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Which of tnc ..,flowing apple to you as an individual'? <br /> Local resident/L,...munity <br /> Business communiry <br /> Base empioveeiresident <br /> Local/regional environmental group <br /> Civic/public interest organization <br /> Religious community <br /> Labor organization <br /> Local homeowner association <br /> _XX Regulatory agency employee <br /> Medical community <br /> School district committee representative <br /> Native american <br /> X$ Local government <br /> Other <br /> Please describe: <br /> 4. If applicable, please state the names of any organizations you are associated with (optional). <br /> California Environmental Health Association (CEHA) <br /> Am i can Water Works Association (A70t 7A) <br /> 5. Please indicate if you are interested in being considered for the community co-chairperson position <br /> on the RAB by checking the box below: <br /> Yes. I would like to be considered. <br /> 6. Are you willing to serve as a member of this RAB for two years? <br /> XX Yes, I am willing to serve as requested. <br /> 7. By submitting this signed application, you are aware that RAB membership requires regular <br /> participation and a commitment of time. <br /> 8. By submitting this signed application, you willingly agree to work cooperatively with other <br /> members of the committee to ensure efficient use of time for addressing community issues related <br /> Ito environmental restoration of NCS Stockton, California. <br /> . 6 -"A I I- -•'�- <br /> Applicant Signature Date <br /> Please return your completed application by folding in two, stapling, and sending to the address on <br /> the back: <br /> 2 <br />