159924 05/28/2008 CITYf0F CARMEL, INDIANA VENDOR: 146900 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M &ECK AMOUNT: $570.00
CARMEL, INDIANA 46032 CASHIER'S OFFICE -MAIL CODE 50 -10C H
100 N SENATE AVE CHECK NUMBER: 159924
INDIANAPOLIS IN 46207 -7060
CHECK DATE: 5128!2008
DEPARTMENT ACCOUNT P O NUMBER INV NUMBER AMOUNT DESCRIPTION
601 5023990 300.00 PERMITS
651 5023990 270.00 PERMITS
fi
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
BRETT R. RANSFORD
Certification Number Class Invoice Number
DS008461 DSL 2091879
g 3450 W. 131st St.
Westfield IN 46074 Obtained By Dale Expires Renewal Fee
Examination 06/30/2008 $30.00
a Address Changes:
Q
PWS Name: Carmel Water Department
3
c
a 5229004
c PWS ID:
Remit Payment to:
If this certification was obtained by Examination and the facility you are employed at has changed,
u please add your new employer in the space provided. NOTE If this certification is
u IDEM Grandfathered or Site Specific, it is valid only for the above location.
Cashier's Office Mail Code 50 -IOC
100 N. Senate Avenue --FOR OFFICE USE ONLY
Indianapolis, IN 46204 -2251 MONEY RECEIPT
Make Check Payable To Operal nature Date Signed
Indiana Department of Environmental Management
Nrax Uo No: Fn pp a;iion
I REMO`/E AT RFRFORATI
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
Certification Number Class Invoice Number
GREG H. HOLLANDER DS987929 DSL 2092268
3450 WEST 131 ST ST.
Westfield IN 46074 Obtained By Date Expires Renewal Fee
Examination 06/30/2008 $30.00
Q Address Changes:
CARMEL WATER DEPT
3 PWS Name:
a 5229004
o PWS ID:
Remit Payment to:
If this certification was obtained by Examination and the facility you are employed at has changed,
please add your new employer in the space provided. NOTE If this certification is
IDEM Grandfathered or Site Specific, it is valid only for the above location.
Cashier's Office Mail Code 50 -IOC
100 N. Senate Avenue -FOR OFFICE USE ONLY
Indianapolis, IN 46204 -2251 MONEY RECEIPT
Make Check Payable To Operator Sig atu a Date Signed
Indiana Department of Environmental Management 5 1 S O
Me— uo Noi Fad A,pl— on
1 REMOVE AT PERFORATION I
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
Certification Number Class Invoice Number
3450 W. 131 s st t S St.
DANIEL R. S DS007817 DSL 2091858
St.
Westfield IN 46074 Obtained By Date Expires Renewal Fee
s'^ o Examination 06/30/2008 $30.00
Q Address Chanties:
3 PWS Name: Carmel Water Department
5 F
5229004
o PWS ID:
Nj Remit Payment to:
If this certification was obtained by Examination and the facility you are employed at has changed,
please add your new employer in the space provided. NOTE If this certification is
U IDEM Grandfathered or Site Specific, it is valid only for the above location.
e Cashier's Office Mail Code 50 10C
e 100 N. Senate Avenue -FOR OFFICE USE ONLY
Indianapolis, IN 46204 -2251 MONEY RECEIPT
Make Check Pay hie To FREMOv 4 ZZ� ale Signed
D
Indiana Department of Environmental Management
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
DANIEL R. IENKINS Certification Number Class Invoice Number
3450 W. 131st St. WT007785 WT3 2094139
Westfield IN 46074 Obtained By Date Expires Renewal Fee
Examination 06/30/2008 $30.00
M Address Changes:
Q Carmel Water Department
3 PWS Name:
a 5229004
c PWS ID:
Remit Payment to: If this certification was obtained by Examination and the facility you are employed at has changed,
f.
please add your new employer in the space provided. NOTE If this certification is
U IDEM Grandfathered or Site Specific, it is valid only for the above location.
