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0 1 0 <br />4. D• you generate 200 or • pounds per • of <br />the types of medical waste listed on Page 3? yes,—np-Z <br />D• you plan to treat your• onsf <br />your by <br />incinerating or itechnology? • <br />If your • guestions3, 4. • •then complete <br />"Certification Statement" on Page 5 and return it with this questionnaire to <br />the address • bottom of' Page 2. You•• not need to complete <br />the rest of • package. <br />TOM / • a r; <br />If you - 1 pounds of • <br />waste per week, transport less than 20 pounds <br />at one time, • have . hauling information <br />document on file 'in your office, you may apply <br />for a Limited Quantity Hauling Exemption. <br />exemption allowsyou or • to transport <br />medicalyourselves, without <br />registered hazardousto a medical <br />waste treatment, faciJity. D• you want to apply <br />for a Limited Quantity Hauling Exemption?• <br />_/ <br />If your . •• r • • • -• •hazardous <br />waste hauler to transport your , waste for treatment and disposal. <br />if your answer is M return this questionnaire and the "Certification <br />Statement" on Page 5 to the address shown below, and a "Limited Hatiling <br />r rr•!7 application will be -• to you. <br />Biosafety• diseasesare:• ••-Crimean Hemo <br />Tick- <br />borne EncephalitisVirus,r •v, Hanzalova, Hypr, <br />NOTE:Forest Disease, Omsk Hemorrhagic Fever, and Russian Spring-Sununer Encephalitis), <br />Marburg Disease, Ebola, Junin Virus, Lassa Fever Virus, and Machupo Virus. <br />This questionnaire acts, as:a guideline only. Please refer to the enclosed "Medij <br />Waste Management Act" for more specific registration/exemption information. <br />N <br />