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Home My WebLink About259587 06/14/16 �( * CITY OF CARMEL, INDIANA VENDOR: 146900 ® I ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M&""ECK AMOUNT: S'**`***330.00* CARMEL, INDIANA 46032 100 N SENATE AVENUE CHECK NUMBER: 259589 ROOM 1255 CHECK DATE: 06/14/16 INDIANAPOLIS IN 46204-2251 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 7683629- 30.00 OTHER EXPENSES 60.1 5023990 76836490 30.00 OTHER EXPENSES 601 5023990 7683712' 30.00 OTHER EXPENSES 601 5023990 7683993' 30.00 OTHER EXPENSES 601 5023990 7684185✓ 30.00 OTHER EXPENSES 601 5023990 7684928e 30.00 OTHER EXPENSES 601 5023990 7685063- 30.00 OTHER EXPENSES 601 5023990 7685164 30.00 OTHER EXPENSES 601 5023990 7685348e 30.00 OTHER .EXPENSES 651 5023990 WOLFE .- 30.00 OTHER EXPENSES 601 5023990 WW020374-1 30.00 OTHER EXPENSES CITY OF CARMEL, INDIANA VENDOR: 146900 / 4I ONE CIVIC SQUARE IND DEPT OF ENVIR MGT DRINKING WCK AMOUNT: $********30.00* {�fLtE CARMEL, INDIANA 46032 own,MAIL CODE 66-34 CHECK NUMBER: 259587 100 N SENATE AVE CHECK DATE: 06/14/16 INDIANAPOLIS IN 46204-2251 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 7684210 30.00 OTHER EXPENSES Indiana Department of Environmental Management 100 N. Senate Avenue IGCN Room 1255 Indianapolis, IN 46204-2251 t ®EM ANNIV=RSARY Lj�l William E.Wolfe 22934 Anthony Road Cicero IN 46034 Indiana Department of Environmental Management _--WASTEWATER TREATMENT PLANT`OPERATOR-RENEWAL APPLICATION Our records indicate your wastewater treatment plant operator certification expires on 06/30/2016. After this date you cannot be the operator in responsible charge of any wastewater treatment plant in Indiana until your certification is renewed. This renewal application form may be submitted, and payment made prior to CEUs being received, but your license will not be reissued until we receive documentation that all required CEUs have been obtained. Licenses are renewable every two years, and all terms for renewal must be met each time before a license is renewed. There is no late fee for renewing late,although if your license expires you cannot work as an operator in responsible charge until your license is renewed. Failure to renew a license within three years of its expiration date will require you to sit for and pass the written test before a new license is issued. License Class Wastewater Operator Class IV April 29, 2016 Certification#: WW006430 Expiration Date: 06/30/2016 Renewal Fee: 30:00 Login Id: WW006430 Password: 491255, Current Continuing Education Hours Earned: General-0.50 Technical- 14.00 Total- 14.50. This may not reflect hours for courses recently attended. If you are not designated as the responsible charge operator for any facility, please write"NONE"in the following table. Please complete the table to identify each wastewater treatment facility where you are the officially designated responsible charge certified operator. If you are in responsible charge of more than four facilities, please include an attachment listing these facilities and provide the required information for each one: I am currently the_responsible charge operator who signs the monthly reports(MRO/MMR)at the following facilities: Facility Name Hours/Week___ -P-ermit# -- -City -- Address Change: Home Phone: Work Phone: (3/759 1" ��3'Y Operator Signature:' " //� Date: d�Co (1) VOUCHER # 161680 WARRANT# ALLOWED 146900 IN SUM OF $ IN DEPT. OF ENVIRONMENTAL MGT. OWQ, MAIL CODE 66-34 100 N SENATE AVE INDIANAPOLIS, IN 46204-2251 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV* ACCT# AMOUNT Audit Trail Code 7684928 01-6040-03 $30.00 L7C�S�z�� u ��•(� Voucher Total fto Cost distribution ledger classification if claim paid under vehicle highway fund �osiw Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 7685164 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number: DS916079 Expiration Date:. 06/30/2016 John A.Mascari Grade: DSL 6220 East 55th Place Obtained By: Examination Indianapolis IN 46226 Login ID: WT998236 Password: 581954 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. DS916079, Grade DSL for a class DSL Water Distribution System expires on June 30, 2016. You are required to obtain 15.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our records indicate that you currently have accumulated 49.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.) If you need to verify the number of technical course hours obtained, you may login o, online using the instructions below. 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, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2017 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2017 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 Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue j /S Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE (1) IDEM Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 7683649 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number: WT 130161 Expiration Date: 06/30/2016 John A.Mascari Grade: WT5 6220 East 55th Place Obtained By: Examination Indianapolis IN 46226 Login ID: WT998236 Password: 581954 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. WT130161, Grade WT5 for a class WT5 Water Treatment Plant expires on June 30, 2016. You are required to obtain 30.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our records indicate that you currently have accumulated 49.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.) If you need to verify the number of technical course hours obtained,you may login online using e, the instructions below. 