HomeMy WebLinkAbout233266 06/04/14 cru F4q'�'. CITY OF CARMEL, INDIANA VENDOR: 146900
® 31 ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL Mme,1ECK AMOUNT: $""`"'""330.00'
s � CARMEL, INDIANA 46032 CASHIER OFFICE-MAIL CODE 50-10C CHECK NUMBER: 233266
100 N SENATE AVE CHECK DATE: 06/04/14
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 6635135 30.00 OTHER EXPENSES
601 5023990 6635233 30.00 OTHER EXPENSES
601 5023990 6635340 30.00 OTHER EXPENSES
601 5023990 6635460 30.00 OTHER EXPENSES
601 5023990 6635461 30.00 OTHER EXPENSES
601 5023990 6636005 30.00 OTHER EXPENSES
601 5023990 6637603 30.00 OTHER EXPENSES
601 5023990 6640276 30.00 OTHER EXPENSES
601 5023990 6640343 30.00 OTHER EXPENSES
601 5023990 6640613 30.00 OTHER EXPENSES
601 5023990 6640637 30.00 OTHER EXPENSES
IDEM Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 6640637
Mail Code 66-34 Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: WT120013
Expiration Date: 06/30/2014
Andrew R.Creasy Grade: WT3
1511 W.Division Rd. Obtained By: Examination
_ Tipton IN 46072
Login ID: WT120013
Password: 1277539
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
-Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. WT120013, Grade WT3 for a class WT3 Water
Treatment Plant expires on 06/30/2014. You are required to obtain 25.00 contact hours of continuing
education-for renewal. Our records indicate that you currently have accumulated 85.00 contact hours
0
towards renewal. This may not reflect hours for courses recently attended.)
0
- Note: If you have not recently attended an approved course, and you do not have the required number of
hours, you need to attend courses prior to July 1, 2014. After this date you are on expired status and are not
a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov.
The cost for the online renewal is$30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal—To renew through the mail, please fill out the section on the back of this page and return
this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal)_$90.combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-1 OC
100 N. Senate Avenue
Indianapolis, IN 46204-2251
SEE FORM ON OTHER SIDE
(1)
Cancel Certification—If you do not want to renew this certification,please write"CANCEL" on this
form, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was as obtained b Examination and the facility u re
y y yo a employed at has changed,please
add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site
Specific, it is valid only for the location below.
Operator Number: WT120013 Invoice Number: 6640637
PWS Name PWS ID
Carmel Water Department 15229004
Address Change:
Home Phone Number: _ SO — 3$S — 107¢
Work Phone Number: 3/7 ^ 73 3 — Z 8
Operator Signature: Date:
(2)
IDEM Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 6635135
Mail Code 66-34 Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: DS007769
Jerry A.Cloud Expiration Date: 06/30/2014
19560 Wind Wood Pkwy. Grade: DSL
Obtained By: Ex
Noblesville IN 4 y amination
_ 6062
Login ID: WT947019
Password: 581424
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Water'Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. DS007769, Grade DSL for a class DSL Water
Distribution System expires on 06/30/2014. You are required to obtain 15.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 53.50 contact hours
0
towards renewal. (This may not reflect hours for courses recently attended.)
Note: If you have not recently attended an approved course, and you do not have the required number of
hours, you need to attend courses prior to.July 1, 2014. After this date you are on expired status and are not.
N a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov.
The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal—To renew through the mail,please fill out the section on the back of this page and return
this entire letter-with $30 fee payment to the remittance address listed. Be sure to sign and date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal) _ $90 combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-1 OC
100 N. Senate Avenue
Indianapolis, IN 46204-2251
SEE FORM ON OTHER SIDE
(1)
Cancel Certification—If you do not want to renew this certification,please write"CANCEL" on this
form, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the facility you are employed at has changed,please
add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site
Specific, it is valid only for the location below.
