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Home My WebLink About209513 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 00353019 Page 1 of 1 ONE CIVIC SQUARE ALTON B CHAFIN CARMEL, INDIANA 46032 C/O WASTEWATER PLANT CHECK AMOUNT: $100.00 CARMEL IN 46032 CHECK NUMBER: 209513 CHECK DATE: 6/5/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 BART 100.00 OTHER EXPENSES /.(•l OF CITY OF CARMEL Expense Report (required for all travel expenses) 2010 mileage reimbursement rate is 50 cents /mile EMPLOYEE NAME: Bart Chafin DEPARTED na TIME: DEPARTMENT: Utilities /Sewer RETURN na TIME: REASON FOR TRAVEL: na DESTINATION CITY: na 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 Car Rental Other Parking Breakfast Lunch I Dinner I Snacks Per Diem 5/8/12 Activated Sludge I Course $25.00 $25.00 5/10/12 Solids Dewatering $25.00 $25.00 5/10/12 Solids Handling Alternatives $25.00 $25.00 5/22/12 Pri ary Treatment $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 0.00 Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.001 $0.001 $0.001 $0.00 $100.00 0 0 o e 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 5/24/2012 Page 1 Approved Enviroment Inc Customer Receipt/Purchase Confirmation Page 1 of 1 From: APPROVED ENVIRONMENT <SUPPORT @APPROVEDCE.COM> To: Alton Chafin <BCroc @aol.com> Subject: Approved Enviroment Inc Customer Receipt/Purchase Confirmation Date: Tue, May 8, 2012 11:35 am Thank you for your order! Order Information Merchant: Approved Enviroment Inc Description: Activated Sludge I Invoice Number: 706C Billing Information Shipping Information Alton Chafin Bart Chafin Camel Wastewater Treatment Plant Carmel Wastewater Treatment Plant 12347 Touchdown Dr. 12347 Touchdown Dr. Fishers, In 46037 Fishers, In 46037 Hamilton Hamilton BCroc(cDaol.com 317/773/6923 Total: US $25.00 Visa Date/Time: 08- May -2012 08:35:13 AM PT Transaction ID: 4363853544 http: /mail.aol.com/36081 -111 /aol-6/en-us/mail/PrintMes sage. aspx 5/23/2012 WASTEWATER OPERATOR /APPRENTICE CONTINUING To ensure proper credit, the wastewater approval number EDUCATION CREDIT REPORT MUST be provided. p: State Form 51139 (R3 4 -08) Training Course Approval Number: INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT T l j�~7 ��r 166 YV Vv 1 VV6 Operator ❑Apprentice Technical 1oHOUR ours Earned: General Contact Hours Earned: 0 01' R ate. >c _a,,,u..�...�,. e��.b .✓y. :ax:.., se 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. .CERTIFIED QPE,R�ATQ (WO RIVIATIQN,�� 1. NAME: 2. ADDRESS (number and street City: `i„ State: ZIP cod Telephone number: F 1IL6 Work: 1 V13 Home /Cell: C Check here if this is an address change E -mail Address: i 3. NAME OF TRAINING COURSE: A C_ X 'j'\j A j S�v10 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: WWW.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. 1 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. SIGNATURE I OF CERTIFIE -OPE TOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE: A S. L j tom? R 6 14. CONTINUING EDUCATION CREDIf HOURS ARE TO BE APPLIED TO: Operator certification /air -nticeyiCTber. Clas Expiration date: W W O 1711 1 K Operator certification /apprentice number :v 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: SupportCa).approvedee.com Certificate ®f Completion Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South Carolina, North Carolina, Maryland, Kentucky and Ontario, Canada. Name: Alton Bart Chaffin Address: 12747 Touchdown Dr., Fishers, In 46037 Course Title: Activated Sludge I Course Value: 1 Contact Hour Approval Number: IN WWT11 -5907 TOI -G00, OH OEPA- S296727 -OM, NC CEO 1130402, MD 3466- 05 -06, KY 10296 Date: 5/8/2012 Approximate Time Spent Taking the Course: 60 minutes. Operator Certification License Number: WWO17998 Operator Class Level: 3 License Expiration Date: 06/30/2012 Operator Signature: Givim Training Provider Signature Ann Bersbach, Approved Environment, Inc. Copyright 2002. Approved Environment, Inc., Indianapolis, Indiana http:// www. approvedce. com/ ontineCEUs /ceuCertificateOfCompletion.asp 5/8/2012 Approved Enviroment Inc Customer Receipt/Purchase Confirmation Page 1 of 1 From: APPROVED ENVIRONMENT <SUPPORT @APP ROVEDCE.COM> To: Bart Chafin <BCroc @aol.com> Subject: Approved Enviroment Inc Customer