| Forest Service, U.S. Department of Agriculture | 
		
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		Form Approved | 
	
	
		| Northern Research Station | 
		
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		OMB 0596-0010 | 
	
	
		| 1992 Folwell Ave. | 
		
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		Expires: XX/XX/XXX | 
	
	
		| St. Paul, MN 55108 | 
		
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		| Phone Number: (651) 649-5150; Fax: (651) 649-5140 | 
		
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		| PRIMARY MILL QUESTIONNAIRE - 2021 | 
		
	
		| Section 1-Mill Information | 
		
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		| Mill Name  | 
		
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		Mill mailing address | 
		
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		City, ST Zip | 
		
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		Phone | 
		
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		Fax | 
		
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		Mill/Company Website | 
		
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		     Company e-mail | 
		
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		Contact Name and Title | 
		
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		     Contact Phone | 
		
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		Contact mailing address | 
		
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		City, ST Zip | 
		
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		       Contact Fax | 
		
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		Contact e-mail | 
		
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		| Mill physical location (if different from Mill mailing address)   | 
		
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		Mill physical address | 
		
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		City, ST Zip | 
		
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		| Mill type (please check) | 
		
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		3-Pulp or pulp/paper mill | 
		
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		 4-Composite panel/Engineered wood product mill | 
		
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		| Number of employees-All: | 
		
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		| Annual mill capacity (volume per year when operating at full capacity): _____________     Unit of measure: ___________________ | 
		
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		| Do this mill process any logs from cities or towns (urban areas)? | 
		
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		YES | 
		
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		NO | 
		
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		If YES, what percent of the total roundwood received was from urban wood?  ________ % | 
		
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		Company Name (if different from Mill Name): | 
		
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		Company mailing address  (if different from Mill): | 
		
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		City, ST Zip | 
		
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		Phone | 
		
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		Fax | 
		
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		| Instructions: | 
		
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		This form is for reporting the quantities and types of logs received by this mill and the disposal of plant residues | 
		
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		resulting from the manufacturing or processing of wood products. COMPLETE SECTIONS 2, 3 AND 4 FOR | 
		
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		 EACH TYPE OF RAW MATERIAL RECEIVED THAT IS NOT EXPORTED OUT OF THE U.S. | 
		
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		 COMPLETE SECTION 2 FOR EACH TYPE OF RAW MATERIAL EXPORTED OUT OF THE U.S. | 
		
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		 If records are not available, please give your best estimates. This survey is voluntary. While you are not required to | 
		
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		respond your cooperation is needed to make the results of the survey comprehensive, accurate, and timely.  | 
		
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		ALL VOLUMES REPORTED WILL BE HELD CONFIDENTIAL AND WILL ONLY BE USED TO AGGREGATE | 
		
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		TO THE COUNTY AND STATE LEVEL. NO INDIVIDUAL MILL PRODUCTION DATA WILL BE RELEASED. | 
		
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		     Check box to omit the above information from "Regional/Statewide Industry" Directories | 
		
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		     Check box if you wish to receive a copy of the report resulting from this study | 
		
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		| Public reporting burden for this collection of information is estimated to average 50 minutes per response, including the time for reviewing instructions, | 
		
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		| instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. | 
		
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		| Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: | 
		
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		| Department of Agriculture, Clearance Officer, OIRM, Room 404-W. Washington, DC 20250; and to the | 
		
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		| Office of Management and Budget, Paperwork Reduction Project (OMB# 0596-0010), Washington, DC 20503.  | 
		
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		| Section 2 - Raw Material (Logs/Roundwood) Received and Processed at Mill in 2021 | 
		
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		| 2.1. Amount of Roundwood received and processed at the mill. | 
		
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		| Enter the TOTAL amount of Raw  | 
		
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		Please Check the Unit of Measure: | 
		
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		Average | 
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		| Material (Logs/Roundwood, chipped | 
		
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		Standard cord (4' X 4' X 8') | 
		
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		If Unit of measure is a weight, | 
		Log | 
		Log Top | 
		
	
		| roundwood, or whole tree chips) | 
		
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		Lake States cord (4' X 4' X 100") | 
		
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		enter a weight conversion factor | 
		Length | 
		Diameter | 
		
	
		| received and processed at the mill. | 
		
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		Green tons (short, 2,000 lbs) | 
		
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		(in feet) | 
		(in inches) | 
		
	
		| Do not include mill residues that were | 
		
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		Green metric tonnes | 
		
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		| used to produce the mill's product. | 
		
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		Thousand cubic feet | 
		
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		Softwoods  ________lbs. per cord | 
		
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		Thousand cubic meters | 
		
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		|      Amount: ________________ | 
		
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		Other : (specify):_____________________ | 
		
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		Hardwoods  ________lbs. per cord | 
		
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		| 2.2.  Enter the AMOUNT/PERCENT of the Species Group and the Origin of Raw Material (Logs/Roundwood) Received and Processed. | 
		
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		| Enter the total amount, or the percent of the total, for each Species received and processed for the mill product. | 
		
