325644 05/23/18 CITY OF CARMEL, INDIANA VENDOR: 00351805
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I; ® ONE CIVIC SQUARE INDIANA DEPT OF ENVIR MGT CHECK AMOUNT: $********30.00*
CARMEL, INDIANA 46032 100 N SENATE AVE,PO BOX 6015 CHECK NUMBER: 325644
M,Iro- PO BOX 6015 CHECK DATE: 05/23/18
INDIANAPOLIS IN 46206-6015
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 BASSETT 30.00 OTHER EXPENSES
VOUCHER NO. 181498 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995)
ALLOWED 20
Vendor# 00351805 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER
IN DEPT ENVIRONMENTAL MGMT CITY OF CARMEL
Im V An invoice or bill to be properly itemized must show: kind of service,where performed,
JCC*) 1ktcr'-%'
INDIANAPOLIS, IN 46204-2251 dates service rendered, by whom, rates per day, number of hours,rate per hour,
numbers of units, price per unit, etc.
Payee
30.00 00351805 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR IN DEPT ENVIRONMENTAL MGMT Terms
Carmel Water Utility MAIL CODE 66-34 Due Date
BOARD MEMBERS
I hereby certify that that attached invoice(s), INDIANAPOLIS, IN 46204-2251
PO# ACCT# or bill(s)is(are)true and correct and that
the materials or services itemized thereon for DATE INVOICE# Description
DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
BASSETT 01-6040-03 $30.00 and received except 5/8/2018 BASSETT $30.00
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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
Cost distribution ledger classification if claim paid motor vehicle highway fund. 20—
Clerk-Treasurer
Indiana Department of Environmental Management
100 N.Senate Avenue
IGCN Room 1255
Indianapolis, IN 46204-2251
001373
Kole D. Bassett
13033 Augustus Cir Apt 303
Fishers IN 46037
Indiana Department of Environmental Management
z WASTEWATER TREATMENT PLANT OPERATOR RENEWAL APPLICATION
Our records indicate your wastewater treatment plant operator certification expires on 06/30/2018. 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 I April:27, 2018
Certification#: WW020374
Expiration Date: 06/30/2018
Renewal Fee: 30.00
Registration Code:237220
Online Login: Use the Register a Person option and enter your license(certification)number and registration code
to create your login credentials.
Current Contact Hours Earned: General-3.00 Technical-7.50 Total-10.50. This may not reflect hours for courses
recently attended.
Online Renewal:Online renewal is available 24 hours a day,7 days a week between May 1,2018 and July 1,2018 at
https:Hmvlicense.in.gov. 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. Use the Register a Person option and
enter your certification number and registration code to create your login credentials.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 if applicable,on the back of this form.
Sign and date in spaces provided 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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