A. Format:

STATE OF NEW MEXICO

BEFORE THE OCCUPATIONAL HEALTH AND SAFETY REVIEW COMMISSION

[NAME OF COMPLAINANT OR PETITIONER],

[complainant/Petitioner],

v. No. [insert case no.]

[NAME(S) OF RESPONDENT(S)],

respondent[s].

[NAME OF INTERVENOR],

Intervenor.

NOTICE OF WITHDRAWAL OF INTERVENTION

Notice is hereby given that Intervenor [Name of Intervenor] withdraws from this case.

[Signature]

[TYPED OR PRINTED NAME]

[Address of signer (use as many lines as necessary)]

[Signer’s telephone number]

B. Usage note: Include Certificate of Service (Section 1001) [now 11.5.5.1001 NMAC] on or immediately following the signature page, to show service upon the other parties.

[1/1/94, 1/1/96; Recompiled 11/30/01]