AB733
Date of Hearing: April 18, 1995

ASSEMBLY COMMITTEE ON ENVIRONMENTAL SAFETY
AND TOXIC MATERIALS
Bernie Richter, Chair

AB 733 (Speier) - As Amended:April 17, 1995

SUBJECT

Drinking water: fluoridation, state mandate.

DIGEST

Existing law:

1) Requires the State Department of Health Services (DHS) to regulate drinking water and to establish standards for monitoring contaminants that may be hazardous to public health. DHS is required to adopt primary and secondary drinking water standards that are at least as stringent as those adopted by the US EPA for contaminants, including fluoride. A primary drinking water standard is a regulation that protects human health by specifying the maximum level of a contaminant that may be present in a municipal drinking water source. A secondary drinking water standard is not health related--rather it regulates the amount of a contaminant which may affect the taste, odor or appearance of water or which otherwise adversely affect the public welfare.

2) Under the California Safe Drinking Water Act, the Office of Environmental Health Hazard Assessment (OEHHA) within the Cal EPA must assess the Risks to human health posed by each specific contaminant in municipal drinking water supplies. OEHHA then determines, using the results of the risk assessment, the level of the contaminant to which humans can be exposed without incurring significant health risks. The "no significant risk" level established for each contaminant is called its "Recommended Public Health Goal."

The act then requires DHS to adopt a "Maximum Contaminant Level" (MCL) for each contaminant for which a Recommended Public Health Goal is established. The MCL must be based on the Recommended Public Health Level but may be less stringent under specified conditions.

This bill:

1) Directs the DHS to adopt regulations that require the fluoridation of all public water systems that have at least 10,000 service connections.

2) Requires that these regulations include: a minimum and maximum permissible concentrations of fluoride; procedures for maintaining proper concentrations of fluoride, including equipment, testing, record-keeping and reporting; and a schedule for the fluoridation of individual public water systems based on the size of the system and the population being served.

3) Permits a public water system scheduled to fluoridate pursuant to the provisions of this bill to comply with the regulations adopted by the DHS at any time, but the requirement to comply may not be enforced until sufficient funding to pay the capital costs for the system is available from any source.

4) Requires the DHS to seek all sources of funding for enforcement of the standards and capital cost requirements and permits a public water system to collect a fee from its customers to recover the costs incurred in complying with the requirement to fluoridate.

5) Specifies that the DHS enforce these provisions unless such authority is delegated pursuant to a local primary agreement.

6) Permits the Attorney General, upon request of DHS, to institute mandamus proceedings, or other appropriate proceedings, in order to compel compliance with these provisions upon reticent owners or operators of public water systems.

FISCAL EFFECT

A funding mechanism is provide in this bill. DHS is currently evaluating the costs of a fluoride mandate to public water supplies. Preliminary (but unofficial) estimates are that initial total capital costs on a statewide basis are projected to be in the range of $35 to $45 million. Annual cumulative operating costs are projected to be in the $10 to $15 million
range. Projected savings to the California MediCal/DentiCal program are expected to reach $250 million per year once the cumulative benefits of fluoride have been achieved.

COMMENTS

1)This is an emotional issue. There are four primary elements:

a) public health policy;
b) state mandates versus local control;
c) costs and funding (capital and operating); and
d) science.

2) Purpose of this bill: This bill is sponsored by the author. According to the author, this bill "is part of the U.S. Public Health Service's national campaign to fluoridate 75 percent of all Americans by the turn of the century . . . . The measure seeks to address the lack of fluoridation in California's public water supplies in an effort to prevent tooth decay, the most prevalent but most preventable and costly of oral health problems among all age groups . . . fluoridation is endorsed by the most prestigious health and advocacy organization in this state and nation .. . hundreds of studies, endorsed by our nation's leading public health organizations, have proven (concluded) again and again that fluoridation in controlled amounts has no harmful consequences to children, adults, and families. Fluoridation has proven benefits. In fluoridated communities . . . more than 50 percent of today's first graders are cavity free . . . (fluoridation is) helping people keep their teeth for life. Over the years, fluoridation has been besieged by extremists who have chosen to spread paranoia and misinformation that flies in the face of an overwhelming body of scientific evidence."

