160331 06/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00351421 Page 1 of 1
ONE CIVIC SQUARE DAVID DYE
CARMEL, INDIANA 46032 CIO WASTEWATER TREATMENT PLANT CHECK AMOUNT: $136.14
•c; a CIO WASTEWATER TREAT CHECK NUMBER: 160331
CHECK DATE: 611012008
DEPARTMENT ACCOU PO NUMBER INVOICE NUMBE AMOUNT DE
651 5023990 052208 136.14 OTHER EXPENSES
haac lbsd DF 9twa Board of Accamu.
:»Data] Form No. 101 UOU
MILEAGE CLAIM
CGS rvve-,
(GOVERNMENTAL UNIT) DR.
ON ACCOUNT OF APPROPRIATION NO. FO
(OF BOAR DEP RTMENT OR INSTITUTION)
DATE FROM TO SPEEDOMETER AUTO �MI).EPa.GE
READING+ MILES
NATURE OF BUSINESS TRAVELED PER MILE
POINT POINT START FINISH
S antC .xrw.zA rt 6 QozraI, a/- 3 y•
I
I
AUTO LICENSE NO. TOTALS ao �3
+SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. s�/Dufr� �e
Pursuant to the provisions and penalties of Chapter 155. Acts 1953. I hereby certify that the foregoing account is just and correct. that the amount claimed is legally due, after allo s credit
and that no part of the same has been paid. nn
Date S� 3 mop X
WASTEWATER OPERATOR CONTINUING EDUCATION To ensure proper credit, the wastewater approval
CREDIT REPORT number MUST be provided.
5
Training Course Approval Number:
State Form 51139 (R2 8 -07) 9
4\ r� INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT �Otv 1 r t a, _r) z —c loo
die Technical Contact Hours Earned:
General Contact Hours Earned:
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In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within thirty (30) days of the conclusion of
the wastewater treatment continuing education course. Mail the completed form to:
Wastewater Continuing Education Coordinator
Indiana Dept. of Environmental Management
100 N. Senate Ave Mail Code 65-42
Indianapolis, IN 462042251
'Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall nohbergiverrto instructors, speakers, or students participating in less than a complete
wastewater treatment continuing education course.
The training provider must retain a copy of this form for their records for a five (5) year period following the
presentation of each wastewater treatment continuing education course.
Training providers are encouraged to provide a copy of the completed and signed credit reporting form to the
certified operator attending the entire wastewater o erator continuing education course
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1. NAME:
2. ADDR_ ESS (number and street):
City: State: ZIP code: Telephone number.
t fG. -k Y ✓b t Home/Cell:
E-mail Address
Check here if this is an address change t� C C+ f t! jV1 C
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3. NAME OF TRAINING COURSE:
AM General Wastewater Trestment Plant Tour and Seminar
4. NAME OF ORGANIZATION SPONSORING COURSE:
Industrial Wastewater Operators Association (IWOA)
5. DATE(S) ATTENDED (month, day, year): 6. LOCATION ATTENDED: 13200 MCKin ley HWY
05/22/2008 A M General H1 plant Mishawaka IN 46545
7. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR AND VERIFIED BY INSTRUCTOR AND TRAINING COURSE
PROVIDER: 7
Technical Contact Hours: General Contact Hours:
I, the undersigned, certify under penalty of law that this document (and any attachments) were prepared under my direction or supervision and that the
information submitted is, to the best of my knowledge and belief, true, accurate, and correct. I also understand that any omissions or misrepresentations may
result in the denial of continuing education credit for this course.
8. SIGNATURE OF INSTRUCTOR.- 9. PRINTED NAME OF INSTRUCTOR:
ZWOA Board Member
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10. SIGNATURE OF ERTIFIED`OPiJR_ATOR: 11. PRINTED NAME OF CERTIFIED OPERATOR:
w7
12. CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO:
Operator certification number. j Class: Expiration date (month, day, year):
q
Operator Certification number: Class: Expiration date (month, day, year):
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A: 960 Haz Dell Pkwy, Indianapolis, IN 46280 -2935
1: Start out going SOUTH on HAZEL DELL PKWY toward E 96TH ST. 0.0 mi
O 2: Turn RIGHT onto E 96TH ST. 1.7 mi
PNTH 3: Turn RIGHT onto N KEYSTONE AVE /IN -431 N. Continue to follow IN-431 N. 5.4 mi
431
ftrk 4: Turn SLIGHT RIGHT onto US -31 N. 116.7
31 mi
R.,.P 5: Take the US- 20 -BYP E ramp toward MISHAWAKA/ELKHART. 0.4 mi
CAS 6: Merge onto US -20 E /ST JOSEPH VALLEY PKWY. 5.6 mi
io
QwTH 7: Merge onto IN -331 N toward MISHAWAKA. 4.3 mi
331
O 8: Turn RIGHT onto MCKINLEY HWY /OLD US -20. 0.8 mi
9: End at 13200 Mckinley Hwy Mishawaka, IN 46545
Estimated Time: 2.0 hours 34 minutes Estimated Distance: 134.83 miles
B: AM Ge n e ral Corp: 13200 Mckinley Hwy, Mishawaka, IN 46545, (574)256 -1581
Total Time: 2.0 hours 34 minutes Total Distance: 134.83 miles
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
351421
DYE, DAVID Purchase Order No.
6170 Buckskin Ct. Terms
Indianapolis, IN 46250 Due Date 5/30/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/30/2008 052208 $136.14
hereby certify that the attached invoice(s), or bill(s) is (are) true and
:orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
&1� u
Date Officer
VOUCHER 085573 WARRANT ALLOWED
351421 IN SUM OF
DYE, DAVID
6`I70 Buckskin Ct.
,Indianapolis, IN 46250
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
052208 01- 7042 -05 $136.14
Voucher Total $136.14
Cost distribution ledger classification if
claim paid under vehicle highway fund