Pulpwood Questionnaire

USDA Forest Service OMB 0596-0010

Expires: 11/31/2009

Timber Removals Questionnaire

[Insert return address here]

Insert mailing address here

Pulpwood Calendar Year

Pulpwood Received

This form is for reporting the kinds and quantities of roundwood that your mill received last year, and how you disposed of the residues that resulted from processing roundwood.

Please complete and return this form in the enclosed envelope. If complete records are not available, please give your best estimate.

Your cooperation is appreciated and needed to make the results of this survey comprehensive, accurate, and timely. This survey is voluntary. All replies will be confidential and will be used only for statistical reports.

This mill received no pulpwood in

No additional information is needed, please return this form

Check here if you wish to receive a copy of the report resulting from this questionnaire.

Person to contact, if necessary, regarding this report:

Name:      Title:     

Telephone Number:       Date:     

Mill Location (if different from the mailing address):      

City or town:       County:     

Burden Statement

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0010. The time required to complete this information collection is estimated to average 30 minutes/hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Section I – Roundwood Received and Chips from Roundwood Received

Enter the amount of material your mill received in the form of roundwood, whole-tree chips, or peeled roundwood. If peeled wood, please write (P) after the quantity. If total-tree chips, please write (T) after the quantity.

(Please check the unit of measure used)

128 cubic-foot cord

160 cubic foot

Green tons

Other (please specify):      

Origin of Pulpwood		Species
State	County	Spruce and Fir	Hemlock and Tamarack	Pine	Aspen and Yellow-Poplar	Oak and Hickory	Other Hard-Woods	Total, All Species
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
Total U.S.		     	     	     	     	     	     	     
Foreign		     	     	     	     	     	     	     
Total, all sources		     	     	     	     	     	     	     

Section I (continued)

This page provides you with additional space for entering the amount of material your mill received in the form of roundwood, whole-tree chips, or peeled roundwood. If peeled wood, please write (P) after the quantity. If total-tree chips, please write (T) after the quantity.

(Please check the unit of measure used)

128 cubic-foot cord

160 cubic foot

Green tons

Other (please specify):      

Origin of Pulpwood		Species
State	County	Spruce and Fir	Hemlock and Tamarack	Pine	Aspen and Yellow-Poplar	Oak and Hickory	Other Hard-Woods	Total, All Species
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
     	     	     	     	     	     	     	     	     
Total U.S.		     	     	     	     	     	     	     
Foreign		     	     	     	     	     	     	     
Total, all sources		     	     	     	     	     	     	     

Section II – Mill Byproducts Received

Enter the amount of material your mill received in the form of wood chips, sawdust, or other byproducts. Include only byproducts that you received from sawmills and other wood-using mills.

(Please check the unit of measure used for each type of byproduct)

	Standard Cord Equivalents	C Unit	Oven-dry Tons	Green Tons	Other (Please Specify)
Wood chips from mill byproducts					     
Sawdust					     
Other byproducts (please specify)1	     	     	     	     	     

Origin of byproduct	Wood chips from mill byproducts		Sawdust		Other byproducts
State	Softwoods	Hardwoods	Softwoods	Hardwoods	Softwoods	Hardwoods
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     
     	     	     	     	     	     	     

Section III – Disposal of Bark Residue

Please enter your best estimate of the PERCENTAGE of bark that was used for the various purposes indicated.

Bark Use		Softwoods	Hardwoods
1	Fiber products (Pulp, hardboard, roofing felt, etc.	     	     
2	Charcoal and chemical wood	     	     
3	Industrial fuel (at this or other facilities)	     	     
4	Miscellaneous (Livestock bedding, mulch, etc.)	     	     
5	Other (please specify):      	     	     
Total		100%	100%

Section IV – Remarks

Use the space below to write comments, or call us at [telephone number]:

     

     

     

     

     

     

     

     

     

     

     

     

1 Examples of other byproducts are veneer cores, pole ends, slabs, etc.

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