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Please check the appropriate response for the questions listed below. <br />REGULATED MEDICAL <br />0 LaboratoryWastesspecimen or i • • •cultures,• ofinfectious <br />live •'attenuatedvaccines, andculture mediums <br />00 Blood or Body Fluids - liquid blood elements or other regulated body fluids, or <br />articles contaminated with blood or body fluids <br />10 Sharps-• blades, broken glass <br />Contaminated Animals - animal carcasses, body parts, bedding materials <br />01 Surgical Specimensor parts or - • -• surgically or by <br />autopsy <br />isolation Wastes - waste contaminated with excretion,• or t• from <br />humans or animals who are isolated due only to the highly communicable diseases <br />listed by Centers for Disease Control as requiring Biosafety Level 4 precau ons.* <br />1. Does • business or of <br />medicalthe -• .r• • <br />If your answer is _n_o, please complete the "Certification Statement" oil Page <br />s and return it with this questionnaire to the address indicated. You do not <br />...• to complete the remainderof questionnaire. <br />If your answer is XM please check the types(s) of waste listed above that <br />•, or • Please complete the restof questionnaire. <br />2. Do you generate less than 200 pounds of medical <br />waste per • you .; a small <br />- <br />•yes_noY- <br />3. Small <br />generators+medical <br />in a permitted common storage facility with <br />other small generators. Do you plan to do this <br />at your • <br />If your answer is 3ns, a PHS-EHD "Common Storage Facility Permit <br />Application!' be -• to you.Please indicateyou <br />applicationmailed <br />-CONTINUEDON <br />0 <br />