Laserfiche WebLink
8—Z5-1 999 1 2: 1 OPM FROM P. 3 <br /> PRE—APPLICATIONLI.C+STIOAli♦.C"s.ME <br /> REGULATED MEDICAL WASTES <br /> • ( ail dttiC sRptY1 <br /> () Laboratory Wastes - specimen or microbiologic cuitores, stocks of infectious agents, live and <br /> attenuated vaccines, and culture mediums <br /> Mood or Body Fluids - liquid blood elements or other regulated body Quids, or articles <br /> cont=inated with blood,or body fluids <br /> Sbtarps -syringes,needles, blades, broken <br /> ( ) Contaminated mak. -animat carcasses,body parts,bedding materials <br /> {) Surgiesl Specimens-human or animal parts or tissues removed surgically or by autopsy <br /> --() Isolation Wastes - waste coutaminated with excretion, exudate, or secretions frons humans or <br /> anivaais who are isolated due only to the lughly communicable diseases listed by Centers for <br /> Disease Control as requiring Biosafety Level 4*precatWous, <br /> 2.mfk1W LW,*4 WUM=A MW COO$WWOO H=000pa AW.T° - V%W COdWO(. oo»80=4 4a.*K XWOWM Kyaweew Damft <br /> o"%11:Habw h.g F~.mrd RMNR SF=V MNnW L. V°r ay L"Pr—O WEAK and wear. <br /> l. Does your business or service Senerate any of the medical.wastes listed above? yes ao— <br /> If your answer is _% please complete the "Certification Statemerot" on Page 3 and mrura it with this <br /> questionnaire to the address indicated. You do not nerd to complete the remainder of this questionnaire. <br /> If your answer is yes. please check the s) of wane listed above that you or your facility generate. <br /> Please complete the cost of this questionnaire. <br /> 2. Do you generate 200 pounds or more of medical www per month? yes_ rao_, `' ('61GG�u <br /> 3. Do you plan to treat your medical waste onsite (at your facility), by autoclaving, incinerating or <br /> using microwave~technology? yes„ „ <br /> If your answers to questions? and 3 are,j, then complete the "Cerdficstion Statement"' on Page 3 and <br /> return it with this quasdo=aiae to the address shown at the bottom of Psgc I. <br /> If your answers to 9jqj9ggs ? or 3 areyescomplete cbe "R�fioelP'er .�►pplimcatic�n For <br /> Medical Waste" form on Page 4 and submit a"'Medical Waste Management Plan" as specified on <br /> Page 5. <br /> 4. If you generate less#tau 20 hounds of medical waste per week,transport less than 20 pounds <br /> at one time, and have a hauling information docuzuent on file iu your office, you may apply <br /> for a Limited Quantity Hauling Exemption- This examption allows you or your staff m transport <br /> medical waw to a medical waste twtment f4ciliry or to a consolidation point until it can be <br /> removed by a registered medical waste hauler. Do you want to apply for a Limited city <br /> Planking Exemption? yes,,/no_ <br /> If your answer is vee, a "Limited Haaudug Exemption" application will be wiled to you. <br /> Z <br />