2 Cashier's Office Mail Code 50 -10C
-FOR OFFICE USE ONLY
100 N. Senate Avenue
Indianapolis, IN 46204 -2251 MONEY RECEIPT
Make Check Payable To O Signature Date Signed
Indiana Department of Environmental Management
Nr Do NoI FWC Apdiniion
I REMOVE AT K.FORA O
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
Certification Number Class Invoice Number
ROBERT O. LOVELL WT885579 WT3 2094609..
g 19156 ALLISONVILLE RD
Noblesville IN 46060 Obtained By Date Expires Renewal Fee
Examination 06/30/2008 $30.00
m Address Changes:
a CARMEL WATER DEPT
3 PWS Name:
e
a 5229004
c PWS ID:
Remit Payment to: If this certification was obtained by Examination and the facility you are employed at has changed,
please add your new employer in the space provided. NOTE tf this certification is
�d IDEM Grandfathered or Site Specific, it is valid only for the above location.
e Cashier's Office Mail Code 50 -10C
cc -FOR OFFICE USE ONLY
100 N. Senate Avenue
Indianapolis, IN 46204 -2251 MONEY RECEIPT
Make Check Payable To Operatqq ig nature A Date Signed
Indiana Department of Environmental Management JS
l
Me,, Ou N,, Fdd Appl,mi,n \J
I REMOVE AT PERFORATION 1
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
Certification Number Class Invoice Number
ROBERT O. LOVELL
}r DS885578 DSL 2092096
g 19156 ALLISONVILLE RD
Noblesville IN 46060 Obtained By Date Expires Renewal Fee
Examination 06/30/2008 $30.00
Address Changes: CARMEL WATER DEPT
cc PWS Name:
H a a
d
of 5229004
C o PWS ID:
Remit Payment to:
ec If this certification was obtained by Examination and the facility you are employed at has changed,
r please add your new employer in the space provided. NOTE If this certification is
U IDEM Grandfathered or Site Specific, it is valid only for the above location.
Cashier's Office Mail Code 50 -IOC
L0 -FOR OFFICE USE ONLY
100 N. Senate Avenue
Indianapolis, IN 46204 -2251 MONEY RECEIPT
Make Check Payable To Operator S' nature Date Signed 4
Indiana Department of Environmental Management
N=1 Do Na FW App—i.
k," I REMOVE AT PERFORATIONI
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
Certification Number Class Invoice Number
JERRY A. CLOUD WT947019 WT3 2094675
3450 W. 131 st St. Obtained By Date Expires Renewal Fee
Westfield IN 46074
Examination 06/30/2008 $30.00
d Address Chances:
Carmel Water Department
3 PWS Name:
c
a 5229004
o° PWS ID:
Remit Payment to If this certification was obtained by Examination and the facility you are employed at has changed,
please add your new employer in the space provided. NOTE If this certification is
u IDEM Grandfathered or Site Specific, it is valid only for the above location.
e Cashier's Office Mail Code 50 -IOC
-FOR OFFICE USE ONLY
100 N. Senate Avenue
Indianapolis, IN 46204 -2251 MONEY RECEIPT
Make Check Pawblc To Operas Signature Date Signed
Indiana Department of Environmental Management 47— d�)
n Na Foia ARpano
I REMOVE AT PERFORATION i
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
Certification Number Class Invoice Number
JERRY A. CLOUD
3450 W. 131st St. DS007769 DSL 2091849
g
Westfield IN 46074 Obtained By Date Expires Renewal Fee
Examination 06/30/2008 $30:00
a Address Changes:
Q Carmel Water Department
3 PWS Name:
c
a 5229004
c PWS ID:
Remit Payment to: If this certification was obtained by Examination and the facility you are employed at has changed,
please add your new employer in the space provided. NOTE If this certification is
U IDEM Grandfathered or Site Specific, it is valid only for the above location.
e Cashier's Office Mail Code 50 -IOC
04 FOR OFFICE USE ONLY
100 N. Senate Avenue
Indianapolis, IN 46204 -2251 MONEY RECEIPT
Make Check Payable To Operator Signature Date Signed
Indiana Department of Environmental Management
Ru�e Do N a Avpcao�
I RF.MO`/E AT PERFORATION
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
Certification Number Class Invoice Number
JAIMfE L. FOREMAN WT057974 WT3 2094762
g 3450 West 131st St.
