HomeMy WebLinkAbout198926 07/06/2011 CITY OF CARMEL, INDIANA VENDOR: 354963 Page 1 of 1
ONE CIVIC SQUARE PETER BRENNAN, JR. CHECK AMOUNT: $125.00
CARMEL, INDIANA 46032 11601 NORTH STRONG ROAD
ALBANY IN 47320 CHECK NUMBER: 198926
CHECK DATE: 7/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 062811 125.00 OTHER EXPENSES
CITY OF CARMEL Expense Report (required for all travel expenses)
�ND
10
2010 mileage reimbursement rate is 50 cents /mile
EMPLOYEE NAME: Pete Brennan DEPARTURE DATE: na TIME:
DEPARTMENT: Utilities /Sewer RETURN DATE: na TIME:
REASON FOR TRAVEL: WWTP operator training 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 I Parking I Breakfastj Lunch Dinner Snacks Per Diem
6/28/11 Activated Sludge 1 $25.00 $25.00
6/28/11 Activated Sludge II $25.00 $25.00
6/28/11 Solids Dewatering $25.00 $25.00
6/28/11 Wastewater Mathematics 1 $25.00 $25.00
6/28/11 Wastewater Mathematics II $25.00 $25.00
$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 $0.00 $0.00 $0.00 $0.001 $0.001 $125.00
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 6/29/2011 Page 1
1
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
Phone: 1- 877 241 -9858
www.approvedce.com
June 28, 2011
Receipt
Peter R Brennan Jr.
City of Carmel Utilities
11601 N Strong Rd.
Albany, fN 47320
765- 748 -7188
pbrennan@carmel.in.gov
Item Item Name Quantity Unit Price Amount
1 Online Course: 1 hours $25.00 $25.00
Activated Sludge I
TOTAL $25.00
Paid By: Visa XXXX6879 Exp. 11/12 Confirmation #062865
Thank you,
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
www.approvedce.com
I
WASTEWATER OPERATOR /APPRENTICE CONTINUING To ensure proper credit, the
wastewater approval number
EDUCATION CREDIT REPORT MUST be provided.
i' State Form 51139 (R3 4 -08) Training Course Approval Number:
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
1816
vJW Q �D �GoO
Operator ❑Apprentice Technical Contact Hours Earned:
1 HOUR
General Contact Hours Earned:
0
n,rw r .<y _z W., t:$ "M1 fii. ;E1'• 7 :7 l
INSTRUCTION
v.>:�:•.._, s•c3•±, i ;...P7.. E :'ti.z': .w"v'•
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) 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 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to 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 three (3) 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/app rentice attending the entire wastewater operator continuing ducation course.
OR/ RENTICE =;INEORIHIATION.;.
CERT,IFtED,.OPER1 T AP-.;P
1. NAME: .t` L rL:�� CAI
2. ADDRESS (number and street):
City: State: ZIP cod Telephone number: -5-6 6
Work: 31 7" �7
A Home /Cell: 65- 7 yii 7l n
Check here if this is an address change E -mail Address:
a r �a��C=,U SE:INFOR1111ATI'O
,d.,, we sv.` u,. c. -r,. H"r,a; �r,.
3. NAME OF TRAINING COURSE: A ur j J���J �A e T
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): o(r, ;g V 7. LOCATION ATTENDED:
VW WV.APPROVEDCE.COM
8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR/APPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
1 HOUR 0
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
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 misrepresentation
may result in the denial of continuing education credit for this course.
10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR:
Ann Bersbach
12. SIGNATU OF CERTI UDOPERATOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
14. CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
\kfW b )7 va,5' 06 -3L a�i0
Operator certification /apprentice number: Class: Expiration date:
Certificate of Completion Approved Environment, Inc. Page 1 of 1
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
1- 877 241 -9858
Email: SupportnW approvedee.com
Certificate of Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South
Carolina, North Carolina, Maryland, Kentucky and Ontario, Canada.
Name: Peter R Brennan Jr
Address: 11601 N Strong RD, Albany, IN 47320
Course Title: Activated Sludge I
Course Value: 1 Contact Hour
Approval Number: IN WWT11- 5907 -TO1 -GOO, OH OEPA- S296727 -OM, NC
CEO 1130402, MD 3466- 05 -06, KY
Date: 6/28/2011
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO17025
Operator Class Level: II
License Expiration Date: 06/30/2011
Operator Signature:
Training Provider Signature
Ann Bersbach, Approved Environment, Inc.
