Declaration of Service: Stipulation for Settlement and Dismissal Without Prejudice

    DECLARATION OF SERVICE BY MAIL, 

Case Name: Erika Maithews, et al. v. Molly Coye 
Court No.: U.S.D.C., Northern District No. C-90-3620 EFL 

  

  

I declare that: 

I am employed in the County of Alameda, California. I am over the os of 18 years 
and not a party to the within entitled cause; my business address is 2101 Webster Street, 
12th Floor, Qakland, California 94612-3049, 

On October 16, 1991, 1 served the attached in 

STIPULATION FOR SETTLEMENT AND DISMISSAL WITHOU T PREJUDICE 

in said cause by placing a true copy thereof enclosed in a sealed envelope with postage 
thereon fully prepaid, in the United States Mail at Oakland, California, addressed as 
follows: 

Joel R. Reynolds Mark Rosenbaum 
Jacqueline Warren ACLU Foundation of Southern California 
Natural Resources Defense Council 633 South Shatto Place 
617 South Olive Street, Suite 1210 Los Angeles, CA 90005 
Los Angeles, CA 90014 

Kim Card 
Jane Perkins Legal Aid Soren of Alameda County 
Michelle Melden 1440 Broadway, Suite 700 
National Health Law Program Oakland, CA 94612 
2639 South La Cienega Boulevard 
Los Angeles, CA 50034 Edward M. Chen 

ACLU Foundation of Northern California 
Bill Lann Lee 1663 Mission Street 
Kevin 5, Reed Suite 460 
NAACP Legal Defense and San Francisco, CA 94103 
Educational Fund, Inc. | 
315 West Ninth Street, Suite 208 
Los Angeles, CA 20015 

I declare under penalty of perjury that the foregoing is true and correct, and that this 
declaration was executed at Oakland, California, on foes 16, 1991. 

: Date 

Oi 3 se (Signature) 

  

  

DET. 16: 731 13:68 ATTORHWEY GEN: OFFICE PAGE . B82 

 



  

CHILDHOOD LEAD POISONING EVALUATION QUESTIONNAIRE 

The following questions are to be answered by the parenis/guardians of EPSDT eligible 
children under 72 months of age at each periodic health assessment. 

1 Does your child live in or regularly visit a house or other location with peeling 
or chipping paint built before 19607 [This can include a day care center, 
preschool, school, barn, home of babysitter, relative, friend, etc. 

Yes No 
RUC ECC a 

Does your child live in or regularly visit a house built before 1960 with recent or 
ongoing renovation or remodeling? 

Yes No 
A ———_] BR. —S Shh 

Does you child have a parent, brother, sister, housemate or playmate who is 
being treated or followed for lead poisoning [i.e., blood lead > 10 ug/dl}? 

Yes No 
Re SVN I————— 

Does your child live with someone whose job or hobby involves exposure to lead 

[i.e., painting, soldering, automobile battery manufacturing or recycling, vehicle 
radiator repair]? 

Yes No 

Does your child live near an active lead smelter or battery recycling plant or 
other industry likely to release lead? 

Yes No 
rp ————— BR ——— 

fa:\ matthews \maithews. qin) 

11:18) ATTORNEY GEW: OFFICE PAGE . BA! 1