HomeMy WebLinkAbout198187 06/06/2011 CITY OF CARMEL, INDIANA VENDOR: 184595 Page 1 of 1
ONE CIVIC SQUARE TERESA LEWIS CHECK AMOUNT: $30.00
CARMEL, INDIANA 46032 338 ORLAND OVERLOOK
WESTFIELD IN 46074 CHECK NUMBER: 198187
CHECK DATE: 6/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 052711 30.00 OTHER EXPENSES
OF
if
CITY OF CARMEL Expense Report (required for all travel expenses)
/NDIAMp
2010 mileage reimbursement rate is 50 cents /mile
EMPLOYEE NAME: Teresa Lewis DEPARTURE DATE: na TIME:
DEPARTMENT: Utilities /Sewer RETURN DATE: na TIME:
REASON FOR TRAVEL: certification renewal fee DESTINATION CITY:
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 ICarRentall Other Parking I Breakfast I Lunch Dinner Snacks Per Diem
5/27/11 Wastewater O erator certification renewal fee $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 $0.00 $0.00 $0.00 $0.00 $0.00 $0.001 $0.00 $0.001 $0.001 $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 5/25/2011 Page 1
Indiana Department of Environmental Management IDEM
100 N. Senate Avenue
Mail Code 65 -42
Indianapolis, IN 46204 -2251
EST.
t986
l
Teresa L. Lewis
9609 Hazel Dell Parkway
Indianapolis IN 46280
WASTEWATER TREATMENT PLANT OPERATOR RENEWAL APPLICATION
License Class Wastewater Operator Class IV May 12, 2011
Certification WW013898
Expiration Date: 06/30/2011
Renewal Fee:
Login Id: WWO1
WW013898
Password: 492936
Current Continuing Education Hours Earned: General 1.00 Technical 16.50 Total 17.50
I am currently the responsible charge operator who signs the monthly reports (MRO /MMR) at the following facilities:
Facility Name Hours/Week Permit Cit
Address Change:
o Home
Current Phone Work Operator Signature: Date:
Your wastewater treatment plant operator certification expires 06/30/2011. After this date, you cannot be the operator
in responsible charge of a wastewater treatment plant until your certification is- ranewed You must meet the continuing education requirement as shown below:
Classes I -SP, A -SO 5 hours earned between 7/1/2009 6/30/2011 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 7/1/2009 6/30/2011 from IDEM approved course with at least 7 of
those hours from courses designated as "technical."
Classes III, IV, C, D 20 hours earned between 7/1/2009 6/30/2011 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, 2011 and July 1, 2011 at
https: /mVlicense.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. 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 tfullerw(aDidem.in.gov
Page 1 of 1
Biller Name Account Amount Pay Date Confirmation Status
IDEM CLASSIC CHECKING •31016 $30.00 05/27/2011 CF32L -NB3QS Processing
IDEM
'13898
Memo: WW cent. renewal WWO13898
This bill payment is processing and can no longer be changed or canceled. Please check back after the pay date for more details.
5/25/2011
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
184595
TERESA LEWIS Purchase Order No.
2985 S HONEY CREEK ROAD Terms
GREENWOOD, IN 46143 Due Date 5/31/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/31/2011 052711 $30.00
I 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 cer
VOUCHER 115169 WARRANT ALLOWED
184595 IN SUM OF
TERESA LEWIS �r 0✓
2986-S-H OXEX- EF �E-E+(-R'OA
C�REE�IV1fO.O.D�I.� -46�.
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
70Y2.a5
052711 01- 0-42 $30.00
Voucher Total $30.00
Cost distribution ledger classification if
claim paid under vehicle highway fund