION R M€RPit. LIGHTING ,Y i2S P€iT€STrttAN i Q TRAVELING WRONG WAY A DAYLkONT C O7HfR MO?OR VEHICLE 2 OTHER ASSOCIATED FACTOR(S) R OTHER'. B OU SK-OAS_ MOTOR VEHICLE ON OTHER RO&DWAY thfARK r 7O 2 IremS) �e%4=n -GAr�ow cluo - l:DARK-STREET LIGHTS E PARKED MOTOR VEHICLE pk A YES i I)DARK-ilT STREET EIGHTS 'F TRAIN E WX-STREET LIGHTS NOT tra BICYCLE +euaTiry�°`° FUNCTIONING* YES �ANIMAL: - No SOBRIETY-DRUG } 3 vc:ec;wnwxArwt: carx6 PHYSICAL ROADWAY SURFACE f �C �IYEs 1 2!� I A aRY F,xED OBJECT: # NO (AAt�SK i TO 21T£At5) FA ; D ! iA HAD NOT BEEN DRINKING FT' u J OTHEROBJ€CT. VAS$aN OBSCUREMENT: 8 ttSO-UNDERINFLUSNCE DOY.0!1 ETC ! *ATTENTION•: C HBD-NOT UNDER INFLUENCE' NDIMNIS) $TOP b ca TRAFFIC D HBO-IMPAIRMENT UNKNOWN' 2 ITEMS] PEDESTRIAN'S ACTIONSH ENTERING i LEVANG RAMP r UNDER DRUG INFLU€NCE' R T• Na PEDESTRtANs IF3vaI vED I PREVIOUS COLLISION F IMPAIRAdENT-PHY'sICAL' iAtaN RIIADWAY" (..CRaSSINC,kN CROSSWALKUNFAMIL AR WITH ROAD Cs IMAIRENT NOTKNaWN.ONROADWAY- I AT INTERSECTION K( DEFECTIVE VES,EOUIP.: CITED H NOT APPLICABLE3N-REPAIR ZONE (C CROSSING IN CROSSWALK•NOT �j YEsEEPY I FATTCU8i1AOWAt WIDTH AT INTERSECTION _ _[j wd SPECIAL INFORMATION DED• D>CROSSING-NOT IN CROSSWALK> (L UNI LVED VEHICLE A HAZAaiaUS MATERIAL C HER E IN ROAD-INCLUDES SHOULDER 11I OTHER` 3 H NO UNUSUAL CONBIF$CNS i F NOT IN ROAD I IN NONE APPARENT APPROACHING f LEAVING SCHOOL BUS 1 10 RUNAWAY VEHICLE SKETCH MISCELLANEOUS :• � +9 I WA}f AlAl 1r . [j r-,[,J�. WMAT$NORTH �f 1 t .._.—._.._...>.....--. - MR osP as 1700s .. . _.. __ .._:: �:: :: STATE Of CALIFORNIA TRAFFIC COLLISION CODING CHP 555 Pa e 2 Rev:8-97) OPI 042 PaQa of DATE Of COLLtSl VAOI� fixtE(:�� NdC y � �OFFICER 10. OltvNER S NAME tOWNER'S ADDRESS NOTIFIED I i PROPERTYYEScl NO DAMAGE DES:RtPTiCtd OF DAMAGE I SEATING POSITION SAFETY EQUIPMENT i EJECTED FROM VEHICLE OCCUPANTS L-AIR SAG DEPLOYED M t C BICYCLE-HELMET A-N N :N VEHICLE M•AIR SAG NOTDEPLOYaD C•NOT EJECTED B•UNxHOWN N-OTHER DRIVER I-FULLY EJECTED C-LAP BELT USED P-NOT REQUIRED V-NO 2-PARTIALLY EJECTED D-LAP SECT NOT USED W-YES 3•UNKNOWN l 2 3 1-DRIVER E-SHOULDER HARNESS USED. f 4 E 2 TO S•PASSENGERS F-SHOULDER HARNESS NOT USED CYNLD RESTRAINT PASSENGER 1 7-STATION WAGON REAR 10•LA,FISKOULCER HARNESS USED IN V€H? l ll ED X-NO 8-REAR OCC TRK OR VAN#H•LAPtSHOUL:ER 4ARNE9S NOT USED R-fN VEHICLE NOT USED Y-YES 7 9-POSITION UNKNOWN -PASSIVE RESTr"NT USED S-fN VEHICLE USE UNKNOWN. D-OTHER K•PASSIVE RESTRAINT NOT USED T•IN VEHICLE IMPROPER USE U NONE IN VEMCLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE. { PRIMARY CGLiU S?ON FACTOR ? 