BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2039


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          Date of Hearing:   April 12, 2016


           ASSEMBLY COMMITTEE ON ENVIRONMENTAL SAFETY AND TOXIC MATERIALS


                                  Luis Alejo, Chair


          AB 2039  
          (Ting) - As Amended April 5, 2016


          SUBJECT:  Solid waste: home-generated sharps


          SUMMARY:  Requires the development and implementation of  
          industry-generated plans to collect and recycle home-generated  
          sharps. Specifically, this bill:  


             1)   Declares that it is the intent of the Legislature, in  
               enacting the Safe Home-Generated Sharps Recovery Program  
               (Program), to ensure affordable and convenient sharps  
               collection opportunities, which, in turn, will help prevent  
               the improper management of those sharps. 


             2)   Repeals the provisions of Senate Bill (SB) 486  
               (Simitian, Chapter 591, Statutes of 2009), which requires a  
               pharmaceutical manufacturer that sells or distributes a  
               medication in California that is usually intended to be  
               self-injected at home through the use of a hypodermic  
               needle, pen needle, intravenous needle, or any other  
               similar device, to submit a plan to the California  
               Department of Resources Recycling and Recovery (CalRecycle)  
               that describes the actions taken by the manufacturer to: 1)  
               support or provide for the safe collection and proper  
               disposal of the waste devices, and 2) educate consumers  








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               about safe sharps management and collection opportunities.


             3)   Authorizes home-generated sharps waste to be managed by  
               a facility or other home-generated sharps collection point  
               operated pursuant to a home-generated sharps stewardship  
               plan. 


             4)   Defines "home-generated sharps stewardship plan" as a  
               plan submitted by an individual producer or by a  
               stewardship organization on behalf of one or more  
               producers. 


             5)   Defines "producer" as: 1) the person who manufactures  
               home-generated sharps and who sells, offers for sale, or  
               distributes those home-generated sharps in the state under  
               that person's own name or brand; 2) if there is no person  
               who is a producer of the home-generated sharps, it is the  
               owner or licensee of a trademark or brand under which the  
               home-generated sharps are sold or distributed in the state,  
               whether or not the trademark is registered; or, 3) if there  
               is no person who is a producer of the sharps per 1) and 2)  
               above, the producer of those sharps is the person who  
               imports the home-generated sharps into the state for sale  
               or distribution. 


             6)   Defines "stewardship organization" as either a nonprofit  
               organization created by one or more producers to act as an  
               agent on behalf of the producers to design, submit, and  
               administer a product stewardship plan pursuant to this  
               chapter; or a producer of a covered product. 


             7)   Requires CalRecycle, on or before January 1, 2018, to  
               adopt regulations. 









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             8)   Requires, on or before February 1, 2018, CalRecycle to  
               appoint a stakeholder advisory committee, with  
               representation from specific sectors, to provide  
               recommendations and guidance to producers and stewardship  
               organizations. Requires the stakeholder advisory committee  
               to annually report to CalRecycle. 


             9)   Requires a pharmaceutical manufacturer that sells or  
               distributes a medication that is intended to be  
               self-injected at home to submit to CalRecycle a plan that  
               describes how the manufacturer supports the safe collection  
               and proper disposal of the home-generated sharps, on or  
               before July 1 of each year.


             10)  Requires, on or before July 1, 2018, a producer or a  
               stewardship organization designated by a producer, to  
               submit a home-generated sharps stewardship plan to  
               CalRecycle. 


             11)  Requires the producer or stewardship organization to  
               consult with the stakeholder advisory committee as it  
               develops its stewardship plan. Requires the plan to provide  
               for the development and implementation of a recovery  
               program to reduce the generation of, and manage the end of  
               life of, home-generated sharps in an environmentally sound  
               and medically safe manner. 


