HomeMy WebLinkAbout198802 06/22/2011 a CITY OF CARMEL, INDIANA VENDOR: 356491 Page 1 of 1
ONE CIVIC SQUARE TARA WASHINGTON
CHECK AMOUNT: $30.00
CARMEL INDIANA 46032
4475 SILVER SPRINGS DR
o GREENWOOD IN 46142 CHECK NUMBER: 198802
CHECK DATE: 6/22/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 052411 30.00 OTHER EXPENSES
Indiana Department of Environment -i Management IDEM
100 N. Senate Avenue
Mail Code 65-42 TARA WASHINGTON 553
Indianapolis, IN 46204 2251 4475 SILVER SPRINGS DR.
GREENWOOD, IN 46142 70- 9240/2719
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Tara M. Rubush
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WASTEWATER TREATMENT PLANT OPERATOR RENEWAL APPLICATION
License Class Wastewater Operator Class 11 May 12, 2011
Certification WWO17403
Expiration Date: 06130/2011
Renewal Fee: $30.00
Login Id: WWO17403
Password: 494936
Current Continuing Education Hours Earned: General 0.00 Technical 14.50 Total 14.50
I am currently the responsible charge operatorwho signs the monthly reports (MROIMMR) at the follo facilities:
Facility Name HourslWeek Permit#
Address Change:
ome
��A oWork O erator Si nature:'~ Date:
Current Phone �X p g
Your wastewater treatment plant operator certification expires 06130/2011. After this date, you cannot be the operator
in responsible charge of a wastewater treatrmmn`: p!ar.! until yo r cert!fi >at'snn is renewed.
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 1, 11, A, 6 I O,hours e�:rned 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 earned between 7!112009 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: /mylicense,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 any questions or concerns about the renewal process, please contact Tonja Fuller -White at (317) 233 -0479
or by e -mail at tfullerw idem.in. ov.
Check Image Page I of I
TARA WASHIN 553
4473 SILVER SPRINGS GR.
GREENWOM, IN 48142 70 92 4 0/2719
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CLOSE WINDOW PRINT CHECK
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VOUCHER 115299 WARRANT ALLOWED
T1037 IN SUM OF
-RH 34�; i- TARA
WASTEWATER PLANT
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
052411 01- 7042 -05 $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 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
T1037
RUBUSH, TARA Purchase Order No.
WASTEWATER PLANT Terms
Due Date 6/14/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/14/2011 052411 $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 icer