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, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2017 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2017 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 Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE (1) IDE Indiana Department of Environmental Management i 100 N. Senate Avenue Invoice Number: 7683712 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number: WT130132 Andrew R. Creasy Expiration Date: 06/30/2016 1511 W.Division Rd. Grade: WT5 _ Tipton IN 46072 Obtained By: Examination Login ID: WT130132 Password: 1277539 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT r, Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. WT130132, Grade WT5 for a class WT5 Water Treatment Plant expires on June 30, 2016. You are required to obtain 30.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our records indicate that you currently have accumulated 51.50 contact hours towards renewal. (This may not reflect hours for courses recently attended.) If you need to verify the number of technical course hours obtained,you may login online using the instructions below. 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, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2017 to get,y_our continuing education hours and renew your certification. Failure to renew by July 1, 2017 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 Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 } SEE FORM ON OTHER SIDE (1) IDEM Indiana Department of Environmental Management i 100 N.Senate Avenue Invoice Number: 7684928 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number. DS140052 Kole D.Bassett Expiration Date: 06/30/2016 Grade: DSM 411 W. College Ave. Obtained By: Examination Morocco IN 47963 Login ID: WT140053 Password: 1736708 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works OpeYator C-ekification Renewal Fee Statement Our records indicate your Water Works Certificate No. DS140052, Grade DSM for a class DSM Water Distribution System expires on June 30, 2016. You are required to obtain 15.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our 7ecords indicate that you currently have accumulated 40.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.)If you need to verify the number of technical course hours obtained, you may login 0 online using the instructions below. o, 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, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2017 to get your.continuing education hours and renew your certification. Failure to renew by July 1, 2017 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 htt-ps://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 Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 ' n SEE FORM ON OTHER SIDE l� (1) 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 146900 IN DEPT. OF ENVIRONMENTAL MGT. Purchase Order No. OWQ, MAIL CODE 66-34 Terms 100 N SENATE AVE Due Date 5/31/2016 INDIANAPOLIS, IN 46204-2251 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/31/2016 7684185 $30.00 1 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 e� w Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 7684185 Mail Code.66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number: WT130152 Expiration Date: 06/30/2016 Anthony W.Isenberger Grade: WT3 6212 Buttonwood Dr. Obtained By: OTT Noblesville IN 46062 Login ID: WT130152 Password: 1279627 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT -Writer Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. WT 130152, Grade WT3 for a class WT3 Water Treatment Plant expires on June 30, 2016. You are required to obtain 25.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our records indicate that you currently have accumulated 56.50 contact hours towards renewal. (This may not reflect hours for courses recently attended.) If you need to verify the number of technical course hours obtained,you may login online using o the instructions below. 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, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2017 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2017 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 Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue A Indianapolis, IN 46204-2251 O SEE FORM ON OTHER SIDE (1) Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 7683629 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number: WT130125 Expiration Date: 06/30/2016 Jerry A.Cloud Grade: WT5 19560 Wind Wood Pkwy. Obtained By: Examination Noblesville IN 46062 Login ID: WT130125 Password: 581424 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT YYater W&rkk Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. WTI 30125, Grade WT5 for a class WT5 Water Treatment Plant expires on June 30, 2016. You are required to obtain 30.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our records indicate that you currently have accumulated 45.50 contact hours towards renewal. (This may not reflect hours for courses recently attended.) If you need to verify the number of technical course hours obtained,you may login online using o, the instructions below. 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, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2017-to get your continuing education hours and renew your certification. Failure to renew by July 1, 2017 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 Drinking Water Branch, OWQ, Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE (1) Indiana Department of Environmental Management .M 100 N.Senate Avenue Invoice Number: 7683993 - Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number: WT998236 Expiration Date: 06/30/2016 John A.Mascari Grade: WT3 6220 East 55th Place Obtained By: Examination Indianapolis IN 46226 Login ID: WT998236 Password: 581954 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. WT998236, Grade WT3 for a class WT3 Water, Treatment Plant expires on June 30, 2016. You are required to obtain 25.