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CITY OF CARMEL, INDIANA VENDOR: 00351805
ONE CIVIC SQUARE IN DEPT OF ENVIRONMENTAL MGMT CHECK AMOUNT: S.......*30.00*
: 4 CARMEL, INDIANA 46032 100 N SENATE AVENUE CHECK NUMBER: 314338
- iroM. MAIL CODE 66-34 CHECK DATE: 07/31/17
INDIANAPOLIS IN 46204-2251
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 WT007785 30.00 OTHER EXPENSES
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°g Indiana Department ofFnvlronmental Management
s. 100 N.Senate Avenne Invoice Number: 1
Mail Code 66-34 Renewal Fee: 30.00
Indianapolis,IN 46204-2251
Monoy Receipt#
(Office Only)
i
May 18,2017 Certificate Number: WT007785
Daniel R.Jenkins Expiration Date: 06/30/2017 t
12672 Stravvtown Ave. Gradc: WT3
Noblesville IN 46060 Obtained By: Examination
Login ID: WT007785
Password: 578507
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INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGICMENT
Water Works Operator CeiV lcallon Renewal Tee Statement
!
Our records indicate your Water Works Certificate No, WT007785, Grade WT3 for a class WT3 Water
Treatment Plant expires on June 30,2017. You aro 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 40.00 contact hours towards renewal. (This may not reflect hours for courses recently
attended.)If you treed 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 `
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hours,you need to attend Purses prior to June 30,2017. After this date you Etre on expired status and are
not a valid certified operat6r. You do have until June 30,2018 to get your continuing education hours and
renew your certification. Failure to renew by June 30,2018 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 tittps://inylicense.ill.eov,
1'he 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.
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Mail Renewal—To renew through the snail,please till 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 sigh 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.
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If you have other drinking water certifications due renewal,you can combine them in one mailing with a
fee payment that covers all of thein. 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 6634
100 N. Senate Avenue
Indianapolis,IN 46204-2251
SEE FORM ON OTHER SIDE
Cancel Certificatloax—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&RE'l'URN ENTIRE LETTER.WHEN RENE BY MAIL OR CANCELLING
If this certification was obtained by Examination and(lie facility you are employed at has changed,please
add your new employer in the space provided. NOTE--If this certification is Gi-andfathered or Site
Specific,it is valid only for the location below.
Operator Number: WT007785 Invoice Number:
PWS Name PWS ID _
Carmel Water Department 5229004
Address Change:
Home phone Number: r - 41 f_�- 3`70
Work Phone Number: `j 7 /LI`
Operator Signature: Date: 7
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