1 k I :.,ST?.UMBERY 4101=PAR AT FAULT TRAFFIC CONTROL DEVICES j 2,:.3 TYPE OF VEHICLE { MOVEMENT PRECEDING 1 ;2 13 ! COLLISION su:aaxvx:usio. c•rca , E5 .4:CCSV'ROLS:FC;I^1CTIOftiNG t IA PASSENGER CAR;STATION WAGON I ASTOPPED •' :E CONTROLS NOTFUNO'tONING` I { PASSSNGERCAR'N/TRAILER $ pRO^.EEDING STRAIGHT: $OTh€F',IMPROPER C CONTROLS OBSCURED _ 1 j t C MOTORCYCLE t SCOOTER ! t C RAN OFF ROAD Q NC CONTROLS PRESENT I FACTOR' r I D PtCKUP OR PANEL TRUCK1 � D MAKINGRIGHT T' R N { i C OTH6RTHAN DRIVER' TYPE OF COLLISION I I E PICKUP I PANEL TRUCKW1`RAILER f E MAKING LE.=T TURN 10 UNKNOWN k A AD•Civ IF TRL?CK OR TRUCK TRACTOR I F MAKING U TURN I r-E�FELL —ASLEEP- - - I •B S:DESWIPE IG TRUCK ITRUCK?RAC-OR WT7RLR. } Ga BACKING t 1 i :.PEAR END i i H SCHOOL HUS WE ER,'MARX 1 70 2 t7EMSI -- I I SLAV INC t STOPPING f)BROADSIDE I I OTHER BUS I PASSING OTHER VIE HICLE ( 1 _.A'CLEAR E±?t7 05JEC� J EMERGENCY V£MiC E - ! J CHANGING LANES S CLGUOY _ I F �Rr�+vED rc H?cHwmY coNS7 ECU?Fa ENT K PARKING MANEUVER 1 • c C RAINING ...._ T G.VEHICLE t PEDESTRIAN I. HICYOLE I L ENTERING TRAFFIC �I}3 SNOWING _ - t {H DTHER' I MOTHER VEHICLE i M OTHER UNSAFE TURNING E FDG i VIStSif ITY F? 1 i l IN PEDESTRIAN N XfNG INTO GPPfi.52NGLANE I F OTHER': MC VEHICLE kNYOLVE*J WITH i i()MOPED f 10 PARKED: wa 1 to NoN-CCLUS/ON P MERGING I PEDESTRIAN �I { ( Q TRAVELING WRONG WAY A DAYLIGHT :C'OTHER MOTOR VEHICLE I Z I # OTHER ASSOCIATED FACTORS) i R OTHEtt i E,'DU$X DAWN :MOTOR VEICCLE ON OTHER ROADWAY r f {MAe7x!7O:f ITEMS) f . !C DARK•STREET UGH-S AARKED MOTOR VEHICLE J `Y A vc xennc.vvo t-44, xea YEs D:DARK•NO;STREETTORTS I F.BRAIN I_ DARK-STREET LIGHTS NOT I G SIGYCLE 7 E a secma ww.