Copyright 2002, Approved Environment, Inc., Indianapolis, Indiana
https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 6/28/2011
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
Phone: 1- 877 241 -9858
www.approvedce.com
June 28, 2011
Receipt
Peter R Brennan Jr.
City of Carmel Utilities
11601 N Strong Rd.
Albany, IN 47320
765- 748 -7188
pbrennan@carmel.in.gov
Item Item Name Quantity Unit Price Amount
1 Online Course: 4 hours $25.00 $100.00
Activated Sludge I1
Solids Dewatering
Wastewater Mathematics I
Wastewater Mathematics 11
TOTAL $100.00
Paid By: Visa XXXX6879 Exp. 11/12 Confirmation #062866
Thank you,
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
www.approvedce.com
I
WASTEWATER OPERATOR/APPRENTICE CONTINUING To ensure proper credit, the
wastewater approval number
EDUCATION CREDIT REPORT MUST be provided.
tD
State Form 51139 (R3 14-08) Training Course Approval Number:
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT �t�t��
�816 Y�•YT 5 dT a1 °Goa
Operator ❑Apprentice Technical 1 HOUR ours Earned:
General Contact Hours Earned:
0
`u;' v' Vi a'
>✓0•F nf�i F.. '�.�r„�i�r w��`�
KIN" ��Fi_�';�� a:.�s:.v�e�:a��'.x"� rz�,., u::= r�i, tis�;. �a. x-, ,INSTRUC_,TIONS:N' =:rs6�.-
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) 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 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to 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 three (3) 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/app rentice attending the entire wastewater operator continuing education course.
rl s g <i-,f' .''1 i b r.,,, 3:2, a Ar
i 1;( CERTIFIEDpbPER;4TORIAPPRENTI,CE INFORIIIIATiON,
1. NAME:
2. ADDRESS (number and street):
City: State: ZI code: J� Eme/Cell: lephone numbe��
L y fed
i J v rk: 1;1 3 J 0
p7&5'7gS( 99'
Check here if this is an addr ss change) E -mail Address: t tl�iNQ tS C At' e j If4 Goj
K�.a. ,m. t�', =�i� v rr c4r -.,q ",f"� i_j'�i�.�'; i"y, T
';'�°�Y't n'�Xa,H., -,x k �r >.r;'; °�a:'Y` 3- '�'r ni::: a �,m z �^a 'S':�,. i. ra,
3. NAME OF TRAINING COURSE: n ii
HC'1" Y Q�ed �1ucl e
4. NAME OF TRAINING COURSE PROVIDER: S. NAME F ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): g 7. LOCATION ATTENDED:
VWWV.APPROVEDCE.COM
8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR/APPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
1 HOUR 0
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
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 misrepresentation
may result in the denial of continuing education credit for this course.
10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR:
Ann Bersbach
12. !=V 0 RATORIAPPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
G� r TAN (a IS
14. CONT )NUING EDUCATION CREDIT HOURS RE TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
WVV Q 17 o a 5> 61 30 1 vIt
Operator certification /apprentice number: Class: Expiration date:
Certificate of Completion Approved Environment, Inc. Page I of I
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
1- 877 241 -98.58
Email: Support(a?approvedce.com
Certificate of Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware South
Carolina, North Carolina, Maryland, Kentucky and Ontario, Canada.
Name Peter R Brennan Jr
Address: 11601 N Strong Rd, Albany, IN 47320
Course Title: Activated Sludge II
Course Value: 1 Contact Hour
Approval Number IN WWT11- 5908- TO1 -G00, OH OEPA- 5296730 -OM, NC
CEO 1130404, MD 3467- 05 -06, KY
Date: 6/28/2011
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO17025
Operator Class Level: II
License Expiration Date: 06/30/2011
Operator Signature: C2��Q
Training Provider Signature
Ann Bersbach, Approved Environment, Inc.
Copyright 2002, Approved Environment, Inc., Indianapolis, Indiana
https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 6/28/2011
I
EFT T "q. WASTEWATER OPERATOR/APPRENTICE CONTINUING To ensure proper credit, the
wastewater approval number
EDUCATION CREDIT REPORT MUST be provided.
