CHP 180 Vehicle Report Reporting Department Location Code Date/Time of Report Notice of Stored Vehicle Delevered Personally File No. Location Towed / Stolen From Odometer Reading VIN Clear in SVS? Yes No Lic. Clear in SVS? Yes No Date / Time Dispatch Notified Log No. Year Make Model Body Type Color License No. ONE / TWO One Two Month / Year State Vehicle Identification No. Engine No. Valuation By Officer Owner 0-500 501-4000 4001+ Other Valuation – Other Registered OwnerSame as R/O Legal OwnerVehicle Status Stored Impounded Released Recovered – Vehicle / Component Towing / Storage Concern(Name, Address, Phone) Storage Authority / Reason Reason for Stop Airbag Yes No 1 2 Driveable Yes No Junk Unk VIN Switched? Yes No ConditionWRECKED Yes No BURNED HULK per 431(c) CVC Yes No VANDALIZED Yes No ENG. / TRANS. STRIP Yes No MISC. PARTS STRIP Yes No BODY METAL STRIP Yes No SURGICAL STRIP per 431(b) CVC Yes No ItemsSEAT (FRONT) Yes No SEAT (REAR) Yes No RADIO Yes No TAPE DECK Yes No TAPES Yes No OTHER RADIO Yes No IGNITION KEY Yes No REGISTRATION Yes No ALT. / GENERATOR Yes No BATTERY Yes No DIFFERENTIAL Yes No TRANSMISSION Yes No AUTOMATIC Yes No MANUAL Yes No CAMPER Yes No VESSEL AS LOAD Yes No FIREARMS Yes No OTHER Yes No Other – FIll In(1) Other (1) Yes No Other – FIll In(2) Other (2) Yes No Other – FIll In(3) Other (3) Yes No Tires / Wheels – ConditionLEFT FRONT RIGHT FRONT LEFT REAR RIGHT REAR SPARE HUB CAPS SPECIAL WHEELS Release Vehicle to R/O or Agent Agency Hold 22850.3 CVC Garage Principal / Agent Storing VehicleSignatureDate / Time Name of Person / Agency Authorizing Release I.D. No. Date CERTIFICATION: I, THE UNDERSIGNED, DO HEREBY CERTIFY THAT I AM LEGALLY AUTHORIZED AND ENTITLED TO TAKE POSSESSION OF THE ABOVE DESCRIBED VEHICLESignature of Person Authorizing ReleaseSignature of Person Taking PossessionReport Type Stolen Vehicle / Component Embezzled Vehicle Plate(s) Report Date / Time of Occurance Date / Time of Reported Name of Reporting Party (R/P) Driver License No. / State Last Driver of Vehicle Date / Time Address of R/P Telephone of R/PI CERTIFY OR DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.Signature of Person Making ReportRemarks[LIST PROPERTY, TOOLS, VEHICLE DAMAGE, ARRESTS]Driver's Name Arrested / Section? Yes No Reported By Cargo / Type Yes No Value Bill of Lading Bill of Lading Attached Bill of LadingMax. file size: 64 MB.Remarks Reset Selections FileMax. file size: 64 MB. Signature of Officer Taking ReportI.D. No. Supervisor Required Notices Sent to Registered And Legal Owners Per 22852 CVC? Yes No Date Notified Stolen / Embezzled Narrative1. Area Rural Urban 2. Taken From Street Parking Lot Garage Driveway Other Taken From – Other: 3. Registration in Vehicle? Yes No 4. Was Neighborhood Checked for Vehicle, Witnesses, Clues, Other Crimes Yes No 5. Payments Current? Yes No 6. Doors Locked? Yes No 7. Keys in Vehicle? Yes No 8. All Keys Accounted For? Yes No 9. When was the vehicle last serviced? 10. Where? 11. Is this the usual mechanic? Yes No 12. Recently Left in Parking Garage or Parking Valet Service? Yes No 13. If yes, where? 14. Vehicle equipped with the original engine? Yes No 15. Original Transmission? Yes No 16. Original Paint? Yes No 17. If Answer to 14, 15, or 16 is No, Provide Additional Information, Serial No., Original Color, Etc. 18. Has Vehicle Been Previously Involved in an Accident? Yes No 19. If Yes, Has Damage Been Fixed? Yes No 20. Parts Damaged 21. Factory Equipped Radio? Yes No 22. If no, Make and Serial NO. 23. Does Vehicle Have Locking Gas Cap? Yes No 22. If No, Make and Serial No. 24. Is Vehicle Fully Insured? Yes No 25. Name / Address of Insurance Company 26. Name / Address of Nearest Relative Not Living With R/p 27. Identifying Marks, Bumper Stickers, Add on Equipment, Etc. 28. Suspect Name Driver License No. / State Address Height Weight Eyes Hair Misc. RECOVERY NARRATIVE29. Name, Date and Case Number of Reporting Agency 30. Area Recovered Rural Urban 31. Description of Recovery Area 32. Recovery Complete Partial 33. Any Evidence Located? Yes No 34. Witnesses, Clues and Other Crimes 35. Have Missing, Identifiable Parts Been Entered in Svs? Yes No COMPONENT RECOVERY36. Description 37. Serial No. NarrativeB. CERTIFICATIONI hereby certify that notices with postage prepaid were deposited in the United States Mail, and these notices, of which this is a copy, were addressed to the person named herein.Name / Title Location Date Deposited C. NOTICE TO DEPARTMENT OF JUSTICEWe have been unable to give notice to the owner of record as required by the Notice of Stored Vehicle (22852 CVC) and the vehicle, after 120 hours of storage, has not been returned. Send to Department of Justice, Stolen Vehicle Unit, P.O. Box 903387, Sacramento, CA 94203-3870. Owner cannot be identified Owner cannot be notified STORING AGENCY / AGENCIA ALMACENAMIENTOSend This Form to the Following Tow Company: GW METRO Officer Email(Required)Enter your email address to receive a copy of the completed form.