HomeMy WebLinkAbout253493 01/15/16 �Coq
a`�'� 4f. CITY OF CARMEL, INDIANA VENDOR: 356491
ONE CIVIC SQUARE TARA WASHINGTON
CHECK AMOUNT: $********60.00*
i� .�� CARMEL, INDIANA 46032 4475 SILVER SPRINGS DR CHECK NUMBER: 253493
,;i To*�` GREENWOOD IN 46142 CHECK DATE: 01/15/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 60.00 OTHER EXPENSES
VOUCHER # 156975 WARRANT # ALLOWED
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356491 IN SUM OF $
WASHINGTON, TARA
SOUTH PLANT
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Carmel Wastewater Utility y
ON ACCOUNT OF APPROPRIATION FOR
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PO# INV# ACCT# AMOUNT Audit Trail Code
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WASHINGTO 01-7042-05 $30.00
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` idiana Department of Environmental ManagementADEM
,10 N.Senate Avenue
Mail Code 65-42 .
Indianapolis, IN 4624.2251.
Es"r
1986
July 17, 2015
�.v
Tara M.Washington'
4475 Silver Springs Dr
Greenwood IN 46142
Re: Admission Slip to Municipal Class
IV .
Wastewater Certification,Exam "
Dear Tara.M.,Washington:
Y app I. ation fir#lie munici al Glass{V wastewat t eats en lar operator examinatlon.has been approxe. .This is your
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admission-slip to the wastewater certification exam.-This letter is valid for 180 days. A proctor will sign your letter after you
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have taken the exam.
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lf:your name,address or certification class.is:not-correct as indicated on this letter,you should contact me as soon as possible.
Please go to http lIMm Kivyteeh:edu/coiporatecollege/workforce-cert-center/ to schedule an exam date/time.at an Ivy:Tech
testing center. Ther.I!is a$30 fee to IvyjT� ech when'"'registerinc 24 hour notice is:required to reschedule,or cancel an
appointment. late cancellations.be no-shows will be assessed another$30 fee:::Application fees are not refundable.
You must bring this:letter with you to the exam.No faxes or copies are allowed.A:valid,:non-expired government issued
picture I.D.is also required.
Pencils;calculators,formula sheets,conversion sheets and scrap paper will"all be-provided. You"will-be asked to store all
personal belongings in.a locker or return items:to your car. Use of cell phones or other electronic devices during the exam,
.::even,dy-ri.ng a break,'is not permitted.
If you,are Date,you may not be allowed to take the,exam_so allow adequate time;to:arrive at the testiocation.You may leave
the room for a short break,no longer than ten minutes,b leaving our testing materials and icture I.D.with the roctor.If you
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do not return to the room within the allotted time,you will not be allowed to resume taking the"exam.
If you have any questions, please-contact me at(317)232-8791.
Sincerely,
Rebecca McMonigle,
Compliance Evaluation Section
Office.of Water Quality
completedTo be .
Proctor Name: ;, - Test:Location:
�_ T~ c,G� Lawre arc
Exam Score;
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Indiana Department of Environmental Management
X90 N.Senate Avenue
Mail Code 65-42
Indianapolis,IN 46204-2251
EST
�ela3e:.
.. December 29, 2015 ti -
Tara M.Washington
4475.Silver Springs Dr
Greenwood IN 46142
Re: Certification Number: WW020533
Class: IV Score: 87
Dear Certified Wastewater Treatment Plant Operator:
C-onsanatulations on receiving a_passingascoreI wour recent ope[ato ertfficatio�.examination Your original
certificate and certification card will be sent.under separate cover. .
PLEASE NOTE THE:FOLLOWING WASTEWATER OPERATOR CERTIFICATION REQUIREMENTS:
1. :Certificates are permanent innature,but must be validated by a current.certification card. The.certification card being.
issued to you.is.valid until June 30,.2017;and must be renewed at that time. A billing notice will be sent to your last
known mailing address at least 30 days prior to the due date. If you change your mailing address,or do not receive your
billing, please notify this office.
2. Operators needing a replacement or duplicate certificate(s)must submit a written request including the following
information: (1)class of wastewater operator, (2)name and classification of the plant to be operated, (3)date of issuance
of the original certificate (if known),and (4)the certificate number.
3_ Priorto:renewing your certification in June 2017,you are required to.obtain at least the following continuing education
contact hours from IDEM-approved training courses based on the classification of your certification-
Classes I-SP
ertification:Classes:)-SP and A-SO 5 contact hours for each two-year renewal.period
Classes I,Il,A and B 10 contact hours for each two-year renewal period
Classes III, IV,C and D 20 contact hours for each two-year renewal period
A minimum of seventy percent(70%)of the required continuing education contact hours must be obtained from the
technical category of approved continuing education courses.that address technical.matters related directly to.wastewater
treatment plant and sewer system operations, maintenance,management;or supervision.