Receipt/Purchase Confirmation Date: Thu, May 10, 2012 1:57 pm Thank you for your order! Order Information Merchant: Approved Enviroment Inc Description: Solids Dewatering Invoice Number: 719C Billing Information Shipping Information Bart Chafin Carmel Wastewater Treatment Plant 12747 Touchdown Dr. Fishers, In 46037 Hamilton BCroc(@aol.co 317- 773 -6923 Total: US $25.00 Visa Date/Time: 10- May -2012 10:57:05 AM PT Transaction 10: 4369123025 http: /mail.aol.com/36081 -111 aol- 6 /en- us /mail/PrintMes sage. aspx 5/23/2012 e R°� To ensure p roper credit, the WASTEWATER OPERATOR /APPRENTICE CONTINUING p p wastewater approval number EDUCATION CREDIT REPORT MUST be provided. State Form 51139 (R3 4 -08) Training Course Approval Number: esie� INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT T <lS Thj�l` 3 Technical Contact Hours Earned: 26 perator ❑Apprentice 1 HOUR General Contact Hours Earned: 0 IiNSTRIJCTION,S 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. .i...... GRTIFtDAERATOR/APP,R7 hITIC,E 1t!tFORIIlIAT10.N 1. NAME: 2. ADDRESS (number and street): `1 7- City: State: ZIP co +dyer Telephone number: Work: b Home /Cell: 2r" 3i7 °'773 Check here if this is an address change E -mail Address: CO.IJRSEIMF®RIVIATION,, 3. NAME OF TRAINING COURSE: 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: 1 16 j")-- WNW.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. 1, 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: 1,10 Ann Bersbach 12. SIGNATUIJE OF CEfD OPE� OR/ PPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE: 1 oat A L T c*j f i+A j Dr- 14. CONTINUING EDUCATION CREDIT HOUIKS ARE TO BE APPLIED TO: Operator certification /apprentice number: Class: Expiration date: y QV/0 '7 1 'Y 6 /3p) 20 Operator certification /apprentice number: Class: Expiration date: Certificate of Completion Approved Environment, Inc. Page 1 of 1 Approved Environment, Inc. P.O. Boa 42744 Indianapolis, IN 46242 1- 877 241 -9858 Email: Support(d..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: Alton Bart Chafin Address: 12747 Touchdown Dr., Fishers, In 46037 Course Title: Solids Dewatering Course Value: 1 Contact Hour Approval Number: IN WWT11 -5910 TOI -GOO, OH OEPA- 5296751 -OM, NC CEO 1140403, MD 3469- 05 -06, KY 10302 Date: 5/13/2012 Approximate Time Spent Taking the Course: 60 minutes. Operator Certification License Number: wwO17998 Operator Class Level: 3 License Expiration Date: 06/30/2012 Operator Signature: a& Training Provider Signature: Ann Bersbach, Approved Environment, Inc. Copyright 2002, Approved Environment, Inc., Indianapolis, Indiana https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/13/2012 Approved Enviroment Inc Customer Receipt /Purchase Confirmation Page 1 of 1 From: APPROVED ENVIRONMENT <SUPPORT @APPROVEDCE.COM> To: Alton Chafin <BCroc @aol.com> Subject: Approved Enviroment Inc Customer Receipt/Purchase Confirmation Date: Thu, May 10, 2012 3:40 pm Thank you for your order! Order Information Merchant: Approved Enviroment Inc Description: Solids Handling Alternatives Invoice Number: 721C Billing Information Shipping Information Alton Chafin Carmel Wastewater Treatment Plant 12747 Touchdown Dr. Fishers, In. 46037 Hamilton BCroc(a)aol.com 317/773/6923 Total: US $25.00 Visa Date/Time: 10- May -2012 12:40:00 PM PT Transaction ID: 4369423683 http: Hmail. aol.com/3 6081 -111 aol- 6 /en- us /mail/PrintMessage.aspx 5/23/2012 STA To ensure proper credit, the WASTEWATER OPERATOR /APPRENTICE CONTINUING wastewater approval number EDUCATION CREDIT REPORT MUST be provided. m! State Form 51139 (R3 4 -08) Training Course Approval Number: INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT ��e i �a'��.� perator ❑Apprentice Technical 1oHOUR ours Earned: General Contact Hours Earned: 0 a x ��IIVSTRUCTIONS�� d x ...W:.