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0 <br />0 <br />4. Do you generate 200 or more pounds per month of <br />the types of medical waste listed on Page 3? yes—X nq._ <br />S. Do you plan to treat your medical waste onsite <br />your by + <br />incinerating or • • • • <br />If your answers to guestionsand 5 are no <br />then complete the <br />"Certification air ur • Page . • return it with this questionnaire t• <br />the address shown at the bottom of'Page 2. You do not need to complete <br />the rest of • package. <br />For •ical Waste form on • <br />Management ' ..''specified • Pages� <br />.' you / pounds of . ;• <br />waste per week, transport less than 20 pounds <br />at • - • - . • have a hauling information <br />document on • office,•apply <br />for • Quantity Hauling Exemption. <br />exemption a • or • to transport <br />mwaste edical yourselves, without <br />registlercdhazardou's waste hauler, to a medical <br />wast :e treatment facility. Do you want to apply <br />for -• Quantity Hauling Exemption?• <br />If your - • you will be • • to hire a registered hazardI <br />waste hauler to transport your waste for treatment and disposal. <br />If your answer is 3M return this questionnaire and the "Certificai <br />Statement" on Page 5 to the address shownbelow,and"Limited <br />NOTE: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, Kurrilinge, 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 />This questionnaire •` . • Please referto the enclosed"Medical <br />