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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'j_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 Vgkons 3. 4 and 5 are no, then complete I <br />"Certification Statemene on Page 5 and return it with this questionnaire <br />the address shown at the bottom of Page 2. 1 <br />If your answers to V&gjons 4 or 5 are ves. please complete the Megistration <br />For Medical Waste form on Page 6 �nd submit a "Medical Waste <br />Management Plan! as specified on Pages 7 & 8. <br />medical <br />i. 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 />•urselves, without hiring <br />registered hazardous • a medical <br />waste treatment f.#+ i# you wantto apply <br />for i Quantity Hauling Exemption? io ;a.,no— <br />If <br />your no, you will be f to hire a registered a. •• <br />waste hauler to transport your waste for treatment and disposal. <br />If your - # thisquestionnaire an• "Certification <br />Statemene on Page 5 to the address shown on Page 2, and a "Limited <br />Hauling Exe3nption7 application will be mailed to you. <br />Tick- <br />borne # •Virus Complex w - • . • Y Hypr, Kumlinge, <br />MarburgForest Disease, Omsk Hemorrhagic Fever, and Russian Spring -Summer Encephalitis), <br />Disease, Ebola, Junin Virus, Lassa Fever and Machupo <br />NOTE-- <br />Thisquestionnaire .:guideline <br />only. r_ refer to the <br />enclosed "Medical <br />Waste - g r Act! for more specific registration/exemption information. <br />