             12)  Specifies that the stewardship plan must contain the  
               following elements:


                  a.        Contact information for all participating  
                    producers;









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                  b.        Procedures for calculating the amount, by  
                    weight, of the home-generated sharps subject to the  
                    plan;


                  c.        Provisions for meeting specified collection  
                    targets;


                  d.        A demonstration of sufficient funding to  
                    implement the plan;


                  e.        Coordination of the home-generated sharps  
                    stewardship plan with existing household hazardous  
                    waste (HHW) and other local collection programs;


                  f.        Programs to reduce the number of  
                    home-generated sharps that are illegally disposed of,  
                    and to maximize the proper end of life management of  
                    home-generated sharps;


                  g.        Education and outreach efforts;


                  h.        Methods for demonstrating that the program  
                    implemented achieves the maximum improvement possible  
                    on the improper disposal of home-generated sharps; 


                  i.        The establishment of at least one  
                    home-generated sharps collection point in every county  
                    in the state, but no less than one home-generated  
                    sharps collection point for every 25,000 people in  
                    each county; and,









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                  j.        Procedures for complying with all applicable  
                    state and federal laws and regulations for the  
                    collection, consolidation, transportation, and  
                    recycling or disposal of home-generated sharps waste. 


             13)  Requires CalRecycle to review a home-generated sharps  
               stewardship plan within 60 days of receipt. Specifies  
               timelines for approval and for requiring resubmission of a  
               revised stewardship plan. 


             14)  Requires an approved plan to be public record, except  
               for any financial, production, or sales data reported to  
               CalRecycle by the producer or stewardship organization.


             15)  Requires, on or before January 1, 2019, or three months  
               after a plan is approved, whichever is later, but no later  
               than April 1, 2019, the producer or stewardship  
               organization to implement the home-generated sharps  
               stewardship program described in the plan.


             16)  Authorizes a retailer to voluntarily participate as a  
               home-generated sharps collection point pursuant to the  
               home-generated sharps program. 


             17)  Requires CalRecycle, on or before January 1, 2023, to  
               consult with producers, stewardship organizations, the  
               stakeholder advisory committee, and all other stakeholders  
               regarding the Program's performance. 


             18)  Requires CalRecycle, once the plan is approved, to post  
               on its Internet Website a list of producers covered under  
               the plan. 








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             19)  Requires, on or before April 1, 2020, and annually  
               thereafter, each producer or stewardship organization  
               implementing a plan to prepare and submit to CalRecycle an  
               annual report with information describing the activities  
               carried out pursuant to the plan and specific  
               recommendations from the stakeholder advisory committee  
               that were accepted or rejected by the stewardship  
               organization. 


             20)  Requires CalRecycle to review and approve or disapprove  
               the annual report and review the accuracy of the list of  
               home-generated sharps collection points that are certified  
               to be established pursuant to the plan. 


             21)  Authorizes CalRecycle, if the annual report does not  
               demonstrate that the applicable program has achieved the  
               collection rate increase as required pursuant to  
               aforementioned collection targets, to require additional  
               actions to improve collection rates. 


             22)  Requires a report deemed approved by CalRecycle if  
               CalRecycle does not disapprove a report within 45 days of  
               receipt. Requires all approved reports to be posted on   
               CalRecycle's Website for one year. 


             23)  Requires a producer or stewardship organization  
               submitting a plan to CalRecycle to pay an annual  
               administrative fee, which shall be set at an appropriate  
               amount to cover CalRecycle's administrative costs. 


             24)  Establishes the Safe Sharps Disposal Account within the  
               Integrated Waste Management Fund and requires the  








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               administrative fees to be deposited into that Account. 


             25)  Authorizes CalRecycle to enforce this article and impose  
               a civil penalty of up to $1,000 per violation per day.  
               Authorizes CalRecycle to impose a civil penalty on a person  
               who knowingly and intentionally violates this article of up  
               to $10,000 per violation per day.


             26)  Establishes the Safe Sharps Disposal Penalty Account  
               within the Integrated Waste Management Fund and requires  
               all penalties to be deposited into that Account. 


             27)  States that any action by a producer, stewardship  
               organization, or retailer is not a violation of the  
               Cartwright Act (Business & Professions Code (B&P) § 16700,  
               et seq.) or the Unfair Practices Act (B&P 1700, et seq.). 