Westfield IN 46074
Obtained By Date Expires Renewal Fee
Examination 06/30/2008 $30.00
a Address Changes:
a Carmel Water Department
3 PWS Name.
a 5229004
°o PWS ID:
Remit Payment to:
y- If this certification was obtained by Examination and the facility you are employed at has changed,
please add your new employer in the space provided. NOTE If this certification is
U IDEM Grandfathered or Site Specific, it is valid only for the above location.
e Cashier's Office —Mail Code 50-IOC
100 N. Senate Avenue -FOR OFFICE USE ONLY
Indianapolis, IN 46204 -2251 MONEY RECEIPT
Mnkc Check Payable To Opera( Si nature i Date Signed
Indiana Department of Environmental Management
R .a Faa APwrnaa
1 REMOVE AT PERFORATION I
a
fix
x.
RETURN TOP PORTION OF THIS STATEMENT WHEN RENEWING BY MAIL, OR CANCELLING
Certification Number Class Invoice Number
STEVE L. COOK DS987856 DSL 2092258
3450 WEST 131ST STREET
Westfield IN 46074 Obtained By Date Expires Renewal Fee
Examination 06/30/2008 $30.00
i Address Chanties:
CARMEL WATER DEPT
o PWS Name:
5229004
PWS ID:
3 Remit Payment to:
If this certification was obtained by Examination and the facility you are employed at has changed,
please add your new employer in the space provided. NOTE If this certification is
IDEM Grandfathered or Site Specific, it is valid only for the above location.
Cashier's Office Mail Code 50 -IOC
-FOR OFFICE USE ONLY
5 100 N. Senate Avenue
Indianapolis, IN 46204 -2251 MONE RECEIPT
eke Check Payablc To Operator Signature Date Signed
tdiana Department of Environmental Management
Rn� oo� Pad A
I REMOVE AT PERFORATION t
VOUCHER 081852 WARRANT ALLOWED
,TIDEM �Z IN SUM OF
I D E M �C�L(��
100 N SENATE AVENUE
INDIANAPOLIS, IN 46204 -2251
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
ac9g `r t OLJPCLID. 03 30. M
2094762 01- 6040 -03 $30.00
�f�lyle�l5 OI I�CUb b 3 SD-DO
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aa�i �l l�C� ot.1�0�tD 03 30 (7�
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Voucher Total
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.
AEI
Payee
TIDEM
IDEM Purchase Order No.
100 N SENATE AVENUE Terms
INDIANAPOLIS, IN 46204 -2251 Due Date 5/19/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/19/2008 2094762 $30.00
.9
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
S Z��/ YI-L
Date Officer
WASTEWATER OPERATOR CLASS III
Certification Number Date Expires Renewal Fee
o 'Norman D. Riley W W018111 06/30/200 8
6775 East 241st Street $30.00
Cicero IN 46034 I am the responsible charge operator of: Hours Permit At City
.ci Address Changes_
a 1.
2.
Mail To: Cashier Mail Code 50 -IOC
Indiana Department of Environmental Management 3
100 N. Senate Avenue
v
Ipdianapolis,IN 46204 -2251
L.
If you are the operator in responsible charge of a
w wastewater treatment facility, please list each 4.
facility at the right, indicate the avg, hours you
c°
spend at each per week. Include any additional facilities on another sheet of paper and include with your renewal.
c
Operator Signature Date Signed
t
flake Chcck Payable To Phone#
ndiana Department of Environmental Management
Pl— Oa Noy Fold Applic
1 REMOVE AT PERFORATION t
WASTEWATER OPERATOR CLASS I
Certification Number Date Expires Renewal Fee
c Jason J Stewart WW017828 06/30/2008 $30.00
18 Lakeshore Ct.
Carmel IN 46033 I am the responsible charge operator of: Hours Permit City
e Address Changes:
Q 1.
