20062315 simmons20062315
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0G5WRBC WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
PRIVATE PROPERTY/PARKING LOTReportable
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
01:25 PM
Date Notified
06/23/2020
Time Arrived
01:46 PM
Date Arrived
06/23/2020
Crash Time
01:24 PM
Crash Date
06/23/2020
Investigating Officer/Deputy
DEPUTY KEVIN GILLIS
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0G5WRBCAdditional InformationPHOTOS
Photos ByDEPUTY KEVIN GILLIS
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT ONE TURNED OFF OF STATE HWY 27 INTO DJ'S MART GAS STATION. VEHICLE THEN HIT A GAS PUMP. THE OPERATOR WAS ARRESTED FOR OWI 2ND
OFFENSE.
Crash Time 01:24 PM
Crash Date 06/23/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
20062315
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0G5WRBC WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5088724
X Coordinate
150542.828125
Longitude
-91.502130051
Latitude
45.863311091
ON STH27 NB
76 FT N
OF STH70 WB
IN THE TOWN OF SAND LAKE
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
PRIVATE PROPERTY
Crash Classification - Location
PRIVATE PROPERTY
Relation To Trafficway
NON TRAFFICWAY - PARKING LOT
Animal Type
Weather Condition(s)
CLOUDY
Environment Factor(s)
Roadway Factor(s)
NONE
Road Surface Condition(s)
DRY
Light Condition
DAYLIGHT
Manner of Collision
00 - NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
UNKNOWN
First Harmful Event
OTHER FIXED OBJECT
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
PARKING LOT OR PRIVATE PROPERTY
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
OTHER FIXED OBJECT
Total LanesSpeed Limit
N/A
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
NO
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
2
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
MINOR DAMAGE
Vehicle Damage
01 - RIGHT FRONT CORNER, 12 - FRONT
Initial Contact Point
01 - RIGHT FRONT CORNER
Bus UseBody Style
UT - SPORT UTILITY VEHICLE
Color
RED - RED
Model
EQUINOX LS
Year
2005
Make
CHEVROLET
Vehicle Identification Number
36700101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 01:24 PM
Crash Date 06/23/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
20062315
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0G5WRBC WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
STONE LAKE, WI 54876 , US
Owner Name
0101Driver Actions
UNKNOWN
Driver Prior Action Other
DROVE INTO GAS PUMP
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
OTHER
Vehicle Removed By
A-1 TOWING
Towed Due To Damage
TOWED BUT NOT DUE TO DISABLING DAMAG
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
OTHER FIXED OBJECT02
Event
03Event
04Distracted By
Injury
LocationStriking Unit #
Distracted By Action
UNKNOWN
Distracted By Source
UNKNOWN
Time of DeathDate of DeathHospital
HAYWARD AREA MEM HOSP
EMS Run #EMS Agency IdentifierMedical Transport
LAW ENFORCEMENT
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
07 - LEFT
Row
01 - FRONT ROW
Safety Equipment
NOT APPLICABLE
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
STONE LAKE, WI 54876 , US
Race
WHITE
Date of Birth
09/06
Sex
MALE
Citations Issued
2
Driver
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 01:24 PM
Crash Date 06/23/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
20062315
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0G5WRBC WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
UNDER THE INFLUENCE OF MEDICATIONS/DRUGS/ ALCOHOL
Drug Type
00101Drug Test ResultsDrug Test TypeDrug Test Given
TEST NOT GIVEN
Alcohol Test Results
PENDING
Alcohol Test Type
BLOOD
Alcohol Test Given
TEST REFUSED BUT OBTAINED
Suspected Drug Use
NO
Suspected Alcohol Use
YES
To/From SchoolAction Other
Action
Prior Action
UNITINDIVIDUAL Violations
DescriptionOPERATING WHILE UNDER THE INFLUENCE(2ND)Statute Number346.63(1)(A)Issue To?
001
UTC Number
BE65081501
DescriptionOPERATING WHILE REVOKED (REV ALC/CONT SUBST/REFUSAL 4th+)Statute Number343.44(1)(B)Issue To?
001
UTC Number
BE65081602
Crash Time 01:24 PM
Crash Date 06/23/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.