20190107 DELCAMPO.pdf19010703
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0S WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
DT4000 (STANDARD CRASH)Reportable
TagsSchool Bus Related
NOActive School ZoneGovernment
Property
Reporting
ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
01
Time Notified
01:29 PM
Date Notified
01/07/2019
Time Arrived
01:35 PM
Date Arrived
01/07/2019
Crash Time
01:27 PM
Crash Date
01/07/2019
Investigating Officer/Deputy
DEPUTY KEVIN GILLIS
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
2
X
V
N
0
S
Additional InformationPHOTOS
Photos ByDEPUTY JORSTAD
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
IT APPEARED THE VEHICLE WAS TRAVELING WESTBOUND ON COUNTY HIGHWAY B, WENT INTO THE DITCH, HITTING THE EMBANKMENT, CAUSING
DAMAGE TO THE VEHICLE. THE VEHICLE WAS LOCATED ON HIDDEN WOODS DRIVE, OFF OF COUNTY HIGHWAY B.
Crash Time 01:27 PM
Crash Date 01/07/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
19010703
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0S WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5103296
X Coordinate
157125.875
Longitude
-91.427991186
Latitude
45.997379883
ON CTHB WB
1223 FT E
OF CTHE EB
IN THE TOWN OF HAYWARD
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - ON ROAD
Animal Type
Weather Condition(s)
CLOUDY
Environment Factor(s)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
WET
Light Condition
DAYLIGHT
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
DITCH
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
STRAIGHT
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
DIVIDED HWY W/O TRAFFIC BARRIER
Emergency Motor Vehicle Use
NON-EMERGENCY, NON-TRANSPORT
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
EMBANKMENT
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
WESTBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
1
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR01
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Extent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
5--RIGHT REAR CORNER, 6--REAR, 7--LEFT REAR CORNER, 11--LEFT FRONT
CORNER, 12--FRONT
Initial Contact Point
12--FRONT
Bus UseNOT A BUSBody Style
4D - 4DR
Color
SIL - SILVER (ALUMINUM)
Model
G6
Year
2007
Make
PONTIAC
Vehicle Identification Number
1G2ZG58B8742267530101
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
ABL9564
VE
H
I
C
L
E
UN
I
T
Vehicle
Crash Time 01:27 PM
Crash Date 01/07/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19010703
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0S WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
9608 N ZHAAWANONG AVE
HAYWARD, WI 54843 , US
Owner Name
01
Driver DistractionsUNKNOWN IF DISTRACTED
01
Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
A-1 TOWING
Towed Due To Damage
TOWED BUT NOT DUE TO DISABLING DAMAG
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventDITCH01
EventEMBANKMENT02
EventDITCH03
EventREENTERING ROADWAY04
Injury
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00
1
01
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
NOT APPLICABLE
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
INDIANDate of Birth
12/15
Sex
FEMALE
Citations Issued
1
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 01:27 PM
Crash Date 01/07/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19010703
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0S WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
NOT OBSERVED
Drug Type
00
1
01
Drug Test ResultsDrug Test TypeDrug Test GivenTEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Violations
DescriptionFAILURE OF OPERATOR TO NOTIFY POLICE OF ACCIDENTSeq Num006Statute Number346.70(1)Issue To?
001
UTC Number
BD19100401
Crash Time 01:27 PM
Crash Date 01/07/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.