3) Background: According to the U.S. Department of Health and Human Services, small amounts of fluoride have been added to drinking water supplies for almost a half a century in thousands of communities and cities in the United States with dramatic effects. National surveys of oral health dating back several decades document continuing decreases in tooth decay in children, adults, and senior citizens in communities where the public water supplies maintain the recommended levels of fluoride.

The Department states that a recent comprehensive Public Health Services review of the benefits and potential health risks of fluoride has concluded that the practice of fluoridating community water supplies is safe and effective.

Approximately 62 percent of Americans live in communities with fluoridated water; only 17 percent of Californians do. Of the 150 largest cities in the US that are not fluoridated, 87 are in California. Los Angeles, San Diego, San Jose and Sacramento are not fluoridated while San Franciso, Long Beach and Oakland are fluoridated.

4) National Public Health Policy Statement of Community Water Fluoridation

From the US Surgeon General and the Assistant Secretary of Health, July,1992.

"The optimum standard for the success of any prevention strategy should be measured by its ability to prevent or minimize disease, ease of implementation, high benefit-to-cost ratio, and safety. Community water fluoridation to prevent tooth decay clearly meets this standard. For almost half a century, small amounts of fluoride have been added to drinking water supplies in thousands of communities and cities in the United States with dramatic effects.

"One of the great advantages of community water fluoridation as a disease prevention measure is that it does not require conscious behavior by individuals in order for them to realize benefits. Whether one is rich or poor, a child at play or in school, a busy adult, or a retired person, their benefits are gained simply by drinking fluoridated water or beverages prepared with fluoridated water. An added advantage is low cost. Nationally, the average annual fluoridation cost is only about fifty cents per person. The lifetime cost of fluoridation per person is approximately the same as the cost of one dental filling.

"The PHS (Public Health Service within the Department of Health & Human Services) continues to recommend the fluoridation of community water supplies where naturally occurring fluoride levels are deficient . . .."

5) The science: There is not a scientific question that fluoride works. It is well established that the fluoride intake of children correlates inversely with their incidence of dental caries. A literature search indicates that in excess of 3700 studies have shown or otherwise conclude that fluoride as a chemical binding agent is beneficial for reducing or
preventing the development of tooth caries.

As stated in Nutritional Biochemistry and Metabolism with Clinical Applications(footnotes -- Linder, Maria C., Ph.D., CSU, Fuller, published by Elsevier, NY) "fluorine is one of three halogens essential for the normal life, health and reproduction of man and animals. It is normally present in the body in quantities comparable to those of iron. Most fluorine is found in bone, where it readily combines with calcium . . . where this improvement contributes to the hardening of the tooth enamel and contributes to the stability of the bone mineral matrix. "This reference further states that "fluorine is one of the few trace elements where doses of beneficial and toxic effects are not widely separated. However, acute toxic effects are rare."

Fluoride is a mineral that reportedly occurs naturally in all water supplies. Fluoridation is the adjustment of the natural fluoride concentration in water supplies. Most pediatric care providers prescribe fluoride supplements for children raised in communities where fluoride in the drinking water supply is below suggested standards. Fluoride in tooth- paste is considered a topical application and is not incorporated into the tooth structure, therefore, the effects of a chemical binding agent are not fully realized.

Much of the discussion which follows has been developed by the vice chair's committee staff and is incorporated herein, almost verbatim.

The controversy over the purported adverse health effects of fluoride is related in part to evidence that exposure to fluoride in sufficiently high doses can produce toxicity in animals and humans. In the 1970's, a limited number of studies reported increased cancer mortality in cities with adjusted water fluoridation relative to cities without adjusted water fluoridation programs. The concern over a possible association between cancer and water fluoridation prompted the US Public Health Service to conduct a comprehensive review of the possible association between fluoride exposure and various adverse health outcomes. The report concluded that there is a lack of evidence of association between levels of fluoride in water and birth defects or problems of gastrointestinal, genitourinary, and respiratory systems. This report and the reports from previous international expert panels which have reviewed earlier data concluded that there is no credible evidence of any association between the risk of cancer and exposure to either natural or adjusted fluoride in drinking water.

With regard to the effects of fluoride on bone, the report found that some epidemiologic studies showed a higher incidence of bone fractures in fluoridated communities. However, these studies looked at using fluoride as treatment for bone fractures and osteoporosis and not fluoridation in water.

