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SAN J O A Q U I N tinvlronmental Health Department <br /> COUNTY <br /> PRE -APPLICATION QUESTIONNAIRE <br /> Regulated Medical Wastes <br /> Please check the appropriate box for the questions listed below : <br /> Pharmaceuticals : prescription or over-the - counter human or veterinary drug , including , but not <br /> ° limited to , a drug as defined in Section 109925 of the Federal Food , Drug , and Cosmetic Act , as <br /> amended (21 U , S . C . A , Sec . 321 ( g ) ( 1 ) ] . This definition does not include RCRA waste . <br /> ❑ Laboratory Wastes : specimen or microbiologic cultures , stocks of infectious agents , live and <br /> attenuated vaccines and culture mediums . <br /> �N Blood or Body Fluids : liquid blood elements , other regulated body fluids , articles contaminated <br /> with blood or body fluids . <br /> Sharps : syringes , needles , blades and contaminated broken glass . <br /> ❑ Contaminated Animals : animal carcasses , tissues , and fluids contaminated with infectious <br /> agents that are contagious to humans . <br /> Surgical Specimens : human or animal parts or tissues removed surgically or by autopsy that <br /> \ are contaminated with infectious agents that are contagious to humans or in a fixative ( e . g . <br /> formaldehyde ) , <br /> ❑ Isolation Wastes : waste contaminated with excretion , exudates , or secretions from humans or <br /> animals that are isolated due to highly communicable diseases . <br /> ❑ Chemotherapy Wastes : waste contaminated through contact with chemotherapeutic agents . <br /> 1 . Does your business or service generate any of the medical waste listed above ? ❑ Yes ❑ No <br /> If your answer is " No " , please complete the " Certification Statement" on Page <br /> 4 and return it with this questionnaire to the address indicated . You do not need <br /> to complete the remainder of this questionnaire and you do not need to pay a <br /> fee , <br /> 2 . Do you generate less than 200 pounds of medical waste per month ? ❑ Yes ❑ No <br /> If you answered " Yes you are a small generator . <br /> 3 . Small generators may store their medical waste in a permitted Common <br /> Storage Facility with other small generators . Do you plan to do this at your <br /> facility ? ❑ Yes ❑ No <br /> 2of11 <br />