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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