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E <br />4, Do you generate 200 or more pounds per on of <br />the typ(,s of medical waste listed oii Page 37 yesXno <br />S. Do you plan to treat your medical waste on.site <br />(at your facility), by autoclaving, <br />incinerating or using microwave technology? Yes---Xl <br />If your wBwers toLc.�.tions 3 <br />,_I _An� --j_fj are no, then complete the <br />"Certification Statemene' on Page 5 and return it with tlu's questionnaire to <br />the address shown at the bottom of Page 2. You do not need to complete <br />the rest of the forms in this package. <br />If your answers to q�j are .!, please complete the "Registration <br />For Medi -cal Waste" form on Page 6 and submit a "Medical Waste <br />Management Plan" as specified on Pages 7 & 8. <br />4. if you generate less than 20 pounds of medical <br />waste per week, trzmsport less than 20 pounds <br />at one tLrnc, and have a hauling information <br />doc,urnent on file in your office, you inay apply <br />for a Limited Quantity Haulilig Exemption. This <br />exemption alloWs you or your- staff to transport <br />medical waste yourselves, without hiri ag a <br />registered hazardous waste hauler, to a medical <br />waste treatment facility. Do you want to apply <br />for a Lin-dted Quantity Hauling Exemption? yes no <br />if your answer is KL% you will be required to hire a registered hazardous <br />waste hauler to trai,-asport your waste for treatment and disposal. <br />if your answer is 3Lcjf!, return this questionnaire and the Tertification <br />Staternent" on Page 5 to the address shown below, and a "Limitcd Hauling <br />Exen. pLion" application will be nailed to you. <br />Biosaffery Level 4 vinises and diseases are: Congo -Crimean Hemorrhagic Fever, Tick- <br />bome Encephalitis Virus Complex (Absettarov, Hanzzalova, Hypr, Kumlinge, Kyasanur <br />Forest Disease, Omsk Hemorrhagic Fever, and Russian Spring -Summer Encephalitis), <br />Marbur,­5 Disease, Ebola, Junin Virus, Lassa Fever Virus, and Machupo VL -us. <br />NO'M <br />f1ruis questionnaire acts as a guideline only. Please refer to the enclosed "Medical <br />Waste Mamigcment Act" for more specific registration/exemption irLfoirrlation. <br />in <br />