State Form 51139 (R3 4-08) Training Course Approval Number:
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT i 5
lA16
Operator ❑Apprentice Technical Contact HOUR ours Earned:
General Contact Hours Earned:
0
•:=x �a��. =INSTRU,GTIONS.� :�;r;,.
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) 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 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to 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 three (3) 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/apprentice attendin the entire wastewater operator continuing education course.
r, "CERTIFIED; UP.ERiAT APP Nl'ICE,INFORIVIA'i'ION
1. NAME:
2. ADDRESS (number and street):
City: State: f� f` P code: T e le l ph� 3nuMber. -7j 6- SGT y
L bay 1 Home /Cell: 1 7 7
Check here if this Is an address change E -mail Address: B? r O J CLO P ev I Gov
:yzf 7..', =;.•"w M;,„„ ,:z.3" .w.'<;• w iii a,i+ ��,,,a &s
s jtl e ,w .,Y IN
COfJRSEFOt21VIATIOtJ,� M
P.:e"'`ifSx 3fP �'"Ya X ;i. tt `.6•a xWR�',•.�.,�••,:.
R ,wax:. ra,•u, a,.¢. �SZm J .i:'r,m�. t,`;.. .sN%.. .a ..J. p' ,5fi: ?A ka
3. NAME OF TRAINING COURSE:
Solids D e wcA t"j
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIXATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED:
(D L WWNV.APPROVEDCE.COM
8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATORIAPPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
1 HOUR 0
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
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 misrepresentation
may result in the denial of continuing education credit for this course.
10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR:
,r Ann Bersbach
12, SIGN OF CERTIFIED OPERATOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED 0PERATOR/AP_PRENTICE:
14. CONTINUING EDUCATION CREDIT HOURS AR TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
Operator certification /apprentice number: Class: Expiration date:
Certificate of Completion Approved Environment, Inc. Page 1 of 1
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
1- 877 -241 -9858
Email: SupportC&approvedce.com
Certificate of Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware South
Carolina, North Carolina, Maryland, Kentucky and Ontario, Canada.
Name: Peter R Brennan Jr
Address: 11601 N Strong Rd, Albany, IN 47320
Course Title: Solids Dewatering
Course Value: 1 Contact Hour
Approval Number: IN WWT11- 5910- TO1 -G00, OH OEPA- 5296751 -OM, NC
CE01140403, MD 3469- 05 -06, KY
Date: 6/28/2011
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO17025
Operator Class Level: II
License Expiration Date: 06/30/2011
Operator Signature:
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc.
Copyright 2002. Approved Environment, Inc., Indianapolis. Indiana
https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 6/28/2011
WASTEWATER OPERATOR/APPRENTICE CONTINUING To ensure proper credit, the
o`�li a wastewater approval number
EDUCATION CREDIT REPORT MUST be provided.
State Form 51139 (R3 4 -08) Training Course Approval Number:
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
�sds V4 W
Operator ❑Apprentice Technical Contact Hours Earned:
1 HOUR
General Contact Hours Earned:
0
F....
INSTRUCTIONS:``:,
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) 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 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to 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 three (3) 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/apprentice attendin the entire wastewater operator continuing education course.
CERTIFIEID'OPERATORIAPPREN.TICE 1, F- ORMATIQN;
a
1. NAME:
N I— r
2. ADDRESS (number and street):
1 16 0 1
City: i{ n State: 1 4 IP code: �y Telephone number: S
�1.� li�N F q T "b Work:
Home /Cell: Q, 7y� '?1
Check here if this is an address change," E -mail Address: P wrem N CZl
-t, Y< .;&..Pa;$d:s dr. "!,i:'LS' K a ±;P;. ir,;'xr .<p�-
r
.x
3. NAME OF TRAINING COURSE:
LA NJ 004e LkMi<_r (r1M le r A4tC�
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED:
VWVW.APPROVEDCE.COM
8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATORIAPPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
1 HOUR 0
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
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 misrepresentation
may result in the denial of continuing education credit for this course.