Operator Number: DS007769 Invoice Number: 6635135
PWS Name PWS ID
Carmel Water Department 15229004
Address Change:
Home Phone Number:
Work Phone Number:
Operator Signature: Date: ��
(2)
anEM Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 6640276
Mail Code 66-34 Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: WT947019
Jerry A.Cloud Expiration Date: 06/30/2014
Grade: WT3
19560 Wind Wood Pkwy. Obtained By:.Examination
Noblesville IN 46062
Login ID: WT947019
Password: 581424
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. WT947019, Grade WT3 for a class WT3 Water
Treatment Plant expires on 06/30/2014. You are required to obtain 25.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 53.50 contact hours
0
towards renewal. (This may not reflect hours for courses recently attended.)
Note: 1f you have not recently attended an approved course, and you do not have the required number of
14. After this date you"are on expired status and are not
hours, you need to attend courses prior to July 1, 20
a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at httys://mylicense.in.gov.
The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal.-To renew through the mail,please fill out the section on the back of this page and return
this entire letter with $30 fee payment to the remittance address listed. Besureto sign and date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal)_ $90 combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-IOC
100 N. Senate Avenue ,
Indianapolis, IN 46204-2251
SEE FORM ON OTHER SIDE
(1)
Cancel Certification—If you do not want to renew this certification,please write "CANCEL" on this
form, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the facility you are employed at has changed,please
add your new employer in the space provided. NOTE If this certification is Grandfathered or Site
Specific, it is valid only for the location below.
Operator Number: WT947019 Invoice Number: 6640276
PWS Name PWS ID
Carmel Water Department 15229004
Address Change:
Home Phone Number: �� ` l ? o
Work Phone Number:
Operator Signature: Date: /
(2)
icw_m Indiana Department of Environmental Management
n 100 N.Senate Avenue Invoice Number: 6640613
'* Mail Code 66-34
Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: WT110146
Expiration Date: 06/30/2014
Kris C.Anthis Grade: WT3
6455 W.Whispering Way N. Obtained By: Examination
Greenfield IN 46140
Login ID: WTI 10146
Password: 811758
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
- Water' Works Operator Ceriification Renewal Fee Statement
Our records indicate your Water Works Certificate No. WTI 10146, Grade WT3 for a class WT3 Water
Treatment Plant expires on 06/30/2014. You are required to obtain 25.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 87.00 contact hours
0
towards renewal. (This may not reflect hours for courses recently attended.)
Note: If you have not recently attended an approved course, and you do not have the required number of,
14. After this date you are on expired status and are not
hours, you need to attend courses prior to July 1, 20
a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov.
The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal=To renew through the mail,please fill out the section on the-back of this page and return
this,entire letter
with $30 fee payment to the remittance address listed. Be sure to sign and date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal)_$90 combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-1 OC
100 N. Senate Avenue
Indianapolis, IN 46204-2251
SEE FORM ON OTHER SIDE
(1)
Cancel Certification—If you do not want to renew this certification,please write"CANCEL" on this
form, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT& RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the facilityyou are employed at has changed,please
Yg
add new —
a your n employer in the space provided. NOTE If this certification is Grandfathered or Site
Specific,it is valid only for the location below.
Operator Number: WT110146 Invoice Number: 6640613
PWS Name PWS ID
Carmel Water Department 15229004
Address Change:
Home Phone Number:
Work Phone Number:
Operator Signature: Date:
(2)
IDEM Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 6635461
Mail Code 66-34 Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: DS120002
Expiration Date: 06/30/2014
Anthony W.Isenberger Grade: DSL
6212 Buttonwood Dr. Obtained By: Examination
Noblesville IN 46062
Login ID: DS120002
Password: 1279627
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. DS120002, Grade DSL for a class DSL Water
Distribution System expires on 06/30/2014. You are required to obtain 15.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 92.00 contact hours
0
towards renewal. (This may not reflect hours-for courses recently attended.)