Finally, the report found that the incidence of dental fluorosis has increased with the introduction of fluoride in drinking water. The average prevalence of dental fluorosis in cities with optimally fluoridated water supplies was about 22 percent (17% very mild, 4% mild, 0.8% moderate, and 0.1% severe). The report states that because dental fluorosis does not compromise oral health or tooth function, an increase in dental fluorosis doesn't present a public health concern.

6) Opposition: Opponents of this proposal claim that fluoridation causes numerous health hazards including bone cancer, impaired immune systems, gum disease, hip fractures, kidney damage, dental fluorosis, and skeletal fluorosis. They also state that "recent scientific studies link an increase of cavities to drinking fluoridated water."

Opponents claim that the scientific data used to support fluoridation is factually inaccurate and scientifically unsubstantiated. According to the background material provided by opponents, research at the University of Bordeaux in France reported in the Journal of American Medical Association (JAMA: March 1995) that there is a statistically significant correlation with increased hip fracture and fluoride in drinking water. However, according to the California Dental Association, the above referenced Study has not been subjected to peer review and thus its validity remains in question.

The opponents also cite a study that found the oral ingestion of fluoride may increase the risk of hip fracture (JAMA; August 1992).The Dental Association also refutes the validity of this study because they claim it did not take into account any other risk factors. The referenced study examined hospital discharge records of patients treated for hip fracture and did not determine whether those patients were actually residents of the fluoridated community examined.

The opponents also argue that "mandating fluoridation would add another toxic burden to our already over-chemicalized and toxin over-burdened population" and that the decision to fluoridate public water supplies should be left up to local government.

7) Perspective: From a practical standpoint, it is relatively easy to fluoridate a public water system which is fed by surface waters. On the other hand, if the public water system is fed from multiple individual wells and the wells are not manifolded together prior to entering the distribution system, the ease of fluoridation may be compromised and the costs exacerbated. Many public water systems in California are fed by groundwater wells.

8) Regarding fluoride standards: The California procedures for regulating contaminants in drinking water are analogous to those followed by the federal EPA under the federal Safe Drinking Water Act.

Until 1986, EPA and the state used the same standards for fluoride. The standard varied for each community depending on average daily maximum temperatures, ranging from 1.4 ppm in localities with average high temperatures above 79.3 degrees F to 2.4 ppm in areas with average high temperatures below 53.7 degrees F.

In April of 1986, EPA adopted new fluoride standards. It set the MCL for health related primary drinking water standards at 4 ppm and the MCL for the secondary drinking water standards at 2 ppm. According to the EPA, the reason for setting the secondary MCL lower than the primary MCL is that fluoride concentrations above 2 ppm can cause the developing teeth of some children to develop a mottled or stained appearance, a condition known as dental fluorosis.

In California, DHS has chosen to continue to regulate fluoride concentrations in drinking water using the pre-1986 standards because it believes dental fluorosis is a health-related condition rather than an aesthetic problem. Therefore, California standards are more stringent than federal standards.


SPONSOR: Author

SUPPORT :
CA DENTAL HYGIENISTS ASSOC
CA MEDICAL ASSOC
CA CONGRESS OF PARENTS, TEACHERS, AND STUDENTS, INC.
CA DENTAL ASSOC
CHILDREN NOW
YOUTH LAW CENTECA ASSOC OF HOSPITALS & HEALTH SYSTEMS
CA CHAMBER OF COMMERCE
OLDER WOMEN'S LEAGUE
THE DENTAL HEALTH FOUNDATION
COUNTY OF SAN LUIS OBISPO HEALTH AGENCY
SONOMA COUNTY INDIAN HEALTH PROJECT, INC.
VENTURA COUNTY PUBLIC HEALTH
CA SCHOOL NURSES ORGANIZATION
CA PUBLIC HEALTH ASSOCIATION, NORTH
THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS
SOUTHERN CALIFORNIA PUBLIC HEALTH ASSOC
DIRECTOR OF DENTAL HYGIENE, WEST LOS ANGELES COLLEGE
SANTA ROSA MEMORIAL HOSPITAL
SHASTA COMMUNITY HEALTH CENTER
COUNTY OF SAN MATEO HEALTH SERVICES AGENCY
MATERNAL CHILD AND ADOLESCENT HEALTH ADVISORY BOARD
COLUSA COUNTY OFFICE OF EDUCATION CHILDREN'S SERVICES
SOUTHERN ALAMEDA COUNTY DENTAL SOCIETY
CENTURY DENTAL PLAN
CHILDREN'S ADVOCACY INSTITUTE
THE DENTAL HEALTH FOUNDATION (SANTA ROSA)
COUNTY OF SACRAMENTO DEPT. OF HEALTH & HUMAN SERVICES
CA CONFERENCE OF LOCAL DIRECTORS OF HEALTH EDUCATION
SAN DIEGO COUNTY DENTAL SOCIETY
PLANNING AND CONSERVATION LEAGUE
TEHAMA COUNTY HEALTH AGENCY
45 INDIVIDUALS