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		| Across the columns at the top of the table, enter the State and county, or Country and Province that the Raw Material (Logs/Roundwood) came from. | 
		
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		| Enter the amount or percent of each species that came from each State and County/Country and Province. The Row should sum to 100% if percent is entered. | 
		
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		| Separate bark on roundwood/logs, Whole tree chips, peeled/flail debarked roundwood/logs by:  | 
		
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		|      Enter "W" after the amount/volume that come into the mill as whole tree chips.  | 
		
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		|      Enter a "P" after the amount/volume that come into the mill as peeled or flail debarked roundwood or chips. | 
		
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		|      No identifier is required for bark on Roundwood/logs, or chipped bark on roundwood/logs. | 
		
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		Amount | 
		Enter County name, State abbrev., or Country and Province of species group received from each county/state or foreign country | 
		
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		or | 
		
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		Total | 
	
	
		
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		Percent | 
		
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		All | 
	
	
		| Species Group Name | 
		Code | 
		by Species | 
		
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		Counties | 
	
	
		| Cedar/juniper | 
		1 | 
		
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		100% | 
	
	
		| Balsam fir | 
		4 | 
		
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		100% | 
	
	
		| Hemlock | 
		5 | 
		
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		100% | 
	
	
		| Jack pine | 
		7 | 
		
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		100% | 
	
	
		| Red pine | 
		12 | 
		
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		100% | 
	
	
		| White pine | 
		14 | 
		
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		100% | 
	
	
		| Other pines | 
		15 | 
		
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		100% | 
	
	
		| Spruce | 
		17 | 
		
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		100% | 
	
	
		| Tamarack | 
		6 | 
		
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		100% | 
	
	
		| Ash | 
		19 | 
		
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		100% | 
	
	
		| Aspen/balsam poplar | 
		20 | 
		
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		100% | 
	
	
		| Basswood | 
		21 | 
		
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		100% | 
	
	
		| White/paper birch | 
		124 | 
		
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		100% | 
	
	
		| Yellow birch | 
		23 | 
		
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		100% | 
	
	
		| Other birch | 
		24 | 
		
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		100% | 
	
	
		| Elm | 
		27 | 
		
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		100% | 
	
	
		| Maple - Hard maple | 
		29 | 
		
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		100% | 
	
	
		| Maple - Soft maple | 
		30 | 
		
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		100% | 
	
	
		| Oak - Red oak | 
		131 | 
		
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		100% | 
	
	
		| Oak - White oak | 
		133 | 
		
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		100% | 
	
	
		| Yellow-poplar | 
		39 | 
		
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		| Other: from list below | 
		
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		100% | 
	
	
		| Other: from list below | 
		
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		100% | 
	
	
		| Other hardwoods not listed | 
		40 | 
		
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		100% | 
	
	
		| Total All Spp Volumes OR 100% | 
		
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		| Other species | 
		
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		8 - Loblolly-Shortleaf pine | 
		
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		10 - Longleaf and slash pine | 
		
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		22 - Beech | 
		
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		26 - Cottonwood | 
		
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		35 - Sweetgum | 
		
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		38 - Black walnut | 
		
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		9 - Lodgepole pine | 
		
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		11 - Ponderosa and Jeffrey pine | 
		
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		25 - Black cherry | 
		
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		28 - Hickory | 
		
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		36 - Sycamore | 
		
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		| 3.1.  Check type of process and equipment in use. | 
		
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		| Wood process type | 
		
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		Equipment | 
		
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		Sulfite | 
		
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		Chipper | 
		
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		Kraft | 
		
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		Debarker | 
		
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		Groundwood/Mechanical | 
		
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		Chip Canter | 
		
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		Semichemical | 
		
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		Hammer mill | 
		
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		Kraft/Groundwood | 
		
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		Other - specify ___________________________________ | 
		
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		Thermochemical | 
		
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		Thermomecnanical | 
		
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		Other - specify ___________________________________ | 
		
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		Other - specify _________________ | 
		
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		| Section 3.2 -- Products produced from logs received in 2021. | 
		
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		| Please check the types of products produced from logs, or chipped logs. | 
		
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		| Composite products | 
		
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		Pulpwood products | 
		
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		Oriented Strand Board (OSB) | 
		
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		Wood pulp | 
		
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		Particle board | 
		
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		Paper | 
		
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		Wafer board | 
		
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		Corrugated medium | 
		
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		Hardboard | 
		
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		Roofing material | 
		
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		Medium density fiber board (MDF) | 
		
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		Insulation board | 
		
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		Other engineered product - | 
		
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		Other pulp product - | 
		
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		Specify:  ______________ | 
		
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		Specify:  ______________ | 
		
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		| Section 3.3 -- Volume of product produced from Raw Material (Logs/Roundwood) Processed in 2021. | 
		
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		| Please enter amount of mill product produced in 2021 by softwoods and hardwoods. | 
		
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		Softwoods | 
		Hardwoods | 
		