•nae Cat a FUNCTIONING_ YES H �'�#ANIMAL. s aD SOBRIETY DRUG ROADWAY SURFACE C vaatasuxr� LArl■t "Teo± r •YES 2 i 3 PHYSICAL A DRY i i FIXEEDCB;ECT ti :'' % 'NO (.MARX t TO ZITEMS) 8 V,lET t [} _'•* i * . e:.; le,v I A HAD NOT BEEN DRINKING C SNOWY ICY _ i j OTt'ER OB,ECT ? IE VISION:OBSCUREMENT: I I $f4m•UNDER INFLUENCE 0 SLIAPERY;MUDIIY OIL- TC-t _2 F INATTENTION- I C HBO•NOT UNDER iNFLUENC°'[ ROADWAY CONDIT?ONISITr7AfFIC Q HBO•IM?AIAMENT UNKNOWN- ROADWAY ARX;?'O 2 17E31S1 Pe.O£STMAN'S ACTIONS fH ENTERNG i LEAVING RAMP UNOER DRUG 3NFS:UENCE' IA HOLES,DEEP RUT` ;A NoPEDES'•R?aN3INVDLVED I I PREvous COLLISION I - r IMPAMMENT•PHYSICAL' . IS LOOS£MATERIAL ON RCAO VAY' :g CROSSING fN CROSSWALK ! I U UNFAMILIAR WITH ROAD L G IMPAIRMENT NOTMNOWN OBSTRUCTIQNONROADWAY` F N ERRSECT10N lK DEFECTIVEVEH EQUIP C?TED H NOT APPLICABLE �f Q CONSTRUCTION.REPAIR ZONE _ { GROSSING L'V CROSSWALK-NOT I i_jygs t I SLEEPY l FATIGUJEO ------ I f S REDUrED•._ROADWAY IMOTti AT tN3ERSEC.ION I t � !�r`10 SPECIAL.INFORMATION FL,^.00EO' --_ 'Q:.CROSS•NG-NOT tN.CROSSWALK —! !L UNINVOLVED VEHICLE !A HAZARL?QUS MATERIAL 1G OTHER'' V LE ''W ROAD-9NCLi1DfS:5HOULDER _ ' f IM OTHER.•. i -' ]KEN `UNUSU:AL CONDMONS �1 F NOT IN ROAD ! I NNONE APRARENT _•..._.. .. _r . 3� --i APPRGAGkifhO t; I .EAVtNG SCHOOL SUS CS RUNAYYAY'J£HICL€ �Y ! SK£7Cti I i rAj .�. MISCELLANEOUS I LISP J�i I I tNOICATt±I.CRT:i I I I i I ................................................................................................................-....-I..'','''', .......................................................................................................................................... . ................................................................................... ....................... STATE OF CALIFORNIA INJURED I WITNESS I PASSENGERS cHp 555 Pae 3(Rev,8-97 OPi 042 page 3 a DATE OF COLLISION IMO, DAY Y" TIME(2400) WCIC t OppCeR Lo. NuwlR aL2 EXTENT OF INJURY("X"ONE) INJURED WA3 I-X"ONE) AGE six ONLY PARTY SEAT SAFETYONLY FATAL SEVERE Oot1 COMPLAINT NJURy N�y INiuzOFPAIR DRIVER PAW PED, JMMYOUST R N . . Z' � ❑ - - I El cl NAME 10.0.S.1 ADORP-03 (mUgeo ONLY)TRANSPORTED BY: TAKEN TO. DESCRIBE INJURIES VICTIM Of VIOLENT CRIME NOMIED El NAME 10.O.0.1ACOR£85 TELEPHONE f�5�4� Stag 5 2. ONAURgDONLY/TRANSPOATEDBY TAKEN TO: MCWHINAIRIES VICTIM OF VIOLENT CRIME NOTIP19D L-j DIE] I ol NAME I D.0.S.I AWREW TELEPHONE 14,� t V QANQQ gujuxgo ONLY)TRANSPORTED ar, TAKEN TO: DESCRIBE tiviuRiEs VICTIM OF VIOLENT CRUZ NOTIFIED I I It NAME.?DO.B.1 AMR939 YgLIPHIONE f D-7,11,2 (fNAIRED ONLY)TRANSPORTED BY. f