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4. D• you 0# or • pounds per month of <br />the types of medical waste listed on Page 3? yes Vlno— <br />riyour• to treatyour '1:. onsite <br />your M" by • <br />incineratingor microwave technology7 • <br />If your answers to M&kons 3. 4 and - 5 are no, then complete th; <br />"Certification Statement" " i 1 Page " andreturn it with this questionnaire •.: <br />addressthe •thebottom • Page 2. <br />exemptionrl <br />For Medical Waste form on Page 6 and submit a "Medical W1 <br />Management Plan7 as specified on Pages 7 & 8. <br />If you generate less than 20 pounds of medical <br />waste per week, transport less than 20 pounds <br />at one time, and have a hauling information <br />document on Me in your office, you may apply <br />for a Limited Quantity Hauling Exemption. This <br />allowsyou oryour ff to transport <br />medicalwasteyourselves, without hiring <br />registered hazardous to .: medical <br />waste treatment M• •:.::want to apply <br />• QuantityExemptioni` !• <br />If your answer is no. you will be required to hire a registered hazardo <br />waste hauler to transport your waste for treatment and disposal. <br />if your answer is = return this questionnaire and the "Certification <br />Statemenf on Page 5 to the address shown on Page 2, and a 11mited <br />Hauling Exemption7 application will be mailed to you. <br />Biosafetya •iseases are: Congo -Crimean Hemorrhagic y <br />borne Encephalitis Virus Complex •v, Hanzalova, Hypr, <br />NOTE:Forest Disease, Omsk Hemorrhagic Fever, and Russian Spring -Summer Encephalitis), <br />Marburg Disease, Ebola, Junin Virus, Lassa Fever Vni-us, and Machupo Virus. <br />questionnaireThis acts as i only. Please refer to the enclosed "M <br />Waste Managementfor •specific information. <br />13 <br />