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Home My WebLink About233266 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