OPPOSED :
CA MUNICIPAL UTILITIES ASSOC
SAFE WATER COALITION, INC.
ASSOC OF CA WATER AGENCIES
THERMALITO IRRIGATION DISTRICT
128 INDIVIDUALS



David C. Nunenkamp
445-0991
aestm:4/12/95

 

Senate Analysis

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES
Senator Diane E. Watson, Chairperson

HEARING DATE:


STAFF ANALYSIS OF ASSEMBLY BILL733(SPEIER)
AS AMENDED IN SENATE JUNE 14, 1995


SUBJECT

Drinking water: Fluoridation.

INTENT

The intent of this bill is to reduce tooth decay among California children.

ABSTRACT

Existing law:

Requires the Department of Health Services (DHS) to regulate drinking water and to establish standards for monitoring contaminants that may be hazardous to public health. DHS is required to adopt primary and secondary drinking water standards that are at least as stringent as those adopted by the US EPA for contaminants, including fluoride. A primary drinking water standard is a regulation that protects human health by specifying the maximum level of a contaminant that may be present in a municipal drinking water source. A secondary drinking water standard is not health related, however it regulates the amount of any contaminant which may affect the taste, odor or appearance of water or otherwise adversely affects public welfare.

Requires the Office of Environmental Health Hazard Assessment (OEHHA) within the Cal EPA to assess the risks to human health posed by each specific contaminant in municipal drinking water. OEHHA then determines the level of the contaminant to which humans can be exposed without incurring significant health risks. The "no" significant risk level established for each contaminant is called its Recommended Public Health Goal.

Requires DHS to adopt a "Maximum Contaminant Level" (MCL) for each contaminant for which a Recommended Public Health Goal is established. The MCL must be based on the Recommended Public Health Level but may be less stringent under specified conditions.

This bill would:

Direct DHS to adopt regulations that require the fluoridation of all public water systems that have at least 10,000 service connections.

Requires these regulations to include: a minimum and maximum permissible concentrations of fluoride; procedures for maintaining proper concentrations of fluoride, including equipment, testing, recordkeeping and reporting; and a schedule for the fluoridation of individual public water systems based on the size of the system and the population being served.

Permits a public water system required to fluoridate pursuant to the provisions of this bill to comply with the regulations adopted by DHS at any time, but the requirement to comply may not be enforced until sufficient funding to pay the capital costs for compliance is available from any source other than the public water system itself.

Requires costs of compliance with the standards, compliance requirements, and regulations be paid from the General Fund, upon appropriation by the legislature. Exempts a public water system from complying with regulations adopted by the department in any year that funds are not appropriated for costs other than capital costs.

Specifies DHS enforce these provisions unless such authority is delegated pursuant to a local primary agreement. Permits the Attorney General, upon request of DHS, to institute mandamus proceedings, or other appropriate proceedings, in order to compel compliance with these provisions upon reticent owners or operators of public water systems.

FISCAL IMPACT

Undetermined. DHS is currently evaluating the costs of a fluoride mandate to public water supplies. Preliminary, yet unofficial, estimates are that initial capital costs on a statewide basis are projected to be in the range of up to $45 million, while annual cumulative operating costs are projected to be up to $15 million. The sponsor estimates a savings to the public/private dental sector of approximately $30 million.

BACKGROUND AND DISCUSSION

Fluoridation of public drinking water historically has been one of the most emotional and disputed public policies. For the past fifty years the issue of fluoridation has been passionately debated, but the debate has been intermittent. Fluoridation of drinking water has been hailed as the cheapest, safest, and most effective way to reduce tooth decay in children by the American Dental Association, the American Medical Association, the World Health Organization, and many established scientific bodies who all have endorsed fluoridation. Yet the product is vehemently opposed by numerous individuals and organizations.