Note: If you have not recently attended an approved course, and you do not have the required number of
hours, you need to attend courses prior to July 1,2014. After this date you are on expired status and are not
a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://inylicense.in.gov.
The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal—To renew through the mail,please fill out the section on the back of this page and return
this entire letter with'$3G fee payment to the remittance address listed. Be sure to sign and date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal)= $90 combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-10C
100 N. Senate Avenue
Indianapolis, IN 46204-2251 1� '
SEE FORMl
ON OTHER SIDE
(1)
Cancel Certification—If you do not want to renew this certification,please write"CANCEL"on this
form, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the facility you are employed at has changed,please
add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site
Specific, it is valid only for the location below.
Operator Number: DS 120002 Invoice Number: 6635461
PWS Name PWS ID
Carmel Water Department 15229004
Address Change:
Home Phone Number: (317 52-9�.5 9-3 q
Work Phone Number: C,'7 J 5 32 -3SI
Operator Signature: Date: PJ
(2)
IDEM Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 6635233
Mail Code 66-34
;4111-6
Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: DS987929
Expiration Date: 06/30/2014
GREG H.HOLLANDER Grade: DSL
3450 WEST 131ST ST. Obtained By: Examination
Westfield IN 46074
Login ID: DS987929
Password: 582980
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
- Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. DS987929, Grade DSL for a class DSL Water
Distribution System expires on 06/30/2014. You are required to obtain 15.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 28.00 contact hours
0
towards renewal. (This may not reflect hours for courses recently attended.)
Note: If you have not recently attended an approved course, and you do not have the required number of
hours, you need to attend courses prior to July 1, 2014. After this date you are on expired status and are not
a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015,will result in termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov.
The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal—To renew through the mail,please fill out the section on the back of this page and return
this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal)_$90 combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-1 OC
100 N. Senate Avenue
Indianapolis, IN 46204-2251 ( �
SEE FORM ON OTHER SIDE
(I)
Cancel Certification—If you do not want to renew this certification,p lease write"CANCEL" on this
form sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the facility you are employed at has changed,please
add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site
Specific, it is valid only for the location below.
Operator Number: DS987929 Invoice Number: 6635233
PWS Name PWS ID
CARMEL WATER DEPT 15229004
Address Change: 3 tj /31 r- a ac-g�
Home Phone Number:
Work Phone Number:
Operator Signature: Date: �' 2�
® Indiana Department of Environmental Management
Eco 100 N.Senate Avenue Invoice Number: 6637603
Mail Code 66-34 Renewal Fee: 30.00
s Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: WT007785
Expiration Date: 06/30/2014
Daniel R.Jenkins Grade: WT3
12672 Strawtown Ave. Obtained By: Examination
Noblesville IN 46060
Login ID: WT007785
Password: 578507
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
- Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. WT007785, Grade WT3 for a class WT3 Water
Treatment Plant expires on 06/30/2014. You are required to obtain 25.00 contact hours of continuing
education•for renewal. Our records indicate that you currently have accumulated 51.50 contact hours
0
towards renewal. (This may not reflect hours for courses recently attended.)
0
Note: If you have not recently attended an approved course, and you do not have the required number of
hours, you need to attend courses prior to July 1, 2014. After this date you are on expired status and are not
a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov.
The cost for the online renewal is$30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal—To renew through the mail,please fill out the section on the back of this page and return
this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal)_ $90 combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-IOC
100 N. Senate Avenue
Indianapolis, IN 46204-2251
SEE FORM ON OTHER SIDE v\
(1)
Cancel Certification—If you do not want to renew this certification,p lease write "CANCEL" on this
form, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the.facility you are employed at has changed,please
add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site
Specific, it is valid only for the location below.
