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5. Do you plan to treat your medical waste ONSITE (at your facility)by autoclaving, <br /> incinerating or suing microwave technology? <br /> ❑Yes ®No <br /> If your answers to questions 3, 4 and 5 are NO complete then complete the <br /> "Certification Statement" and return the questionnaire to the Environmental Health <br /> Department. You do not need to complete the rest of the forms in this package. <br /> If your answers to questions 4 or 5 are YES please complete the "Registration For <br /> Medical Waste"form and submit a"Medical Waste Management Plan." <br /> 6. If you generate less than 20 pounds of medical waste per week, transport less than 20 pounds <br /> at one time, and have a hauling information document on file in your office, you may apply <br /> for a Limited Quantity Hauling Exemption. This exemption allows you or staff to transport <br /> medical waste,without hiring a registered hazardous waste hauler, to a medical waste <br /> treatment facility. Do you want to apply for a Limited Quantity Hauling Exemption? <br /> ❑Yes ®NO <br /> If your answer is NO, you will be required to hire a registered hazardous waste hauler to <br /> transport your waste for treatment and disposal. <br /> If your answer is YES, return this questionnaire and the"Certification Statement' and a <br /> "Limited Quantity Hauling Exemption" application will be mailed to you. <br /> • Bio-safety Level 4 viruses and diseases are: Congo-Crimean Hemorrhagic Fever, Tick-borne <br /> Encephalitis Virus complex (Absettarov, Hanzalova, Hypr,Kumlinge, Kyasanur Forest <br /> Disease, Omsk Hemorrhagic Fever, and Russian Spring-Summer Encephalitis),Marburg <br /> Disease, Ebola, Junin Virus, Lassa Fever Virus, and Machupo Virus. <br /> NOTE: <br /> This questionnaire acts as a guideline only. Please refer to the enclosed"Medical Waste <br /> Management Act" for more specific registration/exemption information. <br /> GUIDELINES FOR THE MEDICAL WASTE MANAGEMENT PLAN <br />