| 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: | 2014-11-02 |
| Time of Incident: | 01:00:00 |
| Location of Incident: | 10150 Franklin High Rd. Elk Grove, Ca |
| Home Team: | Coach |
| Visiting Team: | Manager |
| Age Group and Gender: | U14B |
| Team Affiliation of Individual Committing Incident: | Coach |
| Incident Summary: | Allegations about the officiating. |
| Comments: | PAD complaints must come from DOCs or Club Presidents. Please have the South Valley DOC or President re-submit. |
English