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		Unit of Measure | 
		
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		Unit of Measure | 
		
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		Amount | 
		(codes below) | 
		Amount | 
		(codes below) | 
		
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		| Pulp products | 
		
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		| Composite products | 
		
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		Units of Measure | 
		
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		31 - Green tons | 
		
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		32 - Dry tons | 
		
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		99 - Other (specify) | 
		
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		72 - Thousand Square Feet | 
		
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		98 - Thousand Tons of pulp | 
		
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		       Specify:  _________________ | 
		
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		Percent of finished product exported out of the United States: ________%. | 
		
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		| Section 3.4 -- Volume of mill residues used to produce product in 2021. | 
		
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		| Select the unit of measure the volume is reported in. Indicate the State of origin, mill byproduct, and the volume each species group received. | 
		
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		Wood chips are chips from coarse mill residues. Whole tree chip volumes should be recorded as roundwood on page 2. | 
		
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		Origin of byproduct | 
		
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		Other byproducts | 
		
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		| Check only one | 
		
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		ST code | 
		Wood chips | 
		Sawdust | 
		List: ____________ | 
		
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		| Unit of Measure | 
		
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		State or  | 
		
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		 (office | 
		
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		 XX | 
		foreign Country | 
		
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		use) | 
		Softwood | 
		Hardwood | 
		Softwood | 
		Hardwood | 
		Softwood | 
		Hardwood | 
		
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		 Standard cord | 
		
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		 Dry tons | 
		
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		 Green tons | 
		
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		 Other (specify): | 
		
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		________________ | 
		
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		| Section 3.5 -- Volume of hog fuel/industrial fuelwood received in 2021. | 
		
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		| Please record the volume/amount of roundwood, in-woods chips, whole-tree chips, and/or tops and limbwood used for Boiler/hog fuel/industrial fuelwood | 
		
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		that you received at the mill. Do not include mill residues (example, bark or sawmill chips) | 
		
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		State or  | 
		
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		 Boiler/hog fuel volume  | 
		
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		foreign Country | 
		
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		Softwood | 
		Hardwood | 
		
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		Check the unit of Measure used | 
		
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		(only one) | 
		
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		Dry tons | 
		
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		Green tons | 
		
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		Thousand cu. ft. | 
		
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		Other: | 
		
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		   (specify): _____________ | 
		
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		| Section 4—MILL RESIDUE and MILL RESIDUE USE for 2021 | 
		
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		| 4.1. Please enter the amount of mill residue produced by this mill. | 
		
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		| Enter the amount of mill residues that were generated at the mill by processing Roundwood or whole tree chips,  | 
		
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		|      for each type of mill residue generated, by Softwood and Hardwood. Indicate the "Unit of Measure". | 
		
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		Unit of Measure | 
		
	
		
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		(example: green tons, dry tons, | 
		
	
		| Type of Residue | 
		
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		Softwood | 
		Hardwood | 
		thousand cubic feet, etc.) | 
		
	
		| Bark | 
		
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		| Coarse (chips, slabs, edgings, trims, cores, etc) | 
		
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		| Fine - Shavings (Planer or Lathe) | 
		
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		| Fine - Sawdust | 
		
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		| Whole logs or short sections chipped that are not | 
		
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		| processed as mills primary product | 
		
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		| 4.2. Disposal of mill residues | 
		
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		| Enter the percent for how each type of mill residue was used by the mill ("USE OF MILL RESIDUE:") in the production of the | 
		
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		|      primary product, by type of Residue, and Softwood and Hardwood. If no mill residues were generated, leave blank. | 
		
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		COARSE | 
		FINE | 
		
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		(chips, slabs, edgings, | 
		Shavings | 
		
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		BARK | 
		 trims, cores, etc) | 
		(Planer or Lathe) | 
		Sawdust | 
		
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		Softwood | 
		Hardwood | 
		Softwood | 
		Hardwood | 
		Softwood | 
		Hardwood | 
		Softwood | 
		Hardwood | 
		
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		| USE OF MILL RESIDUE: | 
		Code | 
		% | 
		% | 
		% | 
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		% | 
		% | 
		% | 
		% | 
		
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		| Manufacture of fiber/composite products | 
		1 | 
		
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		| Small dimension and other sawn products | 
		2 | 
		
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		| Charcoal or chemical wood | 
		3 | 
		
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		| Industrial fuel at this plant (on-site) | 
		4 | 
		
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		| Industrial fuel at other plants | 
		5 | 
		
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		| Bio-energy pellets | 
		6 | 
		
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		| Other Bio-energy products(biodiesel,etc) | 
		7 | 
		
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		| Residential fuelwood | 
		8 | 
		
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		| Mulch/Soil additive (includes biochar) | 
		9 | 
		
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		| Animal bedding | 
		10 | 
		
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		| Other misc. uses- please specify:  _______________ | 
		88 | 
		
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		| NOT USED (land fill, burned, etc) | 
		99 | 
		
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		| TOTAL | 
		
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		100% | 
		100% | 
		100% | 
		100% | 
		100% | 
		100% | 
		100% | 
		100% | 
		
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