209556 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 358789 Page 1 of 1
0 ONE CIVIC SQUARE RALPH GRUWELL CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 9035 MT SHASTA SOUTH
W. GLENN VILLAGE CHECK NUMBER: 209556
INDIANAPOLIS IN 46234
CHECK DATE: 6/512012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 051512 100.00 OTHER EXPENSES
44-4
i
CITY OF CARMEL Expense Report (required for all travel expenses)
NDIA j
2010 mileage reimbursement rate is 50 cents /mile
EMPLOYEE NAME: Ralph Gruwell 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
5/15/12 Primary Treatment $25.00 $25.00
5/15/12 Activated Sludge II $25.00 $25.00
5/23/12 UV Disinfection $25.00 $25.00
5/23/12 Removing Metals from WW $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 $0.00 $0.00 $0.00 $0.00 $100.00
DIRECTOR'S STATEMENT: I here y 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 5/25/2012 Page 1
WASTEWATER OPERATOR /APPRENTICE CONTINUING To ensure proper credit, the
EDUCATION CREDIT REPORT wastewater approval number
MUST be provided.
State Form 51139 (R3 4 -08) Training Course Approval Number:
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
W k 7 v\iS 1-
Operator ❑Apprentice Technical Contact Hours Earned:
1 HOUR
General Contact Hours Earned:
'a% t upMyr 0
;IIVSTRUGTIONS
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
CERTIIEDQFERiATOR /APPRN „TICEINFORMATI,UN���'
1. NAME•
n 67
2. ADDRESS (number and street):
City: State: ZIP code: Telephone number:
T IZJ d P'S 5 rJ 14 lo Z 3 4 work:
Check here if this is an address change 13 E -mail Address: Home /Cell: pi 317 86 7
3. NAME OF T COURSE:
C'h' rv► A Q T,P�.4 fir e�rf
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): r 7. LOCATION ATTENDED:
eJ .1S 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.
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. SI ATU OF C RTI D OPERATOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED 0PERATOR/APPRENTICE:
14. CONTINUING EDU ATION CREDIT HOURS ARE TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
W W 01 1 -3D- Z
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
877 241 -9858
Email: Support(,
Certificate of Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South
Carolina, North Carolina, Mary land. Kentucky and Ontario
anada.
Name: Ralph E. Gruwell
Address: 9035 Mt. Shasta dr. south, Indianapolis, Indiana 46234
Course Title: Primary Treatment
Course Value: 1 Contact Hour
Approval Number: IN WWT11 -5905 TO1 -G00, PWSTI 1 -4186, OH OEPA- S296785-
OM, NC CEO] 140414, MD 3464- 05 -06, KY 10305
Date: 5/15/2012
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO18036
Operator Class Level: 1
License Expiration Date: 06/30/2012
Operator Signature: wee
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc.
Copyright 2002, Approved Environment, Ine., Indianapolis, Indiana
http:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/15/2012
TTr WASTEWATER OPERATOR /APPRENTICE CONTINUING p roper credit, the
To ensure
EDUCATION CREDIT REPORT
N,� wastewater approval number
�•j MUST be provided. State Form 51139 (R3 4 -08)
INDIANA DEPARTMENT OF E Training Course Approval Number:
ENVIRONMENTAL MANAGEMENT i
F leis D
�lL?
Operator []Apprentice Technical Contact Hours Earned:
1 HOUR
General Contact Hours Earned:
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 o /a rentice attendin the entire wastewater o erator continuin education course.
