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0 0 ima <br /> 4. Do you generate 200 or more pounds per month of <br /> the types of medical waste listed on Page 3? yes^no^ <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 guestions 3. 4 and 5 are no, then complete the <br /> "Certification Stat t' on Page 5 and return it with this questionnaire to <br /> the address shown at the bottom of`Page 2. <br /> If your answers to guestions 4 or 5 areye- <br /> s, please complete the"Registration <br /> For Medical Waste form on Page 6 and submit a "Medical Waste <br /> Management PW 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 file in your office, you may apply <br /> for a Limited Quantity Hauling Exemption. This <br /> exemption allows you or your staff to transport <br /> medical waste yourselves, without hiring a <br /> registered hazardous waste hauler, to a medical <br /> waste treatment facility. Do you want to apply <br /> for a Limited Quantity Hauling Exemption? yes—no <br /> If your answer is no, you will be required to ° e a registered hazardous <br /> waste hauler to transport your waste for treatment and disposal. <br /> If your answer is 3M return this questionnaire and the "Certification <br /> Statement" on Page 5 to the address onl - and a "Limited Hauling <br /> g <br /> Exemption7 application will be mailed to you. <br /> * Biosafety Level 4 viruses and diseases are: Congo-Crimean Hemorrhagic Fever, Tick- <br /> borne Encephalitis Virus Complex (Absettarov, Hanzalova, Hypr, Kumlinge, Kyasanur <br /> Forest Disease, Omsk Hemorrhagic Fever, and Russian Spring-Summer 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 "Medical <br /> Waste Management Act" for more specific registration/exemption information. <br />