Primary Mill Questionnaire (Page 4 of 8) in pdf

Forest Service, U.S. Department of Agriculture

Form Approved

Nortern Research Station

OMB 0596-0010

Phone Number: (651) 649-5150; Fax: (651) 649-5140

Expires: 09/30/2016

1992 Folwell Ave.

St. Paul, MN 55108

PRIMARY MILL QUESTIONNAIRE - 2015

Section 1-Mill Information

Mill Name

Mill mailing address

City, ST Zip

Phone

Fax

Mill/Company Website

Company e-mail

Contact Name and Title

Contact Phone

Contact mailing address

City, ST Zip

Contact Fax

Contact e-mail

Mill physical location (if different from Mill mailing address)

Mill physical address

City, ST Zip

County of mill

Latitude

Longitude

Mill type (please check)

1-Sawmill

2-Veneer mill

3-Pulp or pulp/paper mill

4-Composite panel/Engineered wood product mill

5-Industrial fuelwood/Biomass/energy plant

6-House/cabin log mill

7-Piling mill

8-Pole mill

9-Post mill

11-Miscellaneous/other mill (specify):

Mill status (check)

Active

Idle

Closed/Out of business

New

Dismantled

Is this a portable mill?

YES

Number of employees-All:

Year mill established:

Company Name (if different from Mill Name):

Company mailing address (if different from Mill):

City, ST Zip

Phone

Fax

Instructions:

This form is for reporting the quantities and types of logs received by this mill in 2015 and the disposal of plant residues

resulting from the manufacturing or processing of wood products. COMPLETE SECTIONS 2, 3 AND 4 FOR

EACH TYPE OF RAW MATERIAL RECEIVED THAT IS NOT EXPORTED OUT OF THE U.S.

COMPLETE SECTION 2 FOR EACH TYPE OF RAW MATERIAL EXPORTED OUT OF THE U.S.

If records are not available, please give your best estimates. This survey is voluntary. While you are not required to

respond your cooperation is needed to make the results of the survey comprehensive, accurate, and timely.

ALL VOLUMES REPORTED WILL BE HELD CONFIDENTIAL AND WILL ONLY BE USED TO

AGGREGATE TO THE COUNTY AND STATE LEVEL.

Check box to omit the above information from "Regional/Statewide Industry" Directories

Check box if you wish to receive a copy of the report resulting from this study

During calendar year 2015

Was Raw Material (logs/roundwood)* received at this mill?

YES

Was Raw Material (logs/roundwood) processed at this mill?

YES

* see Instructions for definition of Raw Material (logs/roundwood).

Official Use Only:

Interviewers Name and Title:

Phone:

Date of Interview:

Interview type

mail

phone

personal contact

e-mail

Public reporting burden for this collection of information is estimated to average 50 minutes per response, including the time for reviewing instructions,

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:

Department of Agriculture, Clearance Officer, OIRM, Room 404-W. Washington, DC 20250; and to the

Office of Management and Budget, Paperwork Reduction Project (OMB# 0596-0010), Washington, DC 20503.