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our records indicate that you currently have accumulated 43.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.) If you need to verify the number of technical course hours obtained,you may login online using the instructions below. 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, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2017 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2017 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 Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate'Avenue Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE V (1) Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 7685348 "~ Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number: DS140159 Jacen H.Rayle Expiration Date: 06/30/2016 Grade: DSL 23690 Dunbar Rd. Obtained By: Examination Arcadia IN 46030 Login ID: DS140159 Password: 1484442 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 1 - - Water-Works Operatorr Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. DS 140159, Grade DSL for a class DSL Water Distribution System expires on June 30, 2016. You are required to obtain 15.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our records indicate that you currently have accumulated 46.50 contact hours towards renewal. (This may not reflect hours for courses recently attended.) If you need to verify the number of technical course hours obtained, you may login o, online using the instructions below. 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, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2017 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2017 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. NfairRenewal-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 Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 UIS- SEE FORM ON OTHER SIDE U (1) Indiana Department of Environmental Management 100 N. Senate Avenue IGCN Room 1255 Indianapolis, IN 46204-2251 !CIDEENOWN - J ANNIVC-RSARY Kole D. Bassett 411 W College Ave Morocco IN 47963 Indiana Department of Environmental Management ----- - - WASTEWATER-TREATMENT PLANT OPERATOR'REN_EWAL APPLICATION Our records indicate your wastewater treatment plant operator certification expires on 06/30/2016. After this date you cannot be the operator in responsible charge of any wastewater treatment plant in Indiana until your certification is renewed. This renewal application form may be submitted, and payment made prior to CEUs being received, but your license will not be reissued until we receive documentation that all required CEUs have been obtained. Licenses are renewable every two years, $ and all terms for renewal must be met each time before a license is renewed. There is no late fee for renewing late,although if your license expires you cannot work as an operator in responsible charge until your license is renewed. Failure to renew a license within three years of its expiration date will require you to sit for and pass the written test before a new license is issued. a License Class Wastewater Operator Class I April 29, 2016 Certification#: WW020374 Expiration Date: 06/30/2016 Renewal Fee: 30.00 Login Id: WW020374 Password: 1770731 Current Continuing Education Hours Earned: General-3.00 Technical-9.00 Total- 12.00. This may not reflect hours for courses recently attended. If you are not designated as the responsible charge operator for any facility, please write"NONE"in the following table. Please complete the table to identify each wastewater treatment facility where you are the officially designated responsible charge certified operator. If you are in responsible charge of more than four facilities, please include an attachment listing these facilities and provide the required information for each one: I am currently the responsible charge operator who signs the monthly reports(MRO/MMR)at the following facilities: Facility Name Hours/Week'__---Permit-# Address Change: lit L Home Phone: Work Phone: ��r S��- ` 1 Operator Signature: Dater 60 lJ` (1) Indiana Department of Environmental Management :N 100 N.Senate Avenue Invoice Number: 7685063 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number: DS895912 JEFFERY L. CARPENTER Expiration Date: 06/30/2016 Grade: DSL 878 Tyne Circle Obtained By: Examination _ Danville IN 46122 Login ID: DS895912 Password: 580889 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water-Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. DS895912, Grade DSL for a class DSL Water Distribution System expires on June 30, 2016. You are required to obtain 15.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our records indicate that you currently have accumulated 32.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.) If you need to verify the number of technical course hours obtained, you may login o, online using the instructions below. 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, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1; 2017 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2017 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 Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 r , SEE FORM ON OTHER SIDE V'' VOUCHER # 165409 WARRANT # ALLOWED 146900 IN SUM OF $ IDEM 100 N. Senate Avenue Indianapolis, IN 46207-7060 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code WOLFE,W.E 01-700'61 $30.00 01. 702. 0 5 'f Voucher Total $30.00 Cost distribution ledger classification if claim paid under vehicle highway fund