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SAN10 A Q U I N Environmental 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 /> ❑ 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 naed 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 /> 2of?1 <br />