Operator Number: WT007785 Invoice Number: 6637603
PWS Name PWS ID
Carmel Water Department 15229004
Address Change:
Home Phone Number:
Work Phone Number:
Operator Signature: Date:
(2)
Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 6635006
'- Mail Code 66-34 Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: DS007817
Daniel R.Jenkins
Expiration Date: 06/30/2014
Grade: DSL
12672 Strawtown Ave.
Obtained By: Examination
Noblesville IN 46060
Login ID: WT007785
Password: 578507
Block
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. DS007817, Grade DSL for a class DSL Water
Distribution System expires on 06/30/2014. You are required to obtain 15.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 51.50 contact hours
0
towards renewal. (This may not reflect hours for courses recently attended.)
Note: If you have not recently attended.an approved course, and you do not have the required number of
hours, you need to attend courses prior to July 1, 2014. After this date you are on expired status and are not
a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov.
The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, & Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal—To renew through the mail,please fill out the section on the back of this page and return
this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
Ifyou have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal) _ $90 combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-1 OC
100 N. Senate Avenue
Indianapolis, IN 46204-2251
SEE FORM ON OTHER SIDE
(I)
Cancel Certification—If you do not want to renew this certification;please write"CANCEL" on this
form, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the facility you are employed at has changed,please
add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site
Specific,it is valid only for the location below.
Operator Number: DS007817 Invoice Number: 6635006
PWS Name PWS ID
Carmel Water Department 5229004
Address Change:
Home Phone Number:
Work Phone Number:
Operator Signature: A Date:
(2)
Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 6640343
Mail Code 66-34 Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: WT057974
_ Jaimie L.Foreman Expiration Date: 06/30/2014
3450 West 131st Street Grade: WT3
Westfield IN 46074 Obtained By: Examination
Login ID: WT057974
Password: 582485
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
- - - —- - - - Water- Works Operator Certifiaation Renewal Fee Statement
Our records indicate your Water Works Certificate No. WT057974, Grade WT3 for a class WT3 Water
Treatment Plant expires on 06/30/2014. You are required to obtain 25.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 70.00 contact hours
0
towards renewal. (This may not reflect hours for courses recently attended.)
0
_ Note: If you have not recently attended an approved course, and you do not have the required number of
hours, you need to attend courses prior to July 1, 2014. After this date you are on expired status and are not
a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you
will have to retest.
Online Renewal-Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov.
The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, & Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal-To renew through the mail,please rill out the section on the back of this page and return
this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal) _ $90 combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office-Mail Code 50-IOC
100 N. Senate Avenue
Indianapolis, IN 46204-2251 (, OJ
, r. , j, `
SEE FORM ON OTHER SIDE
Cancel Certification—If you do not want to renew this certification, please write"CANCEL" on this
fonn, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the facility you are employed at has changed,please
add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site
Specific, it is valid only for the location below.
Operator Number: WT057974 Invoice Number: 6640343
PWS Name PWS ID
Carmel Water Department 15229004
Address Change:
Home Phone Number: 1'5
Work Phone Number:
Operator Signatur : Date: �1��1
(2)
Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 6635340
Mail Code 66-34 Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: DS987856
STEVE L.COOK Expiration Date: 06/30/2014
3450 WEST 131 ST STREET Grade: DSL
Carmel IN 46074 Obtained By: Examination
.Login ID: DS987856
Password: 583445
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
- - Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. DS987856, Grade DSL for a class DSL Water
Distribution System expires on 06/30/2014. You are required to obtain 15.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 43.00 contact hours
a
towards renewal. (This may not reflect hours-for courses recently attended.)
Note: If you have not recently attended an approved course, and you do not have the required number of
hours, you need to attend courses prior to July 1, 2014. After this date you are on expired status and are not
a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew
your certification. Failure to renew b Jul 1
y y 2015 will result In termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov-
The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal—To renew through the mail,please fill out the section on the back of this page and return
this entire Ietter_with $36-fee_payment to the remittance address listed. Be sure to sign-and-date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee payment that covers all of them. For example: (3 renewals x $30/per renewal)_ $90 combined.fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-1 OC
100 N. Senate Avenue
Indianapolis, IN 46204-2251
SEE FORM ON OTHER SIDE
(1)
Cancel Certification—If you do not want to renew this certification,please write "CANCEL" on this
form, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the facility you are employed at has changed,please
add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site
Specific, it is valid only for the location below.