3
d
2.
a Mail To: Cashier– Mail Code 50 -IOC
Indiana Department of Environmental Management 3
100 N. Senate Avenue
Indianapolis, IN 46204.2251
L If you are the operator in responsible charge of a
U wastewater treatment facility, please list each 4.
facility at the right, indicate the avg. hours you
s end at each per week. Include any additional facilities on another sheet of paper and include with your renewal.
Op erator Signature Pe g Date Signed
fake Check Payable To Phone#
ndiana Department of Environmental Management
M-1 Do Nd Fold Appli-i-
t REMOVE AT PERFORATION l
WASTEWATER OPERATOR CLASS I
Certification Number Date Expires Renewal Fee
Joseph W. Faueett
c WW016376 06/30/2008 30.00
835 Emerson Rd
Carmel IN 46032 I am the responsible charge operator of: Hours
c Address Changes p g p Permit City
Q 1.
:a
3
c 2.
:7
x Mail To: Cashier Mail Code 50 -IOC
O Indiana Department of Environmental Management 3
100 N. Senate Avenue
Indianapolis, IN 46204 -2251
L If you are the operator in responsible charge of a
wastewater treatment facility, please list each 4.
facility at the right, indicate the avg. hours you
s end at each per week. J.clude pi Witjo Zl facilities on another sheet of paper and include with your renewal:
9 Operator Sign ur
Date Signed
S� -/y
Fake Check Payable To Phone#
ndiana Department of Environmental Manage nt
Pleme N Noe Fwd Apple -io.
I REMOVE AT PERFORATION i
WASTEWATER OPERATOR CLASS I
Certification Number Date Expires Renewal Fee
Dennis M. Russ
18021 Sanibel Cir. WWO17670 06/30/2008 $30.00
y
Noblesville IN 46062 I am the responsible charge operator of: Hours Permit City
c Address Changes:
Q
b
3
C 2.
a Mail To: Cashier Mail Code 50 10C
Indiana Department of Environmental Management 3
100 N. Senate Avenue
Indianapolis, IN 46204 -2251
If you are the operator in responsible charge of a
W wastewater treatment facility, please list each 4
facility at the right, indicate the avg. hours you
s end at each per week. Include any additional facilities on another sheet of paper and include with your renewal.
Operator Signatu re Date Signed
'O
Make Cheek Payable To 11 tPhone#
Indiana Department of Environmental Management
P1 .Y u, Nul Foie Appii -wn
1 REMOVE AT PERFORATION I
WASTEWATER OPERATOR CLASS IV
William E. Wolfe Certification Number Date Expires Renewal Fee
e
22934 Anthony Road WW006430 06/30/2008 $30.00
Cicero IN 46034
I ant the responsible charge operator of: Hours Permit City
a Address Changes:
a I
d
3
c 2.
m
Mail To: Cashier Mail Code 50 -10C
O Indiana Department of Environmental Management 3
100 N. Senate Avenue
u Indianapolis, IN 46204 -2251
If you are the operator in responsible charge of a
J wastewater treatment facility, please list each 4
facility at the right, indicate the avg. hours you
s end at each per week. Include any additional facilities on another sheet of paper and include with your renewal.
Operator Signatory Date Signed
take Check Payable To Phone# i
ndiana Department of Environmental Management
Please Do Nol Fold Application
1 REMOVE AT PERFORATION I
WASTEWATER OPERATOR CLASS I
Renewal Fee
Certification Number Date Expires
e Ralph E. Gruwell WWO18036 06/30/2008 $30.00
9035 Mt Shasta S Drive West Glen Village
'L Indianapolis IN 46234
y 1 am the responsible charge operator of: Hours Permit City
a. Address Changes:
3
c 2.
a; Mail To: Cashier Mail Code 50- I OC
0 Indiana Department of Environmental Management 3
100 N. Senate Avenue
:•v Indianapolis, IN 46204.2251
tz
'Z If you are the operator in responsible charge of a
U wastewater treatment facility, please list each 4,
facility at the right, indicate the avg. hours you
s end at each per week. Include any additional facilities on another sheet of paper and include with your renewal.