          EXISTING LAW:  


             1)   Authorizes a city and a county HHW element to include a  
               program for the safe collection, treatment, and disposal of  
               sharps waste generated by households. (Public Resources  
               Code (PRC) § 41502) 


             2)   Requires manufacturers of self-injectable medications to  
               annually submit a plan describing how it provides for the  
               safe collection and proper disposal of medical sharps. (PRC  
               § 47115)


             3)   Requires each county to prepare a HHW element which  
               identifies a program for the safe collection, recycling,  
               treatment, and disposal of hazardous wastes, which are  








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               generated by households in the city and which should be  
               separated from the solid waste stream. (PRC § 41510)


             4)   Defines "home-generated sharps waste" as hypodermic  
               needles, pen needles, intravenous needles, lancets, and  
               other devices that are used to penetrate the skin for the  
               delivery of medications derived from a household, including  
               a multifamily residence or household. (Health & Safety Code  
               (H&S) § 117671)  


             5)   Prohibits the disposal of home-generated sharps waste in  
               the trash or recycling containers, and requires that all  
               sharps waste be transported to a collection center in a  
               sharps container approved by the local enforcement agency.  
               (H&S §  118286)


             6)   Pursuant to the Medical Waste Management Act (MWMA) (H&S  
               § 117600, et seq.):


                  a.        Defines "medical waste" as including waste  
                    generated from the consolidation of home-generated  
                    sharps. (H&S § 117690) 


                  b.        Authorizes a registered medical waste  
                    generator to accept and consolidate home-generated  
                    sharps waste with the facility's medical waste stream  
                    under specified conditions. (H&S § 118147)


                  c.        Requires a person generating or treating  
                    sharps waste to ensure that the medical waste is  
                    treated to render it solid waste prior to disposal.  
                    (H&S § 118215)









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                  d.        Requires sharps waste to be rendered  
                    noninfectious prior to disposal by a specified  
                    treatment method. (H&S § 118225)


                  e.        Specifies containerization, storage and  
                    labeling requirements for sharps waste. (H&S §  
                    1118275, 118285, and 118286)


                  f.        Authorizes a local enforcement agency to  
                    approve a location as a point of consolidation for the  
                    collection of home-generated sharps waste, which,  
                    after collection, shall be transported and treated as  
                    medical waste. (H&S § 117904)


          


          FISCAL EFFECT:  Unknown. 


          COMMENTS:  


          Need for the bill: According to the author, "AB 2039 requires  
          sharps manufacturers to design, fund, and administer a take-back  
          program to safely collect and dispose of home-generated sharps  
          to keep them out of the trash ? California has set a goal to  
          recycle 75% of waste by 2020, which will require a great deal  
          more of hand sorting of our waste stream. Inaction on sharps  
          disposal leaves some workers over-exposed to health dangers, a  
          risk compounded by the growing use of home-generated sharps. We  
          must remove sharps from the waste stream on the front end so  
          that important state recycling goals are not unintentionally at  
          cross purposes with worker safety."









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          Medical sharps: An estimated one million Californians inject  
          medications outside traditional health care facilities, which  
          generate approximately 936 million sharps each year, and the  
          numbers of patients using injectable medications will continue  
          to grow because it is an effective delivery method for various  
          medications.  The most common home use of sharps is to manage  
          diabetes.  Other reasons to inject at home include hepatitis,  
          multiple sclerosis, infertility, migraines, allergies,  
          hemophilia, and medications for pets. 


          Sharps waste: According to statistics from CalRecycle, 43% of  
          all self-injectors throw needles in the trash. According to  
          CalRecycle's 2014 waste characterization study, 2014  
          Disposal-Facility-Based Characterization of Solid Waste in  
          California, the composition of California's overall disposed  
          waste stream is dissected by material type. There is not a  
          line-item for home-generated sharps, but under the category of  
          HHW is the subcategory "Remainder/Composite Household  
          Hazardous," which includes household hazardous material that, if  
          improperly put in the solid waste stream, may present handling  
          problems or other hazards, such as pesticides and caustic  
          cleaners, sharps, medications, and supplements. The 2014 report  
          estimates that remainder/composite household hazardous materials  
          comprises more than 94,000lbs (0.2%), of the total solid waste  
          stream. 


