| Type of Incident: | Referee |
| Date of Incident: | 2019-08-24 |
| Time of Incident: | 11:00:00 |
| Location of Incident: | Congress Springs Park |
| Home Team: | Referee assigned by home team |
| Visiting Team: | Norcal Referee assigned by home team |
| Age Group and Gender: | U12G |
| Team Affiliation of Individual Committing Incident: | Referee assigned by home team |
| Incident Summary: | Account from a coach regarding why he was sent off. |
| Comments: | This has been provided to the Head Referee of NorCal for his consideration. |