| Scorekeeper | Referee 1 | Referee 2 |
|---|---|---|
| Johnny Parsons | Patrick Arensberg |
| 1 | 2 | 3 | Final | |
|---|---|---|---|---|
| San Mateo Black Stars 12B | 0 | 1 | 0 | 1 |
| Lake Tahoe Grizzlies 12B | 0 | 0 | 1 | 1 |
| 1 | 2 | 3 | Total | |
|---|---|---|---|---|
| San Mateo Black Stars 12B | 8 | 5 | 2 | 15 |
| Lake Tahoe Grizzlies 12B | 5 | 1 | 5 | 11 |
| P | Time | Team | Goal | Assist 1 | Assist 2 |
|---|---|---|---|---|---|
| 2 | 5:41 | San Mateo Black Stars 12B | Igor Rezvinski | Kody C Cochran | |
| 3 | 3:13 | Lake Tahoe Grizzlies 12B | Jonathan R Yarbrough | Todd E Hilton |
| P | Time | Team | Player | Infraction | Min |
|---|---|---|---|---|---|
| 1 | 9:34 | Lake Tahoe Grizzlies 12B | Todd Hilton | Roughing | 2 |
| 1 | 1:30 | Lake Tahoe Grizzlies 12B | Carver Alford | Roughing | 2 |
| 2 | 38.0 | Lake Tahoe Grizzlies 12B | Unknown | Too Many Men | 2 |
| 3 | 10:04 | San Mateo Black Stars 12B | Unknown | Too Many Men | 2 |
| 3 | 3:20 | Lake Tahoe Grizzlies 12B | Andrew Craig | Tripping | 2 |
| 3 | 2:23 | San Mateo Black Stars 12B | Brandon Kwan | Tripping | 2 |
| 3 | 52.1 | Lake Tahoe Grizzlies 12B | Shawn Calderon | Tripping | 2 |
| 3 | 03.3 | San Mateo Black Stars 12B | Maxim Myagkov | Tripping | 2 |
| HC | Gabriel C Brown |
| 9 | Luca A Tartaglia |
| AC | Marc Tartaglia |
| AC | Gilbert A Kwan |
| 14 | Brandon T Kwan |
| 33 | Henry T Eide (G) |
| 19 | Yeray M Amezcua |
| 15 | Mikala C Gould |
| 32 | Maxim Myagkov |
| 21 | Benjamin Pegg |
| 95 | Morry J Sheynin |
| 61 | Celian L Butre |
| 6 | Ryland A Ewen |
| 66 | Igor Rezvinski |
| 63 | Joshua M Hayden |
| 34 | Owen S Pence |
| 76 | Joshua H Swire |
| 28 | Kody C Cochran |
| 20 | Shreevatsa T Sandilya |
Game Number: 15416