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SANJOAQUIN Environmental Health Department <br /> COUNTY— <br /> PRE-APPLICATION QUESTIONNAIRE <br /> Regulated Medical Wastes <br /> Please check the appropriate box for the questions listed below: <br /> - - -.e <br /> Pharmaceuticals: prescription or over-the-counter human or veterinary drug, including, but not <br /> limited to, a drug as defined in Section 109925 of the Federal Food, Drug, and Cosmetic Act, as <br /> amended [21 U.S.C.A, Sec. 321(g)(1)]. This definition does not include RCRA waste. <br /> Laboratory Wastes: specimen or microbiologic cultures, stocks of infectious agents, live and <br /> attenuated vaccines and culture mediums. <br /> Blood or Body Fluids: liquid blood elements, other regulated body fluids, articles <br /> contaminated with blood or body fluids. <br /> Sharps: syringes, needles, blades and contaminated broken glass. <br /> El Contaminated Animals: animal carcasses, tissues, and fluids contaminated with infectious <br /> agents that are contagious to humans. <br /> ❑ Surgical Specimens: human or animal parts or tissues removed surgically or by autopsy that <br /> are contaminated with infectious agents that are contagious to humans or in a fixative (e.g. <br /> formaldehyde). <br /> Isolation Wastes: waste contaminated with excretion, exudates, or secretions from humans or <br /> animals that are isolated due to highly communicable diseases. <br /> F-1 Chemotherapy Wastes: waste contaminated through contact with chemotherapeutic agents. <br /> 1. Does your business or service generate any of the medical waste listed above?XYes oNo <br /> If your answer is "No", please complete the "Certification Statement" on <br /> Page 4 and return it with this questionnaire to the address indicated. You do <br /> not need to complete the remainder of this questionnaire and you do not need <br /> to pay a fee. <br /> 2. Do you generate less than 200 pounds of medical waste per month? es E] No <br /> If you answered "Yes", you are a small generator. /Y <br /> 3. Small generators may store their medical waste in a permitted Common <br /> Storage Facility with other small generators. Do you plan to do this at your <br /> facility? 2 of 11 E1 Yes.,R(No <br />