Current Practices

Until 1986, the California procedures for regulating contaminants in drinking water were analogous to those followed by the federal EPA under the federal Safe Drinking Water Act. However, DHS has chosen to continue to regulate fluoride concentrations in drinking water using the pre-1986 standards varied for each community depending on average daily maximum temperatures. This could range from 1.4 ppm in localities with average high temperatures above 79.3 degrees F to 2.4 ppm in areas with average high temperatures below 53.7 degrees F. California standards are more stringent than the EPA fluoride standards of 4 ppm for primary drinking water and 2 ppm for secondary drinking water because it is believed that dental fluorosis (defective or incomplete enamel formation developing mottled or stained teeth) is a health related condition rather than an aesthetic problem.

California ranks 47th in mandating fluoridated water supplies currently fluoridating 17 percent of its water supply. As part of the strategy to achieve the Oral Health 2000 goal of fluoridated water supplies available to 75 percent of the U.S. population, the Center for Disease Control, (CDC) has sent an advisor in oral health to California. Department of Health Services requested this advisor more than a year ago to help develop strategies to promote fluoridation in California communities. The plan is to assess those characteristics of individual communities to determine the most effective strategies to promote fluoridation and also pinpoint groups that will support fluoridation, such as dental organizations, social service agencies and civic organizations.

As a result of this effort the sponsor and the many supporters of this bill would mandate fluoridation in California's public water system with an ultimate goal to decrease dental caries and present a cost-savings factor to taxpayers of approximately $80 million with cumulative effects of $160 million annually.

Opponents Perspective

Opponents believe that there are definite distinctions between the fluoride used for testing and that which is applied to the water systems. Fluoride in water is measured by fluorine ion levels and not by type or grade of fluoride. A fluorine ion is the only thing sodium fluoride and fluorosilicic acid have in common and fluoride research is basically performed with a pharmaceutical grade of sodium fluoride under controlled conditions and with distilled or deionized water. Thus this research does not reflect or take into account fluoride blends that occur when fluorine ions react with water treatment chemicals, nor does the research address fluorisilicic acid which is the most used agent for fluoridation.

The Clinical Toxicology of Commercial Products handbook indicates that undiluted fluoride is more poisonous than lead and just slightly less poisonous than arsenic. It is an accumulative poison that remains in the bone over the years. According to the Physicians Desk Reference, in hypersensitive individuals, fluorides occasionally cause skin eruptions such as atrophic dermatitis, eczema, gastric distress, headache, and weakness. These hypertensive reactions usually disappear promptly after discontinuation of the fluoride. From 1990 to 1992, the Journal of the American Medical Association published three separate articles linking increased hip fracture rates to fluoride in the water; a 6-8% increase in the elderly and menopausal women, the highest rate of hip and other fractures in the world. In the March 22, 1990 issue of the New England Journal of Medicine, Mayo Clinic researchers reported that fluoride treatment of osteoporosis increased hip fracture rate and bone fragility. A study by Procter and Gambel showed that as little as half the amount of fluoride used to fluoridate public water supplies resulted in a sizable and significant increase in genetic damage.

 

 

Political History

In 1975, Assemblyman Art Torres and Richard Alatorre opposed a fluoridation proposition on the ballot to fluoride Los Angeles. Questions arose on the fluoridation for minorities who often are underprivileged and on inadequate diets. The American Preventive Medical Association has reported that even 1 ppm found in artificially fluoridated water, can inhibit 32 enzyme systems, damage the immune system, contribute to calcification of soft tissues, worsen arthritis and cause dental fluorosis (unsightly white, yellow or brown spots found in teeth) in children. In 1993, the Subcommittee on Health Effects of Ingested Fluoride of the National Research Council admitted that 8% to 51% and sometimes up to 80% of the children living in fluoridated areas have dental fluorosis.

In 1976 SB 211 (Beilenson) was introduced to authorize $31 million to initiate fluoridation, however, the bill did not cover yearly costs for operation nor added personnel which would have been a permanent expense to California taxpayers. SB 211 failed passage in the Senate Finance Committee.

Proponents Perspective

However, the proponents state that many of the studies reported above have not been subjected to peer review or that they did not take into account any other risk factors and thus their validity remains in question. The 1991 report "Review of Fluoride - Benefits and Risks" from the U.S. P.H.S. contains the most valid of all documented information and research in that fluoride reduces dental caries and remains to be safe in the regulation of fluoridation of community water supplies.