� �.o., 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 o erator continuing education course. �y,k GI= RfIFtED�OPER,4TQR /PRE[VTICE I,fFORIUlAT10N v 1. NAME: I\ 5 2. ADDRESS (number and street): I 2D 1 4 f1txCN �C City: State: ZIP code: Eme/Cell: lephone number: 0 F 2 51') `x L •3� w/. ?)'Y7 '13 023 Check here if this is an address change E -mail Address: GOtJ,RSE..,INFORMAT(ON' W" EN 3. NAME OF TRAINING COURSE: 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 NUMBIER 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: 10&. Ann Bersbach 12. SIGNATURE OF CERTIFff OPERATQR7 PPRE TICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE: 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: Support(a),approvedee.com Certificate Of Completion Courses are approved in the following states: ndiana, Illinois, Ohio, Alabama, Delaware, South Carolina. North Carolina, Maryland, Kentucky and Ontario, Canada. Name: Alton Bart Chafin .Address: 12747 Touchdown Dr., Fishers, In 46037 Course Title: Solids Handling Alternatives Course Value: 1 Contact Hour Approval Number: IN WWTI 1 -5912 T01-G00,, OH OEPA- 5296742 -OM, NC CE02030403, MD 3471- 05 -06, KY 10301 Date: 5/16/2012 Approximate Time Spent Taking the Course: 60 minutes. Operator Certification License Number: ww017998 Operator Class Level: 3 License Expiration Date: 06/30/2012 Operator Signature: Training Provider Signature: Ann Bersbach, Approved Environment, Inc. Copyright 2002. Approved Environment, Inc., Indianapolis, Indiana http:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/16/2012 Approved Enviroment Inc Customer Receipt/Purchase Confirmation Page 1 of 1 From: APPROVED ENVIRONMENT <SUPPORT @APPROVEDCE.COM> To: Alton Chafin <BCroc @aol.com> Subject: Approved Enviroment Inc Customer Receipt/Purchase Confirmation Date: Tue, May 22, 2012 2:05 pm Thank you for your order! Order Information Merchant: Approved Enviroment Inc Description: Primary Treatment Invoice Number: 832C Billing Information Shipping Information Alton Chafin City Of Carmel 12747 Touchdown Dr. Fishers, In 46037 Hamilton BCroc .aol.com 317- 773 -6923 Total: US $25.00 Visa Date/Time: 22- May -2012 11:05:15 AM PT Transaction ID: 4394312927 http://mail.aol.com/36081-1 1 I /aol- 6 /en- us /mail/PrintMessage. aspx 5/23/2012 WASTEWATER OPERATOR/APPRENTICE CONTINUING To ensure proper credit, the wastewater approval number EDUCATION CREDIT REPORT MUST be provided. a State Form 51139 (R3 4 -08) Training Course Approval Number: 'y` _i` INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT w 560' -Qoo �A 16 Aerator ❑Apprentice Technical 1 °HOUR ours Earned: General Contact Hours Earned: 0 `[IdSTRUGTIONS 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. 1. NAME L aj Bq f� j C)4 F -lam 2. ADDRESS (number and street): City: c State: ZIP cqod►e: Telephone number: SN�r -S +tom "7 b V�� Work: Home /Cell: 53 Check here if this is an address change E -mail Address: `3N n C0_t1RSE,INF,,ORMATI,ON .4��a12. 3. NAME OF TRAINING COURSE: 3mAXY N 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: 22. 2- 00— VWVW.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. 1, 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: _11. Ann Bersbach 12. SIGNATUf E OF C TIRED OP T APPRENTICE: 13. PRINTED NAME 4 F CERTIFIED OPERATOR/APPRENTICE: ArTwj is(-4RT C�iA F)tj 14. CONTINUING E E6ffH0URS ARE TO BE APPLIED TO: Operator certification /apprentice number: Class: Expiration date: WWC)1799 (,,J3 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, [N 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, V(aryland, Kentucky and Ontario, Canada. Name: Alton Chafin Address: 12747 Touchdown Dr., Fishers, In 46037 Course Title: Primary Treatment Course Value: 1 Contact Hour Approval Number: IN WWTI I -5905 TO1 -G00, PWST11 -4186, OH OEPA- S296785- OM, NC CEO 1140414, MD 3464- 05 -06, KY 10305 Date: 5/22/2012 Approximate Time Spent Taking the Course: 60 minutes. Operator Certification License Number: WWO17998 Operator Class Level: 3 License Expiration Date: 06/30/2012 l Operator Signature: Training Provider Signature: Ann Bersbach, Approved Environment, Inc. Copyright 2002, Approved Environment, Inc., Indianapolis, Indiana https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion .asp 5/22/2012 VOUCHER 125037 WARRANT ALLOWED T9970 IN SUM OF CHAFIN, ALTON B. WASTEWATER PLANT Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code BART 01- 7042 -06 $100.00 Voucher Total $100.00 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 T9970 CHAFIN, ALTON B. Purchase Order No. WASTEWATER PLANT Terms Due Date 5/25/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/25/2012 BART $100.00 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 dVcer