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4. Do you generate 200 or more pounds per month of the types of medical waste listed on Page 3? yes_no� S. Do you plan to treat your medical waste onsite (at your facility), by autoclaving, incinerating or using microwave technology? yes_no4 If your answers to questions 3, 4 and 5 are no, then complete the "Certification Statement" on Page 5 and return it with this questionnaire to the address shown at the bottom of ` Page 2. If your answers to questions 4 or 5 are 3es: please complete the "Registration For Medical Waste" form on Page 6 and submit a "Medical Waste Management Plan" as specified on Pages 7 & 8. 10, If you generate less than 20 pounds of medical waste per week, transport less than 20 pounds at one time, and have a hauling information document on file in your office, you may apply for a Limited Quantity Hauling Exemption. This exemption allows you or your staff to transport medical waste yourselves, without hiring a registered hazardous waste hauler, to a medical waste treatment facility. Do you want to apply for a Limited Quantity Hauling Exemption? yes - no -i f your answer is no, you will be required to hire a registered hazardous waste hauler to transport your waste for treatment and disposal. If your answer is mss, return this questionnaire and the "Certification Statement" on Page 5 to the address shown 6-n P9 2 and a "Limited Hauling Exemption" application will be mailed to you. * Biosafety Level 4 viruses and diseases are: Congo -Crimean Hemorrhagic Fever, Tick- borne Encephalitis Virus Complex (Absettarov, Hanzalova, Hypr, Kumlinge, Kyasanur Forest Disease, Omsk Hemorrhagic Fever, and Russian Spring -Summer Encephalitis), Marburg Disease, Ebola, Junin Virus, Lassa Fever Virus, and Machupo Virus. NOTE: This questionnaire acts as a guideline only. Please refer to the enclosed "Medical Waste Management Act" for more specific registration/exemption information. 4