According to the U.S. Department of Health and Human Services, small amounts of fluoride have been added to drinking water supplies for almost a half a century in thousands of communities and cities in the United States with dramatic effects. National surveys of oral health dating back several decades document continuing decreases in tooth decay in children, adults, and senior citizens in communities where the public water supplies maintain the recommended levels of fluoride. The department states that a recent comprehensive Public Health Services review of the benefits and potential health risks of fluoride has concluded that the practice of fluoridating community water supplies is safe and effective.

The U.S. Surgeon General and the Assistant Secretary of Health in July of 1992 reported, "The optimum standard for the success of any prevention strategy should be measured by its ability to prevent or minimize disease, ease of implementation, high benefit-to-cost ratio, and safety. Community water fluoridation to prevent tooth decay clearly meets this standard. For almost half a century, small amounts of fluoride have been added to drinking water supplies in thousands of communities and cities in the United States with dramatic effects. One of the great advantages of community water fluoridation as a disease prevention measure is that it does not require conscious behavior by individuals in order for them to realize benefits.....The U.S. Public Health Service continues to recommend the fluoridation of community water supplies where naturally occurring fluoride levels are deficient......."

 

COMMENTS

Numerous organizations and individuals state that we should no longer be quibbling about whether fluoride becomes toxic at 1 ppm or 2 ppm, or whether the possible saving of .8 of one tooth surface over a seventeen-year period is worth the risk of possible skeletal fluorosis or cancer. An overwhelming majority of these maintain that implementation of sound nutritional principles, removal of pollutants that reduce natural immunity, and the guarantee of appropriate health education may prove more effective in resolving the problems of tooth decay along with many other modern degenerative diseases.

Further, a large number of people believe that mandating fluoridation in California eliminates freedom of choice and statewide mandated fluoridation would be invoked for all citizens to ingest what dentists say is good for us. Many citizens state that fluoridation to simply decrease dental caries carries a risk factor much too great to acknowledge and approve

PRIOR ACTIONS

Environmental Safety and Toxic Management: Do Pass (7-5)
Assembly Appropriations: Do Pass as Amended (10-5)
Assembly Floor: Passed (48-18)

POSITIONS

Support: American College of Obstetricians and Gynecologists
California Association of Hospitals and Health Systems
California Conference of Local Directors of Health Education
California Congress of Parents, Teachers, and Students, Inc.
California Dental Hygienists Association
California Dental Association
California Chamber of Commerce
California Medical Association
California Public Health Association, North
California School Nurses Organization
Century Dental Plan
Children's Advocacy Institute
Children NOW
Colusa County Office of Education Children's Services
County of Sacramento Department of Health and Human Services
County of San Mateo Health Services Agency
County of San Luis Obispo health Agency
Dental Health Foundation
Director of Dental Hygiene, West Los Angeles College
Maternal Child and Adolescent Health Advisory Board
Older Women's League
Planning and Conservation League
San Diego County Dental Society
Santa Rosa Public Hospital
Shasta Community Health Center
Sonoma County Indian Health Project, Inc.
Southern Alameda County Dental Society
Southern California Public Health Association
Tehama County Health Agency
Ventura County Public Health
Youth Law Center
45 Individuals

Oppose: American Herbalists Guild
American Preventive Medical Association
Association of California Water Agencies
Axiom Counseling Team (ACT), Riverside, CA
California Association of Naturopathic Physicians (CANP)
California Citizens for Health
Californians for Safe Water
California Municipal Utilities Association
California Naturopathic Association
FANE (Foundation for the Advancement of Nutritional Education)
Health Alliance International,
Fluoridation Information Specialist, Walter Miller
IAAHM (International Academy of Alternative Health and Medicine)
International Academy of Oral Medicine and Toxicology
National Association of Citizens for Health
National Association of Naturopathic Physicians (NANP)
National Nutritional Foods Association
New York State Congress of Parents and Teachers, Inc.
Pure Food Campaign, Riverside, CA
Radiant Health Resources
Safe Water Association, Inc., Fond du lac, WI
Safe Water Coalition, Inc.
Smith Welding, Hanford, CA
Sibo Tool & Die Co., Redwood City, CA
Thermalito Irrigation District
256 Individuals

STAFF ANALYSIS OF ASSEMBLY BILL 733(SPEIER)

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