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4. D• you generate 200 or • pounds per monthof <br />typesthe of ilisted on Page yesZnp.— <br />S. <br />your byautoclaving, <br />incineratingor • • • • <br />If your answers to guestions 3, :1 and 5 are no hen complete the <br />"Certification Statement!'on Page 5 andreturn it with thisquestionnaire to <br />the address shown at the bottom of'Page 2. You do not need to complete <br />the rest of • <br />if your answers to guestions 4 or 5 are yes • •♦•r: <br />For Medical Wasteform on <br />Management PlanPlan7 as specified on <br />you 1 poundsof r <br />waste per transport less than 20 pounds <br />at one time, ihave a hauling information <br />document on - your office,you apply <br />for • Quantity Hauling Exemption. <br />exemption allowsyou or • to transport <br />medical•without <br />registered hazardousto a medical <br />waste treatment facility. D• you want to apply <br />for -i • r • • <br />• <br />If your i• r 1 • • -• •• <br />waste hauler • transport yourfor . • and disposal. <br />If your answer is 3M return this questionnaire and the "Certification <br />Statement" on Page 5 to the address shown below, and a "limited Hauling <br />Rxempti=7 application will be mailed to you. <br />Biosafety Level 4 viruses and diseases are: Congo -Crimean Hemorrhagic Fever, Tick- <br />borne Encephalitis Virus Complex (Absettarov, Hanzalova, Hypr, Kumlinge, Kyasanur <br />Forest Disease, Omsk Hemorrhagic Fever, and Russian -Surnmer Encephalitis), <br />Marburg Ebola,i •Machupo <br />This questionnaire acts, as a guideline only. Please refer to the enclosed "Medic <br />Waste li for •specific'' i • • information. <br />El <br />