ORIGINAL
FATAL 1 Of: 1
County
2 3 2 0 42
08-19-2016
1- Interstate 2- US Primary 3- SC Primary
4- Secondary 5- County 6- PP
TR-310 Collision Location (Rt. # / Name)
Distance O set Direction 1- Interstate Lane # / Dir. # Of 2- US Primary N E N E Miles Feet 3- SC Primary 1 4 S W .00 S W R.R. Id. From Ramp Only To 1- Interstate N E 1- Entrance N E 2- US Primary S W 2- Exit S W 3- SC Primary
696
Second Intersection (Rt. # / Name)
620
CHANZED
Unit #
Street Sex Race M B 158 OVERBROOK CIR 01 #Occ Birth Date City, State, & Zip 07-23-1999 SPARTANBURG SC 293064127 1 State Insurance Company: Driver's License # Class SC 103742617 D UNINSURED Year Body Vehicle Make VIN # 2 0 1 6 MP VIP L9NTEACT9G1051271 State Owner's D.L. # Year License Plate # MOPED 103742617 Owner's Full Name Home Telephone MATTHEWS RICO CHANZED ( ) Bus. Telephone Street 158 OVERBROOK CIR ( ) Contributed To Collision City, State, & Zip SPARTANBURG SC 293064127 Yes No Estimated Speed
Speed Limit
20
25
C.D.L. Req: Yes No Summons #
T/B S Req: Yes No Code Summons #
Alc/Drg info (see back): Yes No
Code Towed By ACE
Yes No
Unit #
Sex
#Occ
Birth Date
Race
Street
Driver's License #
Year
Body
Dir. of Travel:
Class
Vehicle Make
Unit 1: N S E W
Insurance Company:
VIN #
6-Connection
2-Alternate
7-Business
5-Spur
9-Other
0-Main Line
6-Connection
2-Alternate
7-Business
5-Spur
9-Other
Arrived
2322
2325
In / Near City or Town of:
SPARTANBURG GPS COORDINATES 00 00' 00.00" DEGREES MINUTES SECONDS
o Latitude
'
34
Longitude
''
58
o
02.32
'
81
''
56
03.87
Driver/Pedestrian's Full Name CHADWICK MICHAEL
HAROLD Street Sex Race M W 455 PLEASANT VALLEY RD 02 #Occ Birth Date City, State, & Zip 07-27-1993 SPTBG SC 29307 1 State Driver's License # Class Insurance Company: SC 101718285 D NATIONWIDE Unit #
Year Body 2 0 0 8 PK
Vehicle Make CHEV
VIN # 2GCEC19J881291751
State Year License Plate # Owner's D.L. # 2 0 0 8 2683EG 101718285 SC Owner's Full Name Home Telephone CHADWICK MICHAEL ( ) Bus. Telephone Street 455 PLEASANT VALLEY RD ( ) Contributed To Collision City, State, & Zip SPTBG SC Yes No Estimated Speed
Speed Limit
25 Year
Estimated Speed
Unit 2: N S E W
0-Main Line
P-131748
C.D.L. Req: Yes No Summons #
Speed Limit
T/B S Req: Yes No C ode Summons #
License Plate #
Home Telephone ( ) Bus. Telephone ( ) Contributed To Collision Yes No
City, State, & Zip
State
/ CUMMINGS ST
25 State
Driver/Pedestrian's Full Name
Dir. N E S W
5-Spur
/ E PEARL ST
Noti ed
Corrected
6-Connection Miles: 7-Business
Base Intersection (Rt. # / Name)
4- Secondary 5- County 6- Other
Driver/Pedestrian's Full Name MATTHEWS RICO
P-131747
/ E WOOD ST
4- Secondary 5- County 6- Other
02
(Rev. 11/2011) 0-Main Line 2-Alternate
176
From
Time of Collision
On
Date
Amended - Attach Copy of Original Report
# Of Units
SOUTH CAROLINA TRAFFIC COLLISION REPORT FORM
Page #
Toward
SOUTH CAROLINA DPS/OHS & DMV USE ONLY
HAROLD
29307
Alc/Drg info (see back): Yes No
Code Towed By
Yes No
Owner's D.L. #
Owner's Full Name Street City, State, & Zip
C.D.L. Req: Yes No Summons #
T/B S Req: Yes No
Alc/Drg info (see back): Yes No
Summons #
Code
Code Towed By
Yes No
Unit 3: N S E W U nit 1 D a m. $ 500
Unit 2 Dam. $ 1000
U nit 3 D a m. $
$
Property Owner/Witness:
LEOPARD
JOEY
Zip:
J
Y
STARTEX Phone
29377
Photo:
$
Address
345 HICKORY DR SC
P rop. D a m. 2
Property Owner/Witness:
Address State
Prop.Dam. 1
State
Zip:
Phone
8642057730
Describe What Happened (Refer to Units by Number )
N
WITNESS STATED THAT UNIT 1 MADE A LEFT TURN INTO UNIT 2. WITNESS STATED THAT LIGHT HAD TURNED YELLOW AS TRUCK ENTERED INTERSECTION.
NOTICE - THE TR-310 IS FOR STATISTICAL REPORTING PURPOSES ONLY AND IS A REFLECTION OF THE OFFICER’S BEST KNOWLEDGE, OPINION AND BELIEF COVERING THE COLLISION BUT NO WARRANT IS MADE AS TO THE FACTUAL ACCURACY THEREOF. Investigating O cer's Name
Rank
LINDSEY - L W
MPO
Badge #
0 0 8 0
Jurisdiction Code
4 2 0 1
Review Date
08-21-2016
Reviewer's Name
Ronnie Forrester
Rank
Internal Agency Code
Sgt.
08058016