| Type of Incident: | Other — Do not use if a team, player, coach, or spectator is involved.  Use only if the incident cannot be classified as any other Type of Incident above. | 
| Date of Incident: | 2024-03-09 | 
| Time of Incident: | 16:30:00 | 
| Location of Incident: | 1850 sparrowhawk street Manteca ca | 
| Home Team: | Referee | 
| Visiting Team: | Manteca Area SL | 
| Age Group and Gender: | U15B | 
| Team Affiliation of Individual Committing Incident: | Referee | 
| Incident Summary: | Allegation that the referee failed to stop play after the goalkeeper was injured leading to a goal. | 
| Comments: | This is not a PAD issue.  Please direct any comments regarding the officiating to the assignor for the home team.  The PAD Committee hopes the goal has recovered from his injury. |