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4. Do you generate 200 or more pounds per month of <br /> the types of medical waste listed on Page 3? yes no_°,_, <br /> 5. Do you plan to treat your medical waste onsite <br /> (at your facility), by autoclaving, <br /> incinerating or using wave technology? yes—no <br /> If your answers to guestions 3, 1 and 5 are no. then complete the <br /> "Certification Stat on Page 5 and return it with this 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 guestions 4 or 5 are M please complete the ° tion <br /> For Medical Waste form on Page 6 and submit a "Medical Waste <br /> Management Plan7 as specified on Pages 7 & 8. <br /> 4. 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 hire 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 shown below, and a "Limited Hauling <br /> Exemption7 application will be mailed to you. <br /> Biosafety Level 4 viruses and diseases are: Congo-Crimean Hemorrhagic Fever, Tick- <br /> bome Encephalitis Virus Complex (Absettarov, Hanzalova, Hypr, ° ge, 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 for more specific registration/exemption information. <br /> 4 <br />