Operator Number: DS987856 Invoice Number: 6635340
PWS Name PWS ID
CARMEL WATER DEPT 15229004
Address Change:
Home Phone Number:(
Work Phone Number( 3 17 7 3-7—
Operator Signatu e• Date:
(2)
VOUCHER # 135246 WARRANT# ALLOWED
TIDEM IN SUM OF $
IDEM
100 N SENATE AVENUE
INDIANAPOLIS, IN 46204-2251
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
6635233 01-6040-05 $30.00
Gtagb3 U 3 (c 3t.IND
31>,cb
G,61.4t,IazIt 3o.tb
30100
CC)7�3
s�
��3c9�5 "` W-0c>
Voucher Total 3cf),W $
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
TIDEM
IDEM Purchase Order No.
100 N SENATE AVENUE Terms
INDIANAPOLIS, IN 46204-2251 Due Date 5/28/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/28/2014 6635233 $30.00
I hereby certify that the attached invoice(s), or bill(s) is (are)true and
correct and I have audited same in accordance with IC 5-11-10-1.6
s 1 n/y ✓ '
Date Officer
EM
ID Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 6635460
Mail Code 66-34 Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 19,2014
Certificate Number: DS110167
Shawn F.-Cooksey Expiration Date: 06/30/2014
2907 East 186th St. Grade: DSL
Westfield IN 46074 Obtained By: Examination
Login ID: DS110167
Password: 1279623
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. DS 110167, Grade DSL for a class DSL Water
Distribution System expires on 06/30/2014. You are required to obtain 15.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 61.00 contact hours
0
towards renewal. (This may not reflect hours for courses recently attended.)
0
Note: If you have not recently attended an approved course, and you do not have the required number of
hours, you need to attend courses prior to July 1, 2014. After this date you are on expired status and are not
a valid certified operator. You do have until-July 1, 2015 to-get your continuing education hours and renew
your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you
will have to retest.
Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov.
The cost for the online renewal is$30.00 plus an additional processing fee for each certification renewal.
The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID
and Password are listed above.
Mail Renewal-To renew through the mail,please fill out the section on the back of this page and return
this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and.date in
spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take
longer than an online renewal.
If you have other drinking water certifications due renewal, you can combine them in one mailing with a
fee,payment that covers all of them. For example: (3 renewals x $30/per renewal)_ $90 combined fee.
Remit Payment to: Indiana Department of Environmental Management
Cashier's Office—Mail Code 50-1 OC
100 N. Senate Avenue
Indianapolis, IN 46204-2251
SEE FORM ON OTHER SIDE
(1)
Cancel Certification—If you do not want to renew this certification,please write "CANCEL" on this
form, sign and date in spaces provided, and mail to the remittance address listed.
FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING
If this certification was obtained by Examination and the facility you are employed at has changed,please
add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site
Specific, it is valid only for the location below.
Operator Number: DS110167 Invoice Number: 6635460
PWS Name - PWS ID
Carmel Water Department 15229004
Address Change:
Home Phone Number: ,
Work Phone Number:
Operator Signature: Date: 0
(2)
VOUCHER # 135259 WARRANT # ALLOWED
TIDEM IN SUM OF $
IDEM `� 50 0c-
100 N SENATE AVENUE
INDIANAPOLIS, IN 46204-2251
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
6635460 01-6040-05 $30.00
Voucher Total $30.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
TIDEM
IDEM Purchase Order No.
100 N SENATE AVENUE Terms
INDIANAPOLIS, IN 46204-2251 Due Date 5/30/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/30/2014 6635460 $30.00
I hereby certify that the attached invoice(s), or bill(s) is(are)true and
correct and I have audited same in accordance with IC 5-11-10-1.6
Date Officer