          Sharps risk: Improper sharps disposal can affect janitors,  
          housekeepers, pest control workers, groundskeepers, waste  
          management workers, and children or household pets among others.  
          Roughly 25% to 45% of all facilities processing household trash  
          (besides recycling) in California have workers hand-sorting  
          recyclable material out of that trash. A single worker's  
          on-the-job needle stick can mean weeks of taking drugs to  
          prevent the spread of infection, with side effects including  
          nausea, depression, and extreme fatigue as well as months  
          waiting for expensive periodic tests to reveal whether they  








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          contracted life-threatening HIV/AIDs or hepatitis B or C.  
          According to CalRecycle, it costs between $154 to $2,411 for  
          testing/treatment for a single needlestick, and around $4.6  
          million is spent in California every year due to needlesticks,  
          primarily for testing for infection and work loss while testing.  



          In 2013, in connection with AB 1893 (Stone and Eggman) and a  
          related Senate Labor Committee hearing, the Legislature  
          requested that the Commission on Health and Safety and Workers'  
          Compensation review whether provisions of current law offered  
          sufficient protection against sharps injuries for workers  
          outside healthcare occupations. As a result, the University of  
          California, Berkeley (UC Berkeley) released a March 2015, study,  
          Infection Risk from "Sharps" Injuries for Non-healthcare  
          Workers, which found a contrary view. That study stated, "sharps  
          injuries, outside the healthcare setting are uncommon. About  
          1-in-10,000 workers outside healthcare will experience a  
          needlestick in a given year. For specific industries (education,  
          food & hospitality, and waste management) and occupations  
          (custodial services and protective services), this risk is  
          substantially higher. However, even in these specific industries  
          and occupations, the risk of a sharps injury is less than 1/1000  
          workers/year." The study concluded that, "no evidence that  
          additional statutory and regulatory action covering home-health  
          sharps waste or sharps injuries to non-healthcare workers is  
          warranted."





          The California Life Sciences Association asserts the results of  
          the UC Berkeley study can be chalked up to existing  
          opportunities for safe disposal, specifically stating that  
          "because throwing sharps in the trash is already illegal,  
          patients and healthcare providers have access to numerous sharps  
          disposal options ? Current options for disposal include  








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          manufacturers' and others' mail-back programs, disposal with the  
          patient's healthcare provider, disposal at designated household  
          hazardous waste facilities and some pharmacies, needle  
          destruction devices, and disposal via a rigid plastic container  
          (e.g., bleach or detergent bottle) is permitted in ten counties.  
          Furthermore, sharps manufacturers in California must already  
          include safe disposal information in the packaging inserts  
          accompanying the patient's medicine, maintain a call center to  
          answer disposal questions, and post safe disposal information on  
          their websites. These requirements are in addition to the  
          ongoing education and outreach to healthcare providers, and the  
          patient's primary source of information on home-health  
          injectable medicines is generally his or her provider." 





          However, the UC Berkeley study specifically looked at the  
          incidences of needlesticks, the cost to employers, and the cost  
          (if any) and risk faced by workers. Even if the incidence of  
          pricks, the pathogen transfer, and the cost to employers are all  
          low, the intent of AB 2039 is to have a safe mechanism to  
          prevent all injuries given the exponential growth of the  
          consumption of injectable drugs at home. 





          Sharps collection: Home-generated sharps waste is required to be  
          put into an approved sharps container before being transported  
          out to an approved drop-off location or via mail-back program.   
          CalRecycle maintains the Facility Information Toolbox (FacIT)  
          Website, which currently lists more than 600 facilities where  
          residents can take their home-generated sharps such as  
          hospitals, pharmacies, or HHW facilities. 










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          While disposal of sharps is illegal, there is no statutory  
          program in place to require the management of sharps by  
          manufacturers, pharmaceutical companies, pharmacies, or others.   
          Current law allows for a streamlined oversight structure for  
          those that do wish to provide a voluntary disposal for sharps to  
          their customers or the general public, but there is no mandate  
          for them to do so.  Some pharmacies and health care providers  
          have developed programs as a way to assist their customers and  
          have reported some success.  