10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR:
Ann Bersbach
12. SIGNATU F CE T IE PE RATOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
14. CONTINUING EDUCATIO C EDIT HOURS AR 0 BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
V 06 3 0 :2011
Operator certification /apprentice number: Class: Expiration date:
Certificate of Completion Approved Environment, Inc. Page 1 of 1
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
1- 877 241 -9858
Email: Support(a�approvedce.com
Certificate of Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South
Carolina, North Carolina, Maryland, Kentucky and Ontario, Canada.
Name Peter R Brennan Jr
Address: 11601 N Strong Rd, Albany, IN 47320
Course Title: Understanding Wastewater Mathematics
Course Value: 1 Contact Hour
Approval Number IN WWTI 1- 5927- TO1 -G00, OR OEPA- S396252 -OM, NC
CE01030504, MD 3486- 05 -06, KY
Date: 6/28/2011
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO17025
Operator Class Level: I1
License Expiration Date: 06/30/2011
Operator Signature:
Training Provider Signature: r 4..
Ann Bersbach, Approved Environment, Inc.
Copyright 2002, Approved Environment, Inc., Indianapolis, Indiana
https:// www. approvedee. com/ onlineCEUs /ceuCertificateOfCompletion.asp 6/28/2011
To ensure proper credit, the
WASTEWATER OPERATOR /APPRENTICE CONTINUING
wastewater approval number
EDUCATION CREDIT REPORT MUST be provided.
State Form 51139 (R3 4 -08) Training Course Approval Number:
�`•r` INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
,gs W W'T ll -3u g 7 G 0 0
Operator ❑Apprentice Technical 1 HOUR ours Earned:
General Contact Hours Earned:
0
,.tNSTRUGTiONS.,,,��.,
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) 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 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to 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 three (3) 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/apprentice attendin the entire wastewater operator continuing education course.
El Ei'ti4° E �ICE.INFO TI`ON::``: >z'�
1. NAME:
L40r
2. ADDRESS (number and street):
I I (ate► t
City: State: 711 code: Telephone number:
IVN /1 0 i 117`3 l) Work: 3�
Vl 1 `7 V Home /Cell: `5 '7j S1
Check here if this is an address change E -mail Address: N Im
•.CO RSE "•INf`ORMAT'ION. =r�:
3. NAME OF TRAINING COURSE:
Wa s4a w e-v MAeM i cs P�°c c�,ce �ro'tA<_mS
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): 0(0 A vZQ 11 7. LOCATION ATTENDED: VW W APPROVEDCE.COM
8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR/APPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
1 HOUR 0
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
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 misrepresentation
may result in the denial of continuing education credit for this course.
10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR:
Ann Bersbach
12. SIGN E OF CERTI=ERATO PR ENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
14. CONTINUING EDUCATION CREDIT HOURS AR TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
0 17 0 0co- 30 D
Operator certification /apprentice number: Class: Expiration date:
Certificate of Completion Approved Environment, Inc. Page I of I
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
1- 877 -241 -98.58
Email: Support(c�,approvedce.com
Certificate of Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South
Carolina. North Carolina, Maryland, Kentucky and Ontario, Canada.
Name Peter R Brennan Jr
Address: 11601 N Strong Rd, Albany, IN 47320
Course Title: Wastewater Mathematics Practice Problems
Course Value: 1 Contact Hour
Approval Number: IN WWT11- 5928- TO1 -G00, OH OEPA- 5396255 -OM, NC
MD 3487- 05 -06, KY
Date: 6/28/2011
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO17025
Operator Class Level: Il
License Expiration Date: 06/30/2011
Operator Signature:
Training Provider Signature: '4e!�y -'e
Ann Bersbach, Approved Environment, Inc.
Copyright 2002. Approved Environment, Inc., Indianapolis, l.ndiana
it https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 6/28/2011
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
T1042
BRENNAN, PETER Purchase Order No.
WASTEWATER PLANT Terms
Due Date 6/30/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/30/2011 062811 $125.00
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 jjw 111"W
Date �dii Xr�/
VOUCHER 115401 WARRANT ALLOWED
T1042 IN SUM OF
BRENNAN,PETER
WASTEWATER PLANT
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
062811 01- 7042 -06 $125.00
Voucher Total $125.00
Cost distribution ledger classification if
claim paid under vehicle highway fund