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STATE OF CALIFORNIA DEPARTMENT OF CALIFORNIA HIGHWAY PATROL TRAFFIC COLLISION REPORT CHP 555 PAGE 1 (REV. 04-11) OPI 060 C-100 - ti V13 -1 PAGE 1 OF 13 SPECIAL CONDITIONS IAJIIBEil 111JURED 2 HT 6 lillt1 FELONY are JUDICIAL DISTRICT UNINCORPORATED MANTECA SUPERIOR LOCAL REPORT NUMBER 9265 -2018-02430 NUMBER Willi, 0 FiT . RUN 1./ISDENIEA1101i COUNTY REPORTING DISTRICT BEAT SAN JOAQUIN 010 DAY OF WEEK TUESDAY TOW pi AWAY YES NO LOCATION COLLISION OCCURRED ON: LONE TREE RD MO DAY YEAR 07/31/2018 TIME (2400) 1328 NCIC 1 9265 OFFICER I.D. 018767 MILEPOST INFORMATION: OPS COORDINATES LATITUDE 37.827193° LONGITUDE - 121.084229° PHOTOGRAPHS BY: NONE ri r AT INTERSECTION WITH: OR: 500 FEET EAST OF WAGNER RD STATE HWY YES DEL pi NO PARTY 1 DRIVER'S LICENSE NUMBER E0003223 STATE CA CLASS C AIR BAG M SAFETY EQUIP. G VEH. YEAR 2011 MAKE / MODEL CHEVY 2500 I COLOR SERIES WHT LICENSE NUMBER 94812C1 STATE CA DRIVER 119 NALIE(FIRST, MIDDLE, LAST) SIDNEY LEE LINDSEY 1988 CAMT I MIXER GRY 4111R35 11 CA OWNER'S NAME CLAYTON BECK, SAME AS DRIVER Ill PEDES• TRIAN STREET ADDRESS 616 PLACER AVE OWNER'S ADDRESS 14212 BLUFF DR SAME AS DRIVER LOCKEFORD CA 95237 PARKED VEHICLE CITY / STATE /ZIP MANTECA CA 95336 DISPOSITION MCDOWELL'S OF VEHICLE TOW ON ORDERS OF: LI OFFICER - (209)838-3932 ri DRIVER OTHER BICY- CLIST SEX M HAIR BRN EYES URN HEIGHT 5-11 WEIGHT 280 BIRTHDATE YEAR 1.10 DAY 10/10/1952 RACE W PRIOR MECH. DEFECTS bil NONE APP. LI REFER TO NARRATIVE OTHER HOME PHONE (209)401-8596 BUSINESS PHONE (209)480-4818 VEHICLE IDENTIFICATION NUMBER: VEHICLE TYPE DESCRIBE VEHICLE DAMAGE USE NONE MINOR SHADE IN DAMAGED ITP IAN AREA INSURANCE STATE CARRIER FARM 0583-1301-550 POLICY NUMBER 07 I 35 MOD MAJOR pi ROLL-OVER DIR OF TRAVEL W ON STREET LONE OR HIGHWAY TREE RD SPEED LIMIT 55 CA DOT CAL-T TCP/PSC MC/MX PARTY 2 DRIVER'S C2292530 LICENSE NUMBER STATE CA CLASS A AIR BAG P SAFETY EQUIP. G VEH, YEAR 2013 P.IAKE / MODEL! PETE 3AXLE COLOR RED LICENSE NUMBER STL80 STATE CA DRIVER NAME(FIRST, RAMIRO MIDDLE, LAST) RUBIO FLORES 2011 WMARK TANKER COM 5TL6703 CA OWNER'S NAME SUPERIOR TRUCK SAME AS DRIVER LINES PEDES- TRIAN STREET ADDRESS 412 C ST OWNER'S ADDRESS 165 LAUREL AVE SAME AS DRIVER GUSTINE CA 95322 PARKED VEHICLE CITY / STATE WATERFORD / ZIP CA 95386 DISPOSITION OF VEHICLE ALL STAR HEAVY ON ORDERS OF: OFFICER HAUL TOWING - (209)833-7107 pi DRIVER OTHER RIOT- CLIST SEX M HAIR BCE-. EYES BRN HEIGHT 5-06 WEIGHT 175 BIRTHDATE MO DAY 07/17/1959 YEAR RACE H PRIOR MECHANICAL DEFECTS III NONE APP. REFER TO NARRATIVE OTHER HOME PHONE UNKNOWN BUSINESS PHONE UNKNOWN VEHICLE IDENTIFICATION NUMBER: I XPVDP9X3D D209863 VEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE USE NONE MINOR IN DAMAGED AREA ILTII,14.1, INSURANCE CARRIER UNKNOW N UNKNOWN POLICY NUMBER 25 I 29 MOD LIMAJOR pi ROLL-OVER DIR OF OF TRAVEL W ON STREET OR HIGHWAY LONE TREE RD SPEED LIMIT 55 CA 5934 DOT cAL-T TCP/PSC EIC/LIX PARTY 3 DRIVER'S LICENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP. VEH. YEAR MAKE / MODEL! COLOR LICENSE NUMBER STATE DRIVER Eli OWNER'S NAMEIFIRST, MIDDLE, LAST) NAME SAME AS DRIVER PEDES- TA N Ill OWNER'S STREET ADDRESS ADDRESS SAME AS DRIVER PARKED VEHICLE CITY! STATE / ZIP DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER 1=1 DRIVER OTHER BICY- CLIST SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE MO DAY YEAR RACE PRIOR MECHANCIAL DEFECTS NONE APP. 0 REFER TO NARRATIVE OTHER HOME PHONE LI VEHICLE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER: TYPE I DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA UNK LI NONE LI MINOR MOD LI MAJOR LIROLL-OVER INSURANCE CARRIER POLICY NUMBER DIR OF TRAVEL ON STREET OR HIGHWAY SPEED LIMIT CA DOT CAL-T TCP/PSC MC/MX PREPARERS NAME ZACHARY .1 l'OSH 018767 DISPATCH m LI NOTIFIED YES NO N/A REVIEWER'S NAME J. T. JORDAN 015408 DATE REVIEWED 08/13/2018 AN INTERNATIONALLY ACCREDITED AGENCY