Laserfiche WebLink
4 <br /> PRE-APPLICAMON QUESTIONNAME <br /> Please check the appropriate response for the questions listed below. <br /> REGUIATED MEDICAL WASTES <br /> (x) Laboratory Wastes-specimen or 'croiolo 'c cultures, stocks of infectious agents, <br /> live and attenuated vaccines., and culture mediums <br /> (x) Blood or Body Fluids - liquid bloodelements or other regulated body fluids, or <br /> articles contaminated loo r boy fluids <br /> (X) Sharps - syringes, needles, blades, broken glass <br /> (k) Contaminated Animals - animal carcasses, body parts, bedding materials <br /> (X) Surgical Specimens - human or animal parts or tissues removed surgically or by <br /> autopsy <br /> Isolation Wastes - waste contaminated 't excretion, exudate, or secretions from <br /> humans or animals who are isolated due only to the highly communicable diseases <br /> listed by Centersfor Disease Control as requiring Biosafe Level 4 precautions.* <br /> 1. Does your business or service generate any o <br /> e medical wastesaabove? yes xnq.— <br /> if <br /> your answer iso, lease co plete t e " tion Stat t" on Page <br /> 5 and return it with this questionnaire to the address indicated. You do not <br /> need to complete the remainder of this questionnaire. <br /> If your er is 3M please check the es(s) of waste listed above that <br /> you or your facility enerate. Please complete the rest of this questionnaire. <br /> . Do you generate less thari'200 pounds of medical <br /> waste per month? if yes, you are a small <br /> generator. yes® X <br /> 3. Small generators may store their medical waste <br /> in a permittedcommon storage facility with <br /> other small generators. Do you plan to do this <br /> at your facility? yes—no'— <br /> If y <br /> es^ o'I oanswer is M a PHS-EHD "Cornmon Storage Facility Pennit <br /> Application!' e to you. Please indicate if you want the <br /> applicationails elsewhere. <br /> -CONTINUED ON • .ME- <br /> 3 <br />