:D
Operza Signature Date Signed
take Check Payable To Phone#
ndiana Department of Environmental Management
Please Do Na Fuld Application
I REMOVE AT PERFORATION I
WASTEWATER OPERATOR CLASS IV
Certification Number Date Expires Renewal Fee
c David W. Humpal
7131 North Oakland Avenue WW016380 06/30/2008 $30.00
0 Indianapolis IN 46240
I am the responsible charge operator of: Hours Permit City
a Address Changes:
Q I.
R
'.3
2.
y
a Mail To: Cashier— Mail Code 50 -IOC
Indiana Department of Environmental Management 3
.y 100 N. Senate Avenue
v Indianapolis, IN 46204.2251
If you are the operator in responsible charge of a
U wastewater treatment facility, please list each 4
facility at the right, indicate the avg. hours you
spend at each per week. Include any additional facilities on ano er et of paper and include with your renewal.
Operator Signature Date Signed
Iakc Check Payable To Phone#
[ndiana Department of Environmental Management
317 2S� lam �a
Plaou fb N., Fold App11cm1-
I REMOVE AT PERFORATION I
WASTEWATER OPERATOR CLASS III
Certification Number Date Expires Renewal Fee
c Alton B. Chaffin WW017998 06/30/2008 $30.00
12747 Touchdown Dr.
Fishers IN 46037
a I am the responsible charge operator of: Hours Permit City
y Address Changes:
a l
R
3
2.
u
CC Mail To: Cashier- Mail Code 50 -IOC
Indiana Department of Environmental Management 3
100 N. Senate Avenue
Indianapolis, IN 46204 -2251
C:
If you are the operator in responsible charge of a
U wastewater treatment facility, please list each 4
facility at the right, indicate the avg. hours you
Cc
spend at each per week. Include any additional facilities on another sheet of paper and include with your renewal.
Operator Signature Date Signed
S.
:O
a S Jo o?s
n
Make Check Payable To Phone#
Indiana Department of Environmental Management "L� F '3
,dv..
Phase D,, Not Fold Applirelion
I REMOVE AT PERFORATION I
WASTEWATER OPERATOR CLASS I
Certification Number Date Expires Renewal Fee
T- ld B. Oliver
Devinney Ln WW018O94 06/30/2008 $30.00
napolis IN 46221
ess Changes' I am the responsible charge operator of: Hours Permit City
3
c 2.
v
Mail To: Cashier— Mail Code 50 -IOC
C Indiana Department of Environmental Management
100 N. Senate Avenue 3
Indianapolis, IN 46204.2251
'L. If you are the operator in responsible charge of a
U wastewater treatment facility, please list each 4.
facility at the right, indicate the avg. hours you
c s end at each per week. Include any additional facilities on another sheet of paper and include with your renewal.
C Operator Signature D
lake Check N,, ble To
Phone#
ndiana Department of Environmental Management
Pte Ms., Fad Appl -Imn
I REMOVE AT PERFORATION:
V'OLICHER 085513 WARRANT ALLOWED
k46900 IN SUM OF
IDEM
100 N. Senate Avenue
Indianapolis, IN 4620`
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
WW018036 01- 7042 -05 $30.00
WWO06530 it 30.06
tvwD1700 fl 30.
WWDI(,376 1, 30.0L)
Ww016380 30.
WL .017$2$ al_-7oy2.06 3D.0
w Wot 1011 30.oc)
1uW01 g q`I
30. vo
1,u WO#Za9$ 3D.c�C�
11o.C O
Voucher Total
„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
146900
IDEM Purchase Order No.
100 N. Senate Avenue Terms
Indianapolis, IN 46207 -7060 Due Date 5/15/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/15/2008 WW018036 $30.00
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
Date Officer