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R <br />PRE-APPUCATION QUESTIONNAIRE <br />Please check the appropriate response for the questions listed below. <br />REGULATED WIEDICALWASTES <br />LaboratoryWastes -specimen ormicrobiolo cul <br />Sic tures, stocks of infectious agents, <br />an ture <br />•• • i F1 liquid 1 ••1' is' tregulated ►••fluids,or <br />articles contan-driated with blood or body fluids <br />(X) Sharps; - syringes, needles, blades, -broken glass <br />♦1Ktrt r. :t' rrrrrials - animal carcasses, ►•1 parts. bedding <br />.autopsySurgicd'Spedmens huftm -or animal parts or tissues' removed surgicalLv or by <br />Isolation Wastes: -.waste With_,ej=etion,,exudate, or secretions from <br />-humans ora'nimals who. due-ofily to the. higWycommunicable diseases <br />listed'by.-Centers for Disease Control as req Biosafety Level 4 precautions.* <br />I.. ...Does your business or. seM;e generate anv of <br />If <br />your a . t ii 1 i ►lease# t 1 r. - `.*Certification ' ` utr r.r { on Page <br />YOU or your; fadity generate. Please, complete the rest of this questionnaim <br />•, g'engrnte.lessi.i it po=i , -of rM 1 <br />r ►r • t •area -small <br />generator.• <br />your'3.- Siria. :1��enerators may store their. medical.Nvaste <br />in a permitted common storage facility. vnth <br />othei smat -DQ ' Plan to do this - <br />generators you <br />wyesc• <br />if your: Answer - is : M' a PHS-EHD "Common Storage Facility Permit <br />Application mailed- <br />-CONTENUM ON a <br />0 <br />M <br />