                                                  OMB Control No. 20XX-XXXX    
                                            								Approval expires XX/XX/XX  
                                       
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
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)?

 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? 
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.

 Please indicate if this available capacity for processing feedstocks other than manure from your livestock is provided in gallons per year or tons per year. 

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

 Does your farm accept and process food-based feedstocks from off-site sources?

 What was the total volume of food-based materials received in liquid form and processed in the anaerobic digestion system at your farm during the 2015 calendar year?  Please express your answer in gallons.

 What was the total weight of food-based materials received in solid form and processed in the anaerobic digestion system at your farm during the 2015 calendar year? Please express your answer in tons.

 Does your farm accept and process food-based feedstocks from off-site sources?

 What was the total volume of non-food-based materials received in liquid form and processed in the anaerobic digestion system at your farm during the 2015 calendar year?  Please express your answer in gallons. 

 What was the total weight of non-food-based materials received in solid form and processed in the anaerobic digestion system at your farm during the 2015 calendar year?  Please express your answer in tons. 
Types of Feedstocks 
 Please identify the specific types of feedstocks that are received from offsite sources and processed in the co-digestion system at your farm.   Check all that apply.
 Beverage processing industry waste 
 Crop residues 
 Crude glycerine 
 De-icing fluid 
 Fats, oils and greases (FOG) 
 Food processing industry waste
 Food service waste, pre & post-consumer 
 Fruit/vegetative wastes 
 Lab (or Pharma) wastes
 Litters 
 Manure from other farms
 Mixed yard waste
 Paper mill wastes 
 Rendering wastes 
 Retail food waste 
 Septage 
 Source-separated commercial, institutional or residential organic wastes 
 Wastewater solids (sludge)
 Other (please specify) 

 Are your tipping fees equal for all materials?

 Which of the following ranges best represents your tipping fees for co-digesting liquid feedstocks?
 N/A  -  Facility does not process liquid feedstock. 
 Business Confidential/Prefer not to say 
 $0.00-$0.05 per gallon
 $0.06-$0.10 per gallon 
 $0.11-$0.20 per gallon
 $0.21-$0.50 per gallon 
 $0.51-$1 per gallon 
 > $1 per gallon 

 Which of the following ranges best represents your tipping fees for co-digesting solid feedstocks?
 N/A  -  Facility does not process solid feedstock. 
 Business Confidential/Prefer not to say 
 $0-$10 per ton
 $11-$20 per ton 
 $21-$30 per ton 
 $31-$40 per ton 
 $41-$50 per ton 
 $51-$60 per ton
 $61-$70 per ton 
 $71 or more per ton 

 You indicated that you receive and co-digest the feedstocks identified below.  The feedstocks identified in your answer to question 22 above will be listed on this page.  Please indicate whether these feedstocks are in liquid form (with tipping fees in dollars per gallon) or solid form (with tipping fees in dollars per ton) or both?

 You indicated that you receive and co-digest the feedstocks identified below in liquid form.  The feedstocks identified in your answer to question 22 above will be listed on this page.  Which of the following ranges best represents your tipping fee for these liquid feedstocks? 
 Prefer not to say 
 $0.00-$0.05 per gallon
 $0.06-$0.10 per gallon 
 $0.11-$0.20 per gallon
 $0.21-$0.50 per gallon 
 $0.51-$1 per gallon 
 > $1 per gallon 

 You indicated that you receive and co-digest the feedstocks identified below in solid form.  The feedstocks identified in your answer to question 22 above will be listed on this page.  Which of the following ranges best represents your tipping fee for these solid feedstocks? 
 Prefer not to say 
 $0-$10 per ton
 $11-$20 per ton 
 $21-$30 per ton 
 $31-$40 per ton 
 $41-$50 per ton 
 $51-$60 per ton
 $61-$70 per ton 
 $71 or more per ton 

 Please identify the sources of the feedstocks that are received and processed in the co-digestion system at your facility. Check all that apply.
 Airports
 Biodiesel production
 Corporate complexes
 Farmers Markets
 Food/Beverage Processors
 Fruit/Vegetable Farms
 Grocery Stores/Supermarkets
 Healthcare 
 Hospitality
 Industrial
 Laboratories/Pharmaceutical Companies
 Other Livestock Farms
 Municipal/Residential
 Prisons
 Restaurants and Food Service
 Retail Stores
 Schools
 Sports and Entertainment Venues
 Wastewater Treatment Plants
 Other (please specify)

 Please describe any pre-processing/de-packaging that is required before feedstocks from offsite sources are fed into the co-digestion system at your facility. 

 Please identify the following specifications for your digester.
 Temperature range
 Wet or dry
 Batch or continuous
 Number of stages

 How would you describe the anaerobic digestion system at your