TAKEN TO.' OFSCRIBE INJURIES Eli I o I st El VICTIM oFyoLgHTCRIMENOTIRED, El NAMEJO.O.B.I ADDRESS TELEPHONE -7D (04,pmfoom;yI TRANSPOATEDay, TAKEN TO: DESCRIBE INJURIES VICTIM Or VIOLENT CRIME NOTIFIED I J NAME 10.0,8-i'AVORESE TELEPHONE {INJURED ONLY)TRANSPOR-MOty: TAKEN TO: vicTim oP VJ40XLfNT GRIME NOTtRED PREPARER'S NAME tS7..NUOAM MQ DAY YEAR mgmvftptls NAME MO, DAY YEAR ..........................I..,......-........ ...................................................... STATE.OF CALtFOOKA FACTUAL DIAGRAM CNP 555 Pace 4Rev.8-97)-OP!042 DATE flP cowltON W. DAY YEAR! ;,nme a4w) �MC1Ct OpPrEft 1.0, �,/ !MWJtltR ALL MIASUREMV[S ARE APP'TtOXWA TT AND NOT TO KALK UNLOSS STATED(SCALE< ? ,94M„Ts 13 �yf t t t 1 r d9 Si tt, Fy2 17 NARRATIVE/SUPPLEMENTAL A f GNP 558(Rev 7-90)t3Pt 042 Page DATE OF 3NClDtciVT10GCURAENCE TIME fZ4W) NCIC NUMBER 771 LO,NMB #NUMBER "X'ONE W ONE TYPE SUPPLEMENTAL rX'AF Pf CABLE) Narrative Corlision report (1 SA update Q Fatal 17 Hit and runt update i SupplementalC Other: ❑Hazardous materials Q School bus C3 Other: CtTYlCOUNTYMUDiCtAL DISTRICT REPORTING tNSTR1CTtBEAT CtTATK}N N1 SER LOCATIOMSUSJECT STATE Hi WAY RELATED d Yes NO 4, 5. 6, 12. 14. E 15, 7. 5' ir4 19. 20. 22. -r11 ?' /Lr'G 23. G ISN. 24. 25. 1*41 26, LAS"Z' s/' 127 28. 30, 31. PREPARER'S,.�N'iAME AND I.Q.NUMBER HATE REVIEWER'S NAME DATE = Use previous editions until depleted. fa osP 98 ,scan STATE OF CALIFORNIA NARRAT{VEISUPPLEMENTAL CHP 550(Rev 7.90)GPS 042 CATE or INCfDEN?:OCCURRENCE TfME 12400) NC}C NUMBER OFCER I.D.NUMBER NUMBER �x"ONE %'ONE --r TYPE SUPPLEMENTAL rX`APPL"a) Z Narrative koliision report C3 SA update !Fatal 7 Hit and Tun update 4C1 supplemental 11C Other: O-J at p, J Hazardous m er:als School bas C7ther. C,"WCCUNT)%JUDFCIAL OISTRiCT REPURTiNGVS3R iBEA7 I C7TATfitJNNUA#StA LXATI0.WSU8JECT t/1 STATE HiGHWAY RELATED Yes No 1. i fG 2. 3 4. f3 'w 14. 16. --/ Gtr •�� .' .41 S� .� 4 . , 17, z) �+c- �y } i 19. ..G./' + Gr us. .CY �.L V' '�". r"td wf'L z l)'' t 20, j '.» .� ' -Vii' . Z/L' / r4;+ 22. 42 23.,: 24. 29. T rF"" ' '"Y, ,,+ r•°'sftsl�G�tifi't Y'r .,�J" ,.'Y+oC C,. „r J""'7" 29. cit I 3" S yA�.ic`a.NO 1?;.ut:iss a_.,......._._.._.....Y._..�.._._.._..__. ,.__...� ......__,..�.....I c. C.l fic 1 E4V 8`..ittE'� r Jse rrevt4Ls edmons urtti depiecec.