219509 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 00353237 Page 1 of 1
t'. ONE CIVIC SQUARE TESTAMERICA INC
CARMEL, INDIANA 46032 PO BOX 122314 DEPT 2314 CHECK AMOUNT: $119.70
_off,a DALLAS TX 75312-2314 CHECK NUMBER: 219509
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 24138629 119 . 70 OTHER EXPENSES
TestAm e.
ca
TRr-LFAOFR IN FNVIRn NMFNTAL T STING
Invoice/Credit No. 24138629 Invoice Date Jttnual 13,2013
Terms See Below Federal Tax ID 23-2919996
Remit to TestAmerica Laboratories,Inc,Dept 2314 P.O.Box 122314 Dallas TX 75312-2314
Bill to: Ship to:
Carmel WWTP Carmel WWTP
Attn:Accounts Payable 9609 Hazel Dell Pkwy
760 Third Avenue SW Indianapolis,IN 46280
Cannel,IN 46032
Ol . 735 9,•os
P.O.Number W.O.Number Contract Number Work Ordered by
Purchase Order not required Teresa Lewis
Job Description Site Name SDC Number Invoice Contact
See-below Lisa Kem a
Job No. Job Description Receipt Date Quantity Unit Price Amount
Method/rest Description
J19091-1 Carmel 12/19/2012
335.4- Cyanide,Total 1.00 30.00 30.00
200.7 Rev 4.4-Total Recoverable Cadmium 1.00 12.00 12.00
200.7 Rev 4.4-Total Recoverable Chromium 1.00 12.00 12.00
200.7 Rov 4.4-Total Recoverable Copper 1.00 12.00 12.00
200.7 Rev 4.4-Total Recoverable Lead 1.00 12.00 12.00
200.7 Rev 4.4-Total Recoverable Nickel 1.00 12.00 12.00
200.7 Rev 4.4-Total Recoverable Silver 1.00 12.00 12.00
200.7 Rev 4.4-Total Recoverable Zinc 1.00 12.00 12.00
Environmental Management Fee 1.00 5.70 5.70
Project Number Client Number Project Manager Subtotal 1 $119.70
24009460 1406871 Josh McKinney
Latest Sample Receipt Date Latest Report Date Phone Number Total $119.70
12/19/2012 01/13/2013 (330)497-9396
For proper credit,please include invoice number on all remittance.
TostAmerica Canton-4101 Shuffel Street NW,North Canton,OH 44720
This invoice falls under'festAtnerica Laboratories Inc.Standard T&Cs of Net 30 Days unless superseded by another valid contract vehicle in Page 1 of I
place at the dire these services were rendered.
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
00353237
TESTAMERICA INC Purchase Order No.
PO BOX 99742 Terms
Chicago, IL 60690 Due Date 4/15/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/15/2013 24138629 $119.70
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 Officer
VOUCHER # 135299 WARRANT # ALLOWED
00353237 IN SUM OF $
TESTAMERICA INC
PO BOX 99742
Chicago, IL 60690
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
24138629 01-7352-05 $119.70
Voucher Total $119.70
Cost distribution ledger classification if
claim paid under vehicle highway fund