          Currently, out of California's 58 counties, three counties  
          (Tulare, San Luis Obispo, and Santa Cruz) and two cities (Galt  
          and Santa Cruz) have an ordinance that has some level of  
          requirements on retail establishments that sell sharps to accept  
          the used sharps for proper disposal. Other jurisdictions are  
          considering a similar ordinance. According to CalRecycle,  
          approximately 50 counties provide free disposal. At least eight  
          counties and some cities provide free sharps containers and one  
          county provides free mail-back containers to its residents as  
          long as supplies last.

          Sharps collection requirements under the Medical Waste  
          Management Act (MWMA): The Department of Public Health (DPH) has  
          the authority to approve locations as points of consolidation  
          for the collection of home-generated sharps waste, which, after  
          collection, is transported and treated as medical waste. An  
          approved consolidation location is known as a "home-generated  
          sharps consolidation point." A home-generated sharps  
          consolidation point must comply with all of the following  
          requirements: (1) All sharps waste shall be placed in sharps  
          containers; and (2) sharps containers ready for disposal shall  
          not be held for more than seven days without the written  
          approval of the enforcement agency.  


          Under AB 2039, a home-generated sharps stewardship plan must  
          establish at least one home-generated sharps collection point in  
          every county in the state, but no less than one home-generated  








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          sharps collection point for every 25,000 people in each county,  
          and the plan must include procedures for complying with all  
                                                                 applicable state and federal laws and regulations for the  
          collection, consolidation, transportation, and recycling or  
          disposal of home-generated sharps waste.


          Current requirements for sharps manufacturers: Pursuant to SB  
          486, a pharmaceutical manufacturer that sells or distributes a  
          medication in California that is intended to be self-injected at  
          home through the use of a hypodermic needle, pen needle,  
          intravenous needle, or any other similar device, is required to  
          submit a plan to CalRecycle that describes the actions taken by  
          the manufacturer to support or provide for the safe collection  
          and proper disposal of the waste devices, and educate consumers  
          about safe sharps management and collection opportunities. To  
          date, CalRecycle has received sharps collection and disposal  
          plans from 29 pharmaceutical manufacturers or distributors.


          According to the analysis of SB 486, "?with the prohibition of  
          disposal of sharps in the waste stream and no convenient, cost  
          effect [sic] method of management identified, it is time to take  
          steps to find a solution of the problem. The first step to that  
          is to identify what the companies that manufacture the medicines  
          that are dispensed through a 'sharp' are doing to help their  
          customers address the disposal ban issue? The author's office  
          believes that this bill represents a first step toward  
          developing an EPR [Extended Producer Responsibility] approach to  
          the management of sharps, and provides a way to determine what  
          the pharmaceutical industry is doing to assist with the effort  
          to manage sharps."


          In the opinion of the Monterey Regional Waste Management  
          District, the voluntary provisions of SB 486 are not working. As  
          of July 1, 2012, there were 31 plans submitted to CalRecycle,  
          which were read and graded by a 9-person evaluation team,  
          scoring each plan based on published consumer criteria. The  








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          Senate Bill 486 Evaluation Team Consumer Report Card found that,  
          of those 31 manufacturer reports, 20, or nearly 65% of all  
          submitted reports, were graded an F. In addition, 8 other  
          manufacturers were graded "F/Incomplete" for not submitting  
          plans by the legislatively mandated deadline of July 1 and being  
          in violation of state law. 





          AB 2039 proposes to repeal the provisions enacted pursuant to SB  
          486, entirely, and replace them with new requirements for the  
          collection and safe disposal of home-generated sharps.





          Extended producer responsibility: CalRecycle defines extended  
          producer responsibility (EPR) as a strategy to place a shared  
          responsibility for end-of-life product management on the  
          producers, and all entities involved in the product chain,  
          instead of the general public; while encouraging product design  
          changes that minimize a negative impact on human health and the  
          environment at every stage of the product's lifecycle.  This  
          allows the costs of treatment and disposal to be incorporated  
          into the total cost of a product.  It places primary  
          responsibility on the producer, or brand owner, who makes design  
          and marketing decisions. It also creates a setting for markets  
          to emerge that truly reflect the environmental impacts of a  
          product, and to which producers and consumers respond. 