pm
CERT�IFIEDOPERATOR /APPRENTICEINFORMAfTION�� r 3
1. NAME:
►QA UweLL
2. ADDRESS (number and st 'q_5fw
et):
03S, f. S
City: f State: ZIP code: Telephone number:
Work: 317
Home /Cell: R) kj `7 (e l0 7 7
Check here if this is an address change E-mail Address: RG r UW e L L CA r►tne 1 IN Go V
3. NAME OF TRAINING COURSE:
�I e
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:
l�_ Z VWWV.APPROVEDCE.COM
8.T AL 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. SI ATURE OF CERTIF ED OPERATOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR /APPRENTICE:
a I Pti GtQ to e L_L,
14. CONTINUING EDU ATION CREDIT HOURS ARE TO BE APPLIED TO:
Operator certification /apprentice number: Class:
Expiration date:
Operator ceification /app tice number: r I
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: Supportriapprovedce.com
Certificate of Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South
Carolina. North Carolina Nlar }land, Kentucky and Ontario, Canada.
Name: Ralph E. Gruwell
Address: 9035 Mt. Shasta dr. south, Indianapolis, Indiana 46234
Course Title: Activated Sludge II
Course Value: 1 Contact Hour
Approval Number: IN WWT11 -5908 TO]-GOO,, OH OEPA- 5296730 -OM, NC
CE01130404, MD 3467- 05 -06, KY 10297
Date: 5/15/2012
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO18036
Operator Class Level: 1
License Expiration Date: 6/30/2012
Operator Signature:
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc.
Copyri Approved Environment, Inc,, Indianapolis, Indiana
http: /www.approvedce. con/ onlineCEUs /ceuCertificateOfCompletion.asp 5/15/2012
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
IA16� v l
)(Operator ❑Apprentice Technical 1oHOUR ours Earned:
General Contact Hours Earned:
0
r_."� ��STRlJCTI®IdS� emu, 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 wastewa ope rator continuing education course.
C.t,RTIF,tE,D�PR% ACTOR /PPR
1. NAME:
2. ADDRESS (number and street):
10.5 M� :Sh9S�� cfiP� S
City: State: ZIP code: Telephone number:
rod P I! S 2 3 Work: C3 Home /Cell: X17 ?6 y b /077
Check here if this is an address change E -mail Address:
GO`t)RS I'IVFORtNIie�TI,ON�a -,fir
3. NAME OF TRAINING COURSE:
e6fla,�
4. NAME OF TRAINING COURSE PROVIDER: S. NAME OF ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED:
231 Z 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.
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. SI NATU OF CE IFIED OPERATORIAPPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
7
',2 LP E, GR u we L L
14. CONTINUING ED CATION CREDIT HOURS ARE TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
'I'IIA E, (0-3o-12-
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 -98.58
Email: Support(a)approvedcexom
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: Ralph E. Gruwell
Address: 9035 Mt. Shasta dr. south, Indianapolis, Indiana 46234
Course Title: UV Disinfection
Course Value: 1 Contact Hour
Approval Number: IN WWT11 -5936 TO1 -G00, PWST07 -3193, OH OEPA- B443661-
OM, NC CEO 1230701, MD 3928- 07 -03, KY 8328
Date: 5/23/2012
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO18036
Operator Class Level: 1
License Expiration Date: 06/30/2012
Operator Signature:
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc.
Copyright 2002, Approved Environment, Inc., Indianapolis, Indiana
https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/23/2012
SSE "c, WASTEWATER OPERATOR /APPRENTICE CONTINUING To ensure proper credit, the
EDUCATION CREDIT REPORT wastewater approval number
MUST be provided.
State Form 51139 (R3 4 -08) Training Course Approval Number:
'•a` INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT t
�B16 l SLY
Technical Contact Hours Earned:
15pperator ❑Apprentice
1 HOUR
General Contact Hours Earned:
0
3....
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.
CERTIFIER !QP,E,_RATO,R /AP,P,R,E „NTICE 010 NO G X .r >11 �31
1. NAME: rr
�h Go- I t toe LL
2. ADDRESS (number and street):
p 35' SGT AJfA d R S
City: State: ZIP code: Telephone number:
.1
Work:
W t �/t> �S S q Z 2 3# Home /Cell: 3 17 B�g/O(v??
