Fillable AB 617 Community Steering Committee (CSC) (SCAQMD)

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AB 617 Community Steering Committee (CSC) (SCAQMD)

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The AB 617 Community Steering Committee (CSC) (SCAQMD) form is 2 pages long and contains:

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  • 14 check-boxes
  • 29 other fields

Country of origin: US
File type: PDF

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Information provided by you on this worksheet (including contact or other personal information) is a public record and may
be released in response to a California Public Records Act request.
Select ONE community:
East Los Angeles / Boyle Heights / West Commerce
San Bernardino / Muscoy
Wilmington / Carson / West Long Beach
Eastern Coachella Valley
Southeast Los Angeles
South Los Angeles
AB 617 Community Steering Committee (CSC)
Interest Form
Name:
Phone number:
Email Address:
Are you a returning CSC member?
Yes* No
*If yes, please update your contact information under the Affiliation section.
Goals of the AB 617 Community Steering Committee
The purpose of the community steering committee is to support active community involvement and collaboration in the AB
617 implementation process by providing a forum for identifying air pollution issues in the community and potential
solutions. Committee members will be responsible for discussing a variety of topics including but not limited to:
• Community concerns about emission sources to develop a shared understanding of the community’s air pollution challenge;
• Proposed strategies for the community air monitoring and emissions reduction programs;
• Approaches for additional community outreach; and
• Attend regularly scheduled meetings.
Affiliation (fill out all sections that apply):
Active resident (not representing a community organization or a business)
Resident name:
Primary residence address (or nearest intersection):
Community organization
Organization name:
Organization address:
Agency, school, university or hospital
Entity name:
Entity address:
Business representative
Business name:
Business address:
Representative from an elected official’s office
Name of representative:
Name of elected official:
Jurisdiction:
Why are you interested in participating as an AB 617 steering committee member?
What are some ways you can help network within your community?
E-mail form to: ab617@aqmd.gov
La informacin proporcionada por usted en esta hoja de trabajo (incluyendo contacto u otra informacin personal) es un
registro pblico y puede ser divulgada en respuesta a una solicitud de la Ley de Registros Pblicos de California.
Seleccione UNA Comunidad:
East Los Angeles / Boyle Heights / West Commerce
San Bernardino / Muscoy
Wilmington / West Long Beach / Carson
Eastern Coachella Valley
Southeast Los Angeles
South Los Angeles
Formulario de interés Comité Directivo de la Comunidad
(CDC) de AB 617
Nombre:
Teléfono:
Correo electrónico:
¿Has servido como miembro del csc?
Sí* No
* Si la respuesta es afirmativa, por favor actualice su información de contacto abajo en la sección de Afiliación.
Objetivos del Comité Directivo Comunitario AB 617
El propósito del comité directivo de la comunidad es apoyar la participación activa de la comunidad y la colaboración en
el proceso de implementación de AB 617. El CDC proporciona un foro para identificar los problemas de contaminación
del aire en la comunidad y posibles soluciones. Los miembros del comité serán responsables de discutir una variedad de
temas que incluyen, entre otros:
• Preocupaciones de la comunidad sobre las fuentes de emisión para desarrollar un entendimiento compartido del
desafío de la contaminación del aire en la comunidad;
• Estrategias propuestas para los programas comunitarios de monitoreo de aire y reducción de emisiones;
• Enfoques para un alcance comunitario adicional; y
• Asista a las reuniones con regularidad.
Afiliación (llene todas las casillas que apliquen):
Organización
comunitaria
Nombre
de
la
organización:
Dirección
de
la
organización:
Agencia,
colegio,
universidad
u
hospital
Nombre
de
la
entidad:
Direccion
de
la
entidad:
Representante
de
negocios
Nombre
del
negocio:
Dirección
de
negocios:
:
Representante
de
la
oficina
de
un
funcionario
Nombre
del
funcionario
electo:
Jurisdicción:
¿Por qué está interesado en ser miembro del comité directivo AB 617 en la comunidad seleccionada?
¿Cuáles son algunas maneras que puede ayudar a comunicarse con su comunidad?
E-mail form to: ab617@aqmd.gov
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AB 617 Community Steering Committee (CSC) (SCAQMD)

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Completed 15 May 2022

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