HomeMy WebLinkAbout188041 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 00353077 Page 1 of 1
ONE CIVIC SQUARE DENNIS RUSS
i CHECK AMOUNT: $30.00
CARMEL, INDIANA 46032 CIO CARMEL WASTEWATER
CARMEL IN 46032 CHECK NUMBER: 188041
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 060310 30.00 OTHER EXPENSES
CITY OF CARMEL Expense Report (required for all travel expenses)
NDIAwp�
2008 mileage reimbursement rate is 58.5 cents /mile
EMPLOYEE NAME: Dennis Russ DEPARTURE DATE. TIME: NA
DEPARTMENT: Utilities /Sewer RETURN DATE: NA TIME: NA
REASON FOR TRAVEL: NA DESTINATION CITY: NA
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X_ TRAVEL PER DIEM
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
6/3/10 WW 0 erator cert. renewal $30.00 $30.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0.00
Total 1 $0.001 $0.001 $0.001 $0.001 $0.001 $0.001 $0.00 $0.00 $0.00 $0.001 $30.00
DIRECTOR'S STATEMENT: I hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date:
City of Carmel Form ER06 Revision Date 7/8/2010 Page 1
Indiana Department of Environmental Management
100 N. Senate Avenue
Mail Code 65-42
Indianapolis, IN 46204 -2251
EST_
1986
Dennis M. Russ
18021 Sanibel Cir_
Noblesville IN 46062
WASTEWATER TREATMENT PLANT OPERATOR RENEWAL APPLICATION
License Class Wastewater Operator Class I May 3, 2010
Certification WW017670
Expiration Date: 06130/2010
Renewal Fee: $30.00
Login Id:
Current Continuing Education Hours Earned: General 3.00 Technical 14.50 Total 17.50
I am currently the responsible charge operator who signs the monthly reports (MROIMMR) at the following facilities:
Facility Name Hours[Week Permit# cit
Address Change:
,pa'Home
Current Phone Work Operator Signature: Date: f�
Your wastewater treatment plant operator certification expires 0613012010. After this date, you cannot be the operator
in responsible charge of a wastewater treatment plant until your certification is renewed.
You must meet the continuing education requirement as shown below:
Classes I -SP, A -SO— 5 hours earned between 7/1/2008 6130/2010 from IDEM approved course with at least 3.5 of
those hours from courses designated as "technical."
Classes I, II, A, B 10 hours earned between 7!1/2008 6/30/2010 from I DEM approved course with at least 7 of
those hours from courses designated as "technical."
Classes III, IV, C, D 20 hours earned between 7/1/2008 6/30/2010 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, 2010 and July 1, 2010 at
httpsa /myticense.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. Login ID and Password are above.
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:. Cashier —Mail Code 50-10C, Indiana Dept. of Environmental Management, 100 N. Senate Avenue,
Indianapolis, IN 46204 -2251. Make checks payable to IDEM.
Should you have any questions or concerns about the renewal process, please contact Tonja Fuller -White at (317) 233 -0479
or by e-mail at tfullerwp_idem.in.00v
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VOUCHER,# 105818 WARRANT ALLOWED
T9967 IN SUM OF
RUSS, DENNIS
CARMEL WASTEWATER
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
060310 01- 7042 -06 $30.00
Voucher Total $30.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995),
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or hill 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
T9967
RUSS, DENNIS Purchase Order No.
CARMEL WASTEWATER Terms
Due Date 7/12/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/12/2010 060310 $30.00
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