HomeMy WebLinkAbout172370 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1
0 it ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M &ECK AMOUNT: $30.00
CARMEL, INDIANA 46032 CASHIER'S OFFICE -MAIL CODE 50 -10C
100 N SENATE AVE CHECK NUMBER: 172370
INDIANAPOLIS IN 46207 -7060
CHECK DATE: 5/13/2009
DEPARTMENT A CCOU NT PO NU MBE R INV OICE NUMBER AMOUNT DESCRIP
651 5023990 015358 30.00 OTHER EXPENSES
Indiana Department of Environmental Management
100 N. Senate Avenue IDEM
Mail Code 65 -42
Indianapolis, IN 46204 -2251
1
April 30, 2009
Jon L. Osborn
4821 West 73rd Street
Indianapolis IN 46268
WASTEWATER TREATMENT PLANT OPERATOR RENEWAL APPLICATION
Certification WWO15358
Expiration Date: 06/30/2009
Renewal Fee: $30.00
Login Id: WWO15358
Password: 493799
Current Continuing Education Hours Earned: General 0.00 Technical 0.00 Total 0.00
I am the responsible charge operator of: Hours /Week Permit cit
Address Change:
Current Phone S 2 9 2- /0 Operator Signature: Date:
Your wastewater treatment plant operator certification expires 0613012009. After this date, you cannot be the operator
in responsible charge of a wastewater treatment plant until your certification is renewed.
You must meet the continuing education requirement as shown below:
Classes I -SP, A -SO 5 hours earned between 7/1/2007 6/30/2009 from IDEM approved course with at least 3.5 of
those hours from courses designated as "technical."
Classes 1, II, A, B 10 hours earned between 7/1/2007 6/30/2009 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 7/1/2007 6/30/2009 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, 2009 and July 1, 2009 at
httr)s:/ /extranet.in.00v /mvlicense 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 listed
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
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(a)idem.in.gov
-m w
a. .r r ,_w �ntl' i `i "S #i s. r3r�� sr_,. �k”' J;} _ti": ,.X ns: E. s
y �_F r a. E c� 4 r xP 3'; y�.�:; �i, n y v P �Y s 'V ti...F� fi-;i' sr f.,y„ i
y
h� F B Yarn a% -f cr t ..;a••�
g i +,a
c ��K
s 1
i, t E
'i 'f a i-" t„�
i k rte
3 S'� t 1 4f 3
�T Y� J l „rr" Y
I
.F�
a
e,
rr r r �r r� r r �r r r
t �'J �_.N
t `7
1 -f Y I
3�
�t
«i
I 1 I 1 3 1
x �c }'i
Uy 5 f i 1
1 a
A
y
f t�
r i y �J
S
ka S
i a�,j t
�I r i
k:�
i
r 7 l
F
a-
1 L J .iy A 1,
4y 5 a y P 5
s
2 t c
r yf r
d N
s',. ..3. .v t:.� ll F Y. F- l.r._.-.'TY _.b Fi 'v:,` p,V.. <ru �s.i t^E �h ''i' r_K' X43,. sM.:f e.y... 2_.;. tP L?`-
Sheet #000033 Page 2 of 2
Chapter Grade Date
2 96 100 96% 20 Mar 2009
1 27 30 90% 20 Mar 2009
4 107 112 96% 20 Mar 2009
3 68 72 94% 20 Mar 2009
5 93 93 100% 17 Apr 2009
7 102 106 96% 17 Apr 2009
8 79 88 90% 17 Apr 2009
6 153 161 95% 17 Apr 2009
Final grade: 725 762 95% A
This enrollment is complete.
atard F o r Q mNo 301 S' -S eB Rev. 1995) ACCOUNTS PAYABLE VOUCHER
Form No. 301 1995)
TO
ADDRESS
Invoice Date Invoice Number Item Amount
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and that the materials or services
itemized thereon for which charge is made were ordered and received except
19
Signature Title
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.
Officer Title
Voucher No. Warrant No.
ACCOUNTS PAYABLE DETAILED ACCOUNTS
SANITATION DEPARTMENT ACCT.
CARMEL, INDIANA
Favor Of
nd
1
Total Amount of Voucher
Deductions
0!535
p/. D D/ o 0
Amount of Warrant 7(J
Month of 19
Acct.
VOUCHER RECORD No.
Collection System
Operation
Plant
Commercial
General
Undistributed
Construction
Depreciation Reserve
Stock Accounts Merchandise
Total
Allowed
Board Members
Filed
BOYCE FORMS SYSTEMS 1 -800- 382 -8702 325