| 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: | 2015-09-12 | 
| Time of Incident: | 04:00:00 | 
| Location of Incident: | Antioch Comunity Park, Antioch | 
| Home Team: | Delta United SC Firestorm | 
| Visiting Team: | American River FC ARFC -98 | 
| Age Group and Gender: | U19G | 
| Team Affiliation of Individual Committing Incident: | American River FC ARFC -98 | 
| Incident Summary: | Allegation that a team refused to play because there were not 3 licensed referees at the match. | 
| Comments: | This matter is referred to Jason Drury, the Event Coordinator for review. |