312027 6/5/2017 (9,
CITY OF CARMEL, INDIANA VENDOR: 356491
ONE CIVIC SQUARE TARA WASHINGTON CHECK AMOUNT: S"'****'34.17'
CARMEL, INDIANA 46032 5253 COMANCHE TRAIL CHECK NUMBER: 312027
CARMEL IN 46033 CHECK DATE: 05/31/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 REIMB 34.17 OTHER EXPENSES
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Welcome to Indiana Licensing Page 1 of 1
Maim
Indiana
Online Llcensing
Payment Receipt
This page serves as your receipt for this transaction. Your payment will appear on your credit
card statement as "State of Indiana License Fee" or something similar. To maintain this page
for your records, you may print this page by clicking the "Print Receipt" button below.
What to do next?
Renewal
• Check back on the MyLicense site in 24 - 48 hours to see if your expiration date was
extended.
• If so, you will receive your updated wallet card shortly.
• If not, this may mean that there is a problem with your certification renewal. You may
contact program staff at tfullerw@idem.in.gov
Payment received - thank you.
Licensee: Tara M. Washington
License Number: WW020533
Authorization Code: 084138
Received Date: 5/24/2017 9:42:44 AM
Transaction ID: 74866862
Credit Card Number: XXXX XXXX
XXXX 2210
Fee Amount: $30.00
Enhanced Fee: $2.50
Instant Fee: $1.67
Total Payment: $34.17
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https://mylicense.in.gov/eGov/PaymentResult.aspx?answer=processed&credit card numb... 5/24/2017
Indiana Department of Environmental Management
100 N. Senate Avenue
IGCN Room 1255
Indianapolis, IN 46204-2251
001412
Tara M. Washington
4475 Silver Springs Dr
Greenwood IN 46142
Indiana Department of Environmental Management
WASTEWATER TREATMENT PLANT OPERATOR RENEWAL APPLICATION
Our records indicate your wastewater treatment plant operator certification expires on 06/30/2017. 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 contact hours being received,but your license will not
be reissued until we receive documentation that all required contact hours 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 28, 2017
Certification#: WW020533
Expiration Date: 06/30/2017
Renewal Fee: 30.00
Login Id: WW020533
Password: 494936
Current Contact Hours Earned: General - 1.50 Technical -8.50 Total - 10.00. This may not reflect hours for courses
recently attended.
You must meet the continuing education requirement as shown below:
• Classes I-SP, A-SO—5 contact hours earned between 7/1/2015—6/30/2017 from IDEM approved course with at
least 3.5 of those hours from courses designated as"technical."
• Classes I, II,A, B—10 contact hours earned between 7/1/2015—6/30/2017 from IDEM approved course with at least
7 of those hours from courses designated as"technical."
• Classes III, IV,C, D—20 contact hours earned between 7/1/2015—6/30/2017 from IDEM approved course with at
least 14 of those hours from courses designated as"technical."
Online Renewal:Online renewal is available 24 hours a day,7 days a week between May 1,2017 and July 1, 2017 at
hitt s:;'rn0cense.in aov. The cost for the online renewal is$30.00 plus an additional$4.17 in processing fees. The forms of
payment accepted online are Visa, MasterCard, & Discover credit and debit cards. Your login ID and Password to this site
are provided above. Online renewal is recommended to expedite your renewal process; licenses are generated at the time
of payment if contact hours are already completed and on record.
Mail Renewal: If you wish to renew by mail,fill out the responsible charge information,and send this form with your$30
renewal fee to: Indiana Department of Environmental Management,Wastewater Continuing Education Director,100 N.
Senate Avenue, Room 1255,Indianapolis, IN 46204-2251. Make checks or money orders payable to IDEM. Please
allow 4-6 weeks for processing of your renewal.
If you have two wastewater certifications due for renewal at this time, you can combine applications into one mailing and
include a fee payment of$60 that covers both.
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