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Mr. Micah Nelson EQ -820 <br />March 21, 2014 <br />Page 3 <br />information set forth below and must be filed (received) by the Agency Clerk in the Office of <br />General Counsel of the Department at 3900 Commonwealth Boulevard, MS 35, Tallahassee, <br />Florida, 32399-3000, within 21 days of receipt of this Order. Petitioner, if different from the <br />applicant shall mail a copy of the petition to the applicant at the time of filing. Failure to file a <br />petition within this time period shall waive the right of anyone who may request an <br />administrative hearing under Sections 120.569 and 120.57, F.S. <br />Pursuant to Subsection 120.569(2), F.S., and Rule 28-106.201, F.A.C., a petition for <br />administrative hearing shall contain the following information. <br />a) The name, address, and telephone number of each petitioner; the name, address, and <br />telephone number of the petitioner's representative, if any, the site owner's name and <br />address, if different from the petitioner, the DEP facility number, and the name and <br />address of the facility; <br />b) A statement of when and how the petitioner received notice of the Department's action or <br />proposed action; <br />C) An explanation of how each petitioner's substantial interests are or will be affected by the <br />Department's action or proposed action; <br />d) A statement of the disputed issues of material fact, or a statement that there are no <br />disputed facts; <br />e) A concise statement of the ultimate facts alleged, including a statement of the specific <br />facts the petitioner contends warrant reversal or modification of the Department's action <br />or proposed action; <br />f) A statement of the specific rules or statutes the petitioner contends requires reversal or <br />modification of the Department's action or proposed action; and <br />g) A statement of the relief sought by the petitioner, stating precisely the action petitioner <br />wishes the Department to take with respect to the Department's action or proposed action. <br />How to Pursue Mediation <br />In addition to requesting an administrative hearing, any petitioner may elect to pursue mediation. <br />The election may be accomplished by filing with the Department a mediation agreement with all <br />parties to the proceeding (i.e., the applicant, the Department, and any person who has filed a <br />timely and sufficient petition for hearing). The agreement must contain all the information <br />required by Rule 28-106.404, F.A.C. The agreement, signed by all parties, must be received by <br />the Agency Clerk in the Office of General Counsel of the Department at 3900 Commonwealth <br />Boulevard, Mail Station 35, Tallahassee, Florida, 32399-3000 within 10 days after the deadline <br />for filing a petition, as set forth above. Choosing mediation will not adversely affect the right to <br />a hearing if mediation does not result in a settlement. <br />Pursuant to Rule 28-106.404, F.A.C., an agreement to mediate must include the following. <br />(i) The name, address, and telephone number of the persons who may attend the mediation, <br />(also the DEP facility number, the name and address of the facility if applicable); <br />(ii) The name, address, and telephone number of the mediator agreed t&bythe parties; <br />r` <br />www. dep. statefl. 1. us <br />