2834-24 Mitchell-Valley-All-Way-Stop-Report.pdf

122 02 30. Eyes DL Class Restrictions Endorsements 31. State 60. Eyes DL Class Restrictions Endorsements 61. State 0 5 - - - - - - - - 0 2 OP - - - - - - 01 NJ NJ 123 105 32. Driver's License Number 33. DOB mm dd yy 34. Expires mm yy 62. Driver's License Number 63. DOB mm dd yy

64. Expires mm yy 01 03 H4372 75064 57695 0 7 1 5 6 9 0 8 2 2 D2377 4940 0 01632 0 1 2 8 6 3 0420 35. Owner's First Name Initial Last Name 65. Owner's First Name Initial Last Name 106 124 Same as Same as - Driver Driver 04 107 36. Number & Street 66. Number & Street

66. Number & Street 125 - - - 04 108 37. City State Zip 67. City State Zip 126a 01 - - 26 109 38. Make 39. Model 40. Color 41. Year 42. Plate No. 43. State 68. Make 69. Model 70. Color 71. Year 72. Plate No. 73. State 126b 01 HONDA CIVIC BL 2018 Z26JYZ NJ HONDA CRV BK 2010 D25DLR NJ - 110 44. VIN 45. Expires 74. VIN 75. Expires 126c 01 S H H K K 7 H 4 5 J U 4 0 6 2 5 0 04/21 5 J 6 R E 4 H 3 4 A L 0 9 1 6 4 0 08/18 - 111

126d 46. Vehicle Removed to: 76. Vehicle Removed to: 01 - - - 112 126e Driven Towed Disabled Towed Disabled & Impounded Driven Towed Disabled Towed Disabled & Impounded - Left at Scene Towed Impounded Left at Scene Towed Impounded 26 113 127a 47. Authority 77. Authority - Owner Driver Police Owner Driver Police

iver Police Owner Driver Police 26 114 127b 48. Alcohol Drug Test 49. Hazardous Material 78. Alcohol Drug Test 79. Hazardous Material - Given: No Yes Refused None On Board Spill Given: No Yes Refused None On Board Spill - 115 Type: Breath Blood Urine Type: Breath Blood Urine 127c - - - - - - - - - - - - 116 Results: 0. - - % Pending Hazard Class Placard No. Results: 0. - - % Pending Hazard Class Placard No. 127d 01 50. Carrier No. 51. GVWR / GCWR (trucks & buses only) 80. Carrier No. 81. GVWR / GCWR (trucks & buses only)

(trucks & buses only) 80. Carrier No. 81. GVWR / GCWR (trucks & buses only) 10,000 lbs. 10,000 lbs. - 117 USDOT - - - - - - - None USDOT - - - - - - - None 127e 10,001 - 26,000 lbs. 10,001 - 26,000 lbs. 04 MC/MX - - - - - - - 26,001 lbs. MC/MX - - - - - - - 26,001 lbs. 26 128 52. Motor Carrier or Government Entity 82. Motor Carrier or Government Entity - -

- 26 129 Number & Street Number & Street - - 11 130 City State Zip City State Zip - - - - - - 11 131 135. Damage to Other Property Yes (If Yes, describe) No -

07 132 07 Oper. 136. Charge 137. Summons No. Oper. 138. Charge 139. Summons No. 133 - - - - - - 03 Oper. 140. Charge 141. Summons No. Oper. 142. Charge 143. Summons No. 134 - - - - - - 03 83 84 85 86 87 88 89 90 91 92 93 94 95 Names & Addresses of Occupants If Deceased, Date & Time of

If Deceased, Date & Time of Death A 01 01 01 - 48 F - - - 11 04 - - TRACY HILLMAN 562 SCOTLAND ROAD ORANGE NJ 07050 ASHLEY COLEMAN 562 SCOTLAND ROAD ORANGE B 01 03 01 - 20 F - - - 11 04 - - NJ 07050 LUIS DELGADO-GORDILLO 162 RANDOLPH PLACE C 02 01 01 - 55 M - - - 11 04 - - WEST ORANGE NJ 07052 ELIZABETH DELGADO 162 RANDOLPH PL WEST D 02 03 01 - 52 F - - - 11 04 - - ORANGE NJ 07052 NJTR-1 (Rev. 01/17)

New Jersey Police Case Number Crash Investigation Report 18019718 2 3 83 84 85 86 87 88 89 90 91 92 93 94 95 Names & Addresses of Occupants If Deceased, Date & Time of Death E F G H I J 144. Crash Diagram Show NORTH by Arrow (Not to Scale) SEE NJTR-1B 145. Crash Description/Narrative Driver (1) reports that while driving north on Valley Road, her vehicle (1) was struck by vehicle (2) as vehicle (2) was traveling west on Mitchell Street through the intersection. Driver (2) reports that while driving west on Mitchell Street through the intersection of Valley Road, his vehicle (2) was struck by vehicle (1). 146. Officer's Signature 147. Badge # 148. Reviewer Badge # 149. Case Status Pending Complete CARROLL, DANIEL V 178 JACKSIC,CHRISTOPHER 137 NJTR-1 (Rev. 01/17)