Request for Hearing Form with date.docx
CP-2026-LB058-0007-ADOSH · Arizona Division of Occupational Safety and Health · 2026-08-04
REQUEST FOR HEARING
OAH Received (OAH USE ONLY)
DATE:
July 28, 2026
TO:
[email redacted]
FROM:
DIVISION OF OCCUPATIONAL SAFETY & HEALTH
RETURN E-MAIL: (Required)
[email redacted]
1)
Docket No. (IT MUST CONFORM WITH OAH PROCEDURES: CP-2026-LB058-0007-ADOSH
2)
Check one:
☒
Contested Case (agency action not taken pending hearing.)
☐
Appealable Agency Action (appeal from agency action.) Date Party Requested Hearing:
3) Caption (Required):
DIVISION OF OCCUPATIONAL SAFETY AND HEALTH OF THE INDUSTRIAL COMMISSION OF ARIZONA, Complainant
v.
TLF MANUFACTURING LLC DBA RYSSO-PETERS,
Respondent
4)
Requested date and time of hearing*
N/A
*The requested date will be accommodated if practicable. The date MUST be within 60 days of the date a party requested a hearing in an appealable agency action, or within 60 days of this request for hearing in a contested case, UNLESS at least one of the following factors is true (check appropriate box). In the absence of a designated factor, the date will be chosen by OAH within the required 60 days. BY CHECKING A BOX, THE AGENCY IS CERTIFYING TO THE OAH THAT THE FACTOR IS TRUE.
☒
All parties agree to a date beyond 60 days
☐
OAH to set case for intervening prehearing within 60 days
5)
Approximate predicted length of hearing: Unknown
Complainant/Petitioner/Appellant (or Counsel/Rep)
Respondent/Appellee (or Counsel/Rep)
(REQUIRED) Name Address
(REQUIRED) Name Address
DIVISION OF OCCUPATIONAL SAFETY AND HEALTH OF THE INDUSTRIAL COMMISSION OF ARIZONA,
Complainant
Represented by:
Robert Irani Esq.,
Legal Division
800 West Washington Street, Suite 303
Phoenix, AZ 85007
TLF MANUFACTURING LLC DBA RYSSO-PETERS
Respondent
Represented by:
Jesse Atencio
Premier Risk Management
1523 W. Whispering Wind Drive
Suite 250
Phoenix, AZ 85305
(If known)
Phone
(602) 542-5293
(If known)
Phone
(602) 243-7263
(If known)
[email redacted]
(If known)
[email redacted]
FOR USE BY OAH ONLY:
Special Advisement FROM OAH
Assigned ALJ: Tammy L. Eigenheer
Assigned HEARING:
DATE:
10/15/26
TIME:
9am-12pm
LOCATION:
Special Advisement FROM Agency (need for interpreter/special accommodation, etc.)
Assigned PREHEARING (if applicable)
See attached File Transfer Memorandum w/ 3 attachments
DATE:
TIME:
LOCATION: