HomeMy WebLinkAbout220190 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M&ECK AMOUNT: $30.00
CARMEL, INDIANA 46032 CASHIER OFFICE-MAIL CODE 50-10C
100 N SENATE AVE CHECK NUMBER: 220190
INDIANAPOLIS IN 46204
CHECK DATE: 5/21/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 WWO13898 30 . 00 OTHER EXPENSES
Indiana Department of Environmental Management
100 N. Senate Avenue
Mail Code 65-42
Indianapolis, IN 46204-2251
--EST.......
1986
Teresa L. Lewis
338 Orland Overlook
Westfield IN 46074
WASTEWATER TREATMENT PLANT OPERATOR RENEWAL APPLICATION
License Class Wastewater Operator Class IV May 9, 2013
Certification#: WW013898
Expiration Date: 06/30/2013
Renewal Fee: $30.00
Login Id: WWO13898
Password: 492936
Current Continuing Education Hours Earned: General-0.50 Technical-27.50 Total- 28.00
1 am currently the responsible charge operator who signs the monthly reports(MRO/MMR)at the following facilities:
Facility Name Hours/Week Permit# City
Address Change: 1 n
❑ Home
r
Current Phone#: ❑Work Operator Signature: �. a Date:5-13-13
3' /
Your wastewater treatment plant operator certification expires 06/30/2013. 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 7/1/2011 —6/30/2013 from IDEM approved course with at least 3.5 of
those hours from courses designated as"technical."
• Classes I, II,A, B—10 hours earned between 7/1/2011 —6/3012013 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 7/1/2011 —6/30/2013 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 10, 2013 and July 1, 2013 at
https://mylicense.in.gov. 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 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. Make checks payable to IDEM.
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(@idem.in.gov.
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 5/14/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/14/2013 050913 $30.00
1 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
t,13
Date Officer
VOUCHER # 135480 WARRANT # ALLOWED
146900 IN SUM OF $
IDEM
100 N. Senate Avenue
Indianapolis, IN 46207-7060
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
050913 01-7042-05 $30.00
Voucher Total $30.00
Cost distribution ledger classification if
claim paid under vehicle highway fund