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Home My WebLink About249056 08/26/15 (9, CITY OF CARMEL, INDIANA VENDOR: 362110 ONE CIVIC SQUARE BRIAN TOLAN CHECK AMOUNT: S"."'*"30.00* CARMEL, INDIANA 46032 608 S UNION ST CHECK NUMBER: 249056 WESTFIELD IN 46074 CHECK DATE: 08/26/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 30.00 OTHER EXPENSES 1D Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number; 7126543 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,M 46204-2251 Money Receipt It (Office Only) May 18,2015 Certificate Number: WT062953 Expiration Date: 06/30/2015 Brian S.Tolan Grade: WT3 Carmel Water Utilities Obtained By: Examination 608 South Union Street Westfield 1N 46074 Login ID: WT062953 Password: 582719 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator CerliJicotion Renewal Fee Statement Our records indicate your Water Works Certificate No. WT062953, Grade WT3 for a class WT3 Water Treatment Plant expires on June 30, 2015. You are required to obtain 25.00 contact hours of continuing g education for renewal. Our records indicate that you currently have accumulated 65.00 contact hours 0 towards renewal. (This may not reflect hours for courses recently attended.) Note: If you leave not recently attended an approved course, and you do not have the required number of s hours, you need to attend courses prior to July 1, 2015. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2016 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2016 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, & Disc-over 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 clue renewal, you can c6m6ine them in one mailing`ivith a fee payment that covers all of them. For example: (3 renewals x$30/per renewal)_$90'e6mbined-fee. Remit Payment to: Indiana Department of Environmental Management Drinking Water Branch, OWQ, Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-225I 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: WT062953 Invoice Number: 7126543 PWS Name PWS ID Carmel Water Department 5229004 a Address Change: G Home Phone Number: 3 t? 4 "7 6 60 3 Work Phone Number: Ai7 ?33 2-?65- Operator SSSOperator Signature; Date: MAN 310 Za 16 (2) 2-25MMO 3499 BRIAN S TOLAN 608 S UNION ST. WESTFIELD,IN 46074-9302 DATE PAY TO THE lUD1AfVa � u�r�tJr Bd'�}{Uicor•�cµc-'�a�.- 1�A�/al�Ew�ar $ 3Q 'o .0 ORDEROF n ARS 8 � 9" BMO eptlarris Bank e BMO Harris Bank N.A. Chicago,Iliinols ,Hato 1gJ4(G&7 f 2{o 5d3 ; �lT 47-163 l 1 June 5,2015 Your Drinking Water Operator certification,number WT062953,is enclosed. EqPORTANTCERTM, CATION INTORMATION ADDRESS CHANGE: It is your responsibility to notify the Indiana Department of Environmental Management of any change of address. You may e-mail us at rkesiarnidem.in.gov or fax to(317)234-7462 or call(317)234-7431. NAME CHANGE: A name change request must be submitted in writing. Mail to:Indiana Department of Environmental Management,Office of Water Quality,Drinking Water Branch-Mail Code 66-34, 100 N.Senate Ave., Indianapolis,W 46204-2251 -or you can fax to(317)234-7462. CERTII-ICATION RENL(WAL-The Drinking Water Operator Certification Program will forward a certification renewal notice to the certified operator and address provided no later than thirty.days prior to the expiration of your certification. Df IN' 6 EN'IItONIN1E;4T Q iAiAN,I GE1fE_NF, �Dnnkiagwnie�.r3rarIA- tna c«te 6-6-3 4.. '_: Your certification will expire on 06/30/2018. If you have any _ _ - - — .::<1,00N.Sen3teA�•enu�.,.:: _ Indanapolis,rN0204-2251„_- questions,please contact Ruby Keslar at(317)234-7431 or email _.. Certificate Number Es la-ationDate= rkeslar(&idem.in.Qov. an -- �s is qualified as a v=_Wateff' aGent Plant_operator: - li. IND)ANA DE 'ARTMENT QF'E1 V1I_6NNIENTAL MANk1GEMENT VVaterBrauch Mail Code 66=34 �. en Indianapolis, 'I � Indianapolis,IN 46204-2251 f; 0 ! _ =W ater Works"OTerator-Certificate = i This 1s to certify that Brian S. T.olan =• _ _ -~ 'has fulfilled the ce_uirendnts for Certlfieaf>on.lis.r�giiirecl li_y the;I_awS.of tli °State _ q '.• of Indiana,and is duly certified as.-` _ _ f Grade WTD V4'ater TreatWel f-Plant Operator=° `'" isL 1 ; - I In tlie'St to of Iizdlana alyd is entitled t0he rights and rivileges_as,providec4 by Abe State of lndi6a ,=' ands ibJect to the powers bfrevacation as vested tlisaid Agency Testimony Witness the Signature of the Commissioner, y In Tes - !, -11/0220 6 - - Certificate Number: WT-062953 _- Thomas : 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 TBRIAN BRIAN TOLAN Purchase Order No. DISTRIBUTION OFFICE Terms Due Date 8/18/2015 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 8/18/2015 7126543 $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 VOUCHER # 152826 WARRANT # ALLOWED TBRIAN IN SUM OF $ BRIAN TOLAN DISTRIBUTION OFFICE Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 7126543 01-6040-03 $30.00 Voucher Total $30.00 Cost distribution ledger classification if claim paid under vehicle highway fund