The public reporting and record keeping burden for this collection of information is estimated to average 30 minutes per response.  Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460.  Include the OMB control number in any correspondence.  Do not send the completed form to this address.
                                       
*Please Note:  This is a complete list of the questions found in this survey.  Depending on how the respondent answers the subsequent questions asked will vary.

Data Tracking Form for On-Farm Anaerobic Digesters Co-Digesting Food-based Materials
                                       
Project/Facility Information
 Please provide the following information about your Project/Farm.
Project/Farm Name
Street address
City/Town
State
Zip code
Phone Number

 Please provide the following information for the contact person for facility operations
Name
Title
Email Address
Phone number

 Please provide the contact address (if different from Facility Address)
Street address
City/Town
State
Zip code

 If you do not wish to have your facility's general information (facility name, city, state, facility type and operational status) included in future EPA reports, please check the box below
         ☐ Please do not include the information above in future publications summarizing the data collected via this survey.
         
Organic Waste Processing
 It is assumed that your anaerobic digestion system was primarily built to process livestock manures produced on your farm. In addition to this manure waste stream, are organic wastes accepted from offsite sources and processed in your anaerobic digester (practice of co-digestion)?
 Yes
 No

 If organic waste is currently not accepted from offsite sources and processed in your anaerobic digester, is your facility planning for or interested in receiving organic wastes from offsite? 
 Yes
 No

Facility operating status
 Please identify the status of your facility
         ☐ Planning stage/ Design stage/Permitting process 
         ☐ Under construction
         ☐ Operational
         ☐ Temporary shut-down
         ☐ Ceased operation
         ☐ Other

 What is the targeted date for your co-digestion system to be operational?

 What date did your co-digestion system become operational?

 What date did your co-digestion system temporarily shut-down?

 What is the targeted date for your co-digestion system to re-start operations?

 What date did your co-digestion system cease operations?

 Please state the reason your co-digestion system ceased operations.

On-Farm Co-Digestion Capacity
 Taking into account the average volume of manure from your livestock processed in your anaerobic digestion system, please identify the available capacity to process other feedstocks from offsite sources.
         [Type in number here]     Choose an item.

 Please briefly describe how you calculated the available capacity to accept feedstocks from offsite sources.

 Please identify the number of months during the year 2015 that your anaerobic digestion system received and processed feedstocks from offsite sources.

Processed Waste
 Does your farm accept and process food-based feedstocks from off-site sources?
 Yes
 No

 Please describe the total amount of food-based feedstock accepted by your facility in 20XX. Do this by typing in the amount of food waste, and selecting the units, feedstock type, and feedstock source.
         [Type in number here]     Choose an item.  of   Choose an item.   from    Choose an item.

 Does your farm accept and process food-based feedstocks from off-site sources?
 Yes
 No

 Please describe the total amount of non-food-based feedstock accepted by your facility in 20XX. Do this by typing in the amount of non-food waste, and selecting the units, feedstock type, and feedstock source.
         [Type in number here]     Choose an item.  of   Choose an item.   from    Choose an item.

 Do you collect tipping fees?
 Yes
 No

 Are you willing to share information about the tipping fees you collect?
 Yes
 No

 How much revenue did your facility collect in tipping fees in 20XX?

 If you would like to provide any other relevant or important information related to tipping fees, please do so below.

Pre-processing/operations
 Are pre-processing or de-packaging activities conducted on your feedstocks before they are added to your digester?
             Offsite
             Onsite (at your farm)
             Both

 Please identify the pre-packaging or de-packaging activities that are conducted at your facility. Check all that apply.
         ☐Manual or mechanized de-packaging
         ☐Screening for debris or sorting
         ☐Grinding and/or maceration
         ☐Third party processing
         ☐Shredding
         ☐Heating
         ☐pH adjustment
         ☐Centrifugal separation
         ☐Liquid/solid separation
         ☐Other (please specify)
      
  Please identify the operating temperature range for your digester.
             Mesophilic
             Thermophilic
             Unheated/Ambient
            
  Please indicate if your digester is "wet" or "dry."
             Wet, low-solids system, less than 15% (by volume) solids content.
             Dry, high-solids system, greater than 15% (by volume) solids content.

 How would you describe the anaerobic digestion system at your farm? (select all that apply)
             Continuously Stirred Tank Reactor (CSTR)
             Plug-flow
             Covered Lagoon
             Fixed film
             Suspended Media
             Percolating Bed
             Upflow Anaerobic Sludge Blanket (UASB)
             Anaerobic Sequencing Batch Reactor (ASBR)
             Membrane Bioreactor (MBR)
             Hybrid/Multi-stage
             Other (please specify)

Product End-Uses
 Please provide the average biogas production volume at your facility during calendar year 20XX in one of the units identified below. 
         [Type in number here] Choose an item.
            
 Is the biogas produced at this facility?
         ☐Used onsite
         ☐Sold
         ☐Flared
         ☐Other (please specify)

 Please identify how the biogas produced at this facility is used. It could be used onsite by the facility or offsite by a purchaser. Check all that apply.
         ☐Produce mechanical power 
         ☐Produce heat and electricity (CHP) 
         ☐Produce electricity (including net metering) 
         ☐Produce electricity (sold to grid) 
         ☐Fuel boilers and furnaces to heat digesters 
         ☐Fuel boilers and furnaces to heat other spaces 
         ☐Compressed to vehicle fuels: used for company fleet/personal vehicles 
         ☐Compressed to vehicle fuels: sold to customers 
         ☐Renewable natural gas (processed in order to inject to pipeline) 
         ☐Other (please specify) 

 Are you able to utilize all of the biogas produced?
 Yes
 No

 Do you flare the excess biogas?
 Yes
 No

 Do you have a gas cleaning system?
 Yes
 No

 What is removed by your gas purification system? Check all that apply.
         ☐Moisture
         ☐Sulfur
         ☐ Siloxanes
         ☐ Carbon Dioxide
         ☐ Compressed Gas
         ☐ Hydrogen sulfide
         ☐ Particulates
         ☐ Oxygen
         ☐ Nitrogen
         ☐ VOCs
         ☐ Other (please specify)

 Do you beneficially re-use the solid digestate you produce? (Select all that apply) 
         ☐Yes, de-watered/dried and land applied
         ☐Yes, composted into a reusable or salable product
         ☐Yes, processed into animal bedding
         ☐Yes, processed into other salable product (e.g., flower pots)
         ☐No, landfilled
         ☐No, incinerated
         ☐Other (please specify)

 If any digestate was disposed of in landfills or incinerated in 20XX, please specify the amount in tons or gallons (if known).
         [Type in number here]     Choose an item.

 Is the de-watered/dried digestate further treated prior to land application?
 Yes
 No

 How do you manage the liquid digestate you produce? Check all that apply.
         ☐ Beneficially reused as fertilizer via land application
         ☐ Recirculated through digester
         ☐ Discharged to a wastewater treatment plant
         ☐ Other (please specify)

 Is the liquid digestate further treated prior to land application?
 Yes
 No

 Please indicate what the further treatment is and why it is necessary.

 Do you recover nutrients from your digestate? 
 No
 Yes, phosphorous recovery by chemical precipitation (e.g., struvite)
 Yes, ammonia recovery
 Other (please specify)