Not more that 30%of the required continuing education contact hours may be obtained from non=technical subject matter.
of approved continuing education courses that enhance the performance of the certified operator's responsibilities but are
not directly related.to wastewater treatment plant and sewer system operations,maintenance,management,or
supervision:
If a course is not approved by IDEM within 90 days of its completion,,the course cannot be used,in:fulfilling the continuing
r`education,-requirement.
The continuing education requirements must be satisfied in.full in order to renew your certification in June 2017.:If you fail
to renew on time and were the operator in responsible charge of a facility, both you and the facility would be in violation of
State law.
If you have any questions, please contact Rebecca McMonigle at 317-232-8791. Again,congratulations on your new
certification.
Sincerely,
Mark W.Stanifer, Chief
Compliance Branch
Office of Water Quality
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Indianapolis Lawrence f Municipal Wastewater Operator,Class IV 1
First:TARA
Last WASHINGTON
Candidate ID:738937
`AFprnr{ittexis {' The Mutticipal1ifestewater Uperator,Glass fUexam equizesa,payment of$30.OfS
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How will you be paying for the exam?
MYACCOUNT Q Pay now via credit card online.
:Profile Already paid as part of an Ivy Tech course I am currently taking.------- ...... fi: Already paid through my employer or other third-party. J— —
Already paid via Cash(CreditiCheck at campus BusinesslBursar Office.(Note:Appointment will not be approved until payment has been
verified.)
If you plan to pay at your campus Business/Bursar Office,but have not yet done so,please return to this scheduling system after
payment has been made.
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i
Ivy Tech Community College of Indiana 2016
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6F04431'060000069819698190 8220
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i CURewards Points
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CHRISTOPHER L WASHINGTON ® 1021
4475 SILVER SPRINGS DR.
GREENWOOD,IN 46142 � { 7ae240/2719
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FOR OFFICE USE
APPLICATION FOR WASTEWATER TREATMENT PLANT OPERATOR Classification
CERTIFICATION EXAMINATION
State Form 47289(R7/2-15) Status
Approved by State Board of Accounts,2014
as INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Pursuant to 327 IAC 5-22 Remarks
NOTE- A$30.00 FEE MUSTa.BE.S7VIMITaTED FOR EACH CERTIFICATION EXAMINATION"AM0C' + I:
FAILURE TO FILE A PROPERLY COMPLETED APPLICAifON MAY RESULT IN THE APPLICATION
BEING DISAPPROVED. APPLICATIONS ARE DUE NO LATER THAN 45 DAYS PRIOR TO THE DATE OF
THE EXAMINATION IF YOU INTEND TO TAKE THE EXAM AT IDEM.THERE IS NO DUE DATE IF YOU
PLAN TO TAKE THE EXAM AT IVY TECH.(APPLICATION FEE IS NONREFUNDABLE.)
1.This is an application for:(check one) ❑wastewater Apprentice ❑ Certified Operator
2.Classification requested:(check one) Industrial: []A-SO ❑A ❑B ❑C ❑D
Municipal: ❑ I-SP ❑I ❑II ❑III ❑IV
3.If you are applying for Certified Operator,would you accept a lower operator classification if you do not currently meet the education and experience
requirements for your first choice? ❑YES [-]NO
4.Where would you like to take the exam?
❑ At IDEM in Indianapolis when it is next offered(annually in October).This is a paper exam only.
❑
Atone of the-participating-IVY-Tech locations(any standard business day). --------
Note: Ivy Tech charges an additional$30 fee for administering the test.This is a computerized exam only.
,GENERLINFORMAT16W RALLAl PPLICANTS: leaser e.or_ 'ri'ntae !'bl ,' n; „ ;
77 Name of applicant(last,first middle)
Fj Mr. Miss Mrs. FlMs. MDr.
B.Mailing address(number and street):
City: State: ZIP code: County:
Office telephone number: Home telephone number:
Fax number: E-mail address:
C.Date of birth:(month/day/year) D.Have you ever applied for wastewater certification in Indiana before?
❑ Yes ❑ No
E.Are you presently a certified operator in Indiana? Certification number: Date of expiration:(month/day/year)
[—]Yes ❑No
II.EDUCATION ANDTRAIMNG-Mist be com leted.,for certification a' "'licarifs ,o tlonal'foraerticea' licants'
List below all high schools and post high schools attended.
Name/Location of School From(month/year) To(month/year) Diploma(GED)or Type of
Degree and Date of Graduation
High School Graduate?
❑Yes ❑ No
College Graduate?
❑Yes ❑ No
Other:
If you are applying for Class IV/Class D certification,original transcripts must be enclosed. For the consideration of using college education
to substitute for work experience,original college transcripts must be enclosed.
If you would like to have your original transcripts retumed,please check the box and enclose a self-addressed,stamped envelope.❑
Specialized Training or Classes Relevant to Certification
Title of Specialized Training or Class Company/School Attended Dates Attended Credits or Contact Hours
(month/day/year) earned:
Copies of credit report forms or proof of attendance must be enclosed.
"Contact Hour"means a fifty(50)to sixty(60)minute instructional session,approved by the Commissioner and involving a qualified instructor or
lecturer. Ten 10 contact hours equals one 1 continuing education unit CEU .
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