          By shifting costs and responsibilities of product disposal to  
          producers and others who directly benefit, EPR provides an  
          incentive to eliminate waste and pollution through product  
          design changes. 









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          There are a number of existing, statewide EPR programs for  
          various products, including, but not limited to paint, used oil,  
          and, most recently, mattresses. 

          AB 2039 proposes building on the models of the aforementioned  
          programs to develop EPR for home-generated medical sharps. 


          Related bills: 


             1)   SB 1229 (Jackson) would provide that an entity  
               registered with the federal Drug Enforcement Agency to  
               receive a controlled substance for the purpose of  
               destruction is not liable for civil damages, or subject to  
               criminal prosecution, for maintaining a secure drug  
               take-back bin on its premise. This bill will be heard in  
               the Senate Judiciary Committee on April 12. 
             2)   AB 1159 (Gordon, 2015) proposed establishing a pilot  
               product stewardship program for the management of medical  
               sharps and household primary batteries. It was approved by  
               the Assembly Environmental Safety & Toxic Materials  
               Committee on April 28, 2015 by a 6-0 vote. AB 1159 was held  
               in the Assembly Appropriations Committee. 


             3)   AB 1893 (Stone/Eggman, 2014) proposed requiring  
               customers be given a free sharps disposal container with  
               the sale of 50 or more medical sharps for self-injection.  
               AB 1893 was pulled by the author from the Assembly Floor. 


             4)   AB 403 (Stone/Eggman, 2013) proposed requiring  
               manufacturers that sell medical sharps to establish a  
               product stewardship plan for home-generated medical waste.   
               AB 403 was held in the Assembly Appropriations Committee.










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          REGISTERED SUPPORT / OPPOSITION:




          Support



          California Product Stewardship Council (Sponsor) 


          Atlas Disposal Industries 


          Bay Counties Waste Services


          BMS Technologies


          Burrtec Waste Industries


          Butte County


          Cal-Waste Recovery Systems


          Californians Against Waste 


          California Alliance for Retired Americans


          California Refuse Recycling Council










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          California State Association of Counties


          California Teamsters Public Affairs Council Cal-Waste Recovery  
          Systems


          City and County of San Francisco


          City of Sacramento


          City of Lakewood


          City of Sunnyvale 


          Consolidated Fabricators Corp.


          County of Santa Clara 


          CR&R Environmental Services


          Davis Waste Removal Co. Inc. 


          Desert Valley Disposal, Inc. 


          Drug Policy Alliance


          East Bay Counties Waste Services









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          East Bay Sanitary Co. 


          E-Recycling of California 


          Garaventa Enterprises


          Garden City Sanitation


          GreenWaste Recovery


          Inland Empire Disposal Association


          Kern County


          Kern Refuse, Inc.


          League of California Cities


          Los Angeles County Integrated Waste Management Committee/Task  
          Force


          Los Angeles County Waste Management Association


          MarBorg Industries


          Marin Sanitary Service








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          Monterey Regional Waste Management District


          Napa Recycling & Waste Services


          Northern Recycling Operations & Waste Services, LLC


          Palm Springs Disposal Services


          Recology 


          Rural County Representatives of California


          San Diego County Board of Supervisors


          San Francisco Public Utilities Commission


          Silicon Valley Leadership Group


          Solid Waste Association of North America


          Solid Waste Association Orange County


          South Lake Refuse & Recycling


          Southern California Disposal & Recycling Stanislaus County








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          Strategic Materials


          Turlock Scavenger Company


          United Pharmacy 


          Upper Valley Disposal & Recycling


          Western Placer Waste Management 


          Authority 


          Varner Bros




          Opposition



          Advanced Medical Technology Association


          Amgen


          AstraZeneca


          BD








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          Biocom


          Biotechnology Industry Organization


          Biotechnology Innovation


          Bristol-Myers Squibb


          Cal Chamber


          California Life Sciences Association


          California Manufacturers and Technology Association


          Industrial Environmental Association


          Eli Lilly


          Medtronic


          Pharmaceutical Research and Manufacturers of America (PhRMA)


          Silicon Valley Leadership Group


          PhRMA








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          Analysis Prepared by:Paige Brokaw / E.S. & T.M. / (916) 319-3965