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4. • you generateii or • pounds per month of <br />the types of medical waste listed on Page 3? yes Vno— <br />S. Do you plan to treat your medical waste onsite <br />(at your facility), by autoclaving, <br />incinerating or using microwave technology? yes no <br />if your answers to V&§9ons 3. :1 and 5 are no, then complete th,-- <br />"Cerdfication Statemenf on Page 5 and return it with this questionnaire tt <br />the address shownthe bottom of <br />your answers to M&�ons 4 or 5 are yes. please <br />For Medical Waste form on Page 6 �nd submit a Nedical Wast,; <br />PW as specified on Pages 7 & 8. <br />6. 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 file in your office, you may apply <br />for ♦ Quantity rr• <br />e--cemption allows you or your staff to transport <br />medical wasteyourselves, hiring a <br />registered hazardous waste hauler, to a medical <br />waste treatment .« r• you wantto apply <br />for a Limited Quantity Hauling Exemption? ye4-.�no <br />if your answer is no, you will be required to hire a registered hazardoi-M <br />waste hauler to transport your waste for treatment and disposal. I <br />if your answer is = return this questionnaire and the "Certification <br />Statemenf • ♦. Page to the i ♦ shown on Pagef ♦ limited <br />Hauling Exempdon7 application ill be mailed toyou. <br />Tick- <br />borneEncephalitisComplex i. _ • Hanzalova,r <br />Forest Disease, Omsk Hemorrhagic Fever, and Russian Spring-Surnraer Encephalitis), <br />Marburg 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 "Mediml <br />Waste Management Ace for more specific registration/exemption information. <br />V <br />