| 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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 | 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: | 
 | 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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		| 
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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 | 
 | Please Check the Unit of Measure: | 
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 | Average | Average | 
	
		| 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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		| 
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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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 | Total | 
	
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 | Percent | 
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 | All | 
	
		| Species Group Name | Code | by Species | 
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		| 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 | 
 | 26 - Cottonwood | 
 | 35 - Sweetgum | 
 | 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 | 
 | 28 - Hickory | 
 | 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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 | 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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 | 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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 | XX | foreign Country | 
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 | use) | Softwood | Hardwood | Softwood | Hardwood | Softwood | Hardwood | 
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 | Green tons | 
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 | Other (specify): | 
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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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 | foreign Country | 
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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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		| 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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 | 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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		| 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 | 
 | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 
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