Check here if this is an address change E -mail Address: y
ON 11 }CO .t�..,;3
3. NAME OF TRAINING COURSE:
rn o v r e fR �S o wt �'1 _f �'e r
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:
�J -23— WWW.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. SI�iG�1TU OF TIF D OPERATORIAPPRENTICE: 13. R TED NAME OF CERTIFIED C TOR/AP PRENTICE:
14. CONTINUING EDUCATION CREDIT HOURS ARE TO BE APPLIED TO: G L
Operator certification /apprentice number: Class: Expiration date:
A) LIV 016036 _T� �•3o- lZ
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: Indiana, Illinois, Ohio, Alabama, Delaware, South
Carolina., North Carolina, Maryland, Kentucky and Ontario, Canada.
Name: Ralph E. Gruwell
Address: 9035 Mt. Shasta dr. south, Indianapolis, Indiana 46234
Course Title: Removing Metals from Wastewater
Course Value: 1 Contact Hour
Approval Number: IN WWT11 -5926 TO1 -G00, OH OEPA- S396249 -OM, NC
CE01030503, MD 3485- 05 -06, KY 10307
Date: 5/23/2012
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO18036
Operator Class Level: 1
License Expiration Date: 06/30/2012
Operator Signature:
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc.
Copyright 2002. approved Environment, Inc,, Indianapolis. Indiana
https:// www. approvedee. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/23/2012
h
Approved Environment Inc.
2346 S Lynhurst Dr Ste F201 B M Inc.
INDIANAPOLIS, IN 46241 (317) 241 -9858 Approved Environment, Inc.
US
Description: Online Course: Primary Treatment
Order Number: P.O. Number:
Customer ID: Invoice Number: 770C
Billing Information Shipping Information
Ralph E. Gruwell
9035 Mt. Shasta Dr. South
Indianapolis, IN 46234
Shipping: 0.00
Tax: 0.00
Total: USD 25.00
Date /Time: 15- May -2012 17.30:16
Transaction ID: 4354330930
Transaction Status: Captured /Pending Settlement
Authorization Code: 026669
Payment Method:
Approved Environment Inc. JEInc.
2346 S Lynhurst Dr Ste F201 B Approved Environment, Inc.
INDIANAPOLIS, IN 46241 (317) 241 -9858 PP
US
Description: Online Course: Activated Sludge II
Order Number: P.O. Number:
Customer ID: Invoice Number: 771 C
Billing Information Shipping Information
Ralph E. Gruwell
9035 Mt. Shasta Dr. South
Indianapolis, IN 46234
Shipping: 0.00
Tax: 0.00
Total: USD 25.00
Date/Time: 16- May -2012 16:30:16
Transaction ID: 4354330934
Transaction Status: Captured /Pending Settlement
Authorization Code: 842833
Payment Method:
q
Approved Environment Inc.
Inc.
2346 S Lynhurst Dr Ste F201 B
INDIANAPOLIS, IN 46241 (317) 241 -9858 Approved Environment, Inc.
US
Description: Online Courses: UV Disinfection Removing Metals
Order Number: P.O. Number:
Customer ID: Invoice Number: 821C
Billing Information Shipping Information
Ralph E. Gruwell
9035 Mt. Shasta Dr. South
Indianapolis, IN 46234
Shipping: 0.00
Tax: 0.00
R q Total: USD 50.00
Date/Time: 18- May -2012 17:30:16
Transaction ID: 4354330950
Transaction Status: Captured /Pending Settlement
Authorization Code:
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
T1025
GRUWELL, RALPH Purchase Order No.
WWTP Terms
Due Date 6/4/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/4/2012 051512 $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 O cer
R
VOUCHER 125038 WARRANT ALLOWED
T1025 IN SUM OF
GRUWELL, RALPH
WWTP
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
051512 01- 7042 -06 $100.00
Voucher Total $100.00
Cost distribution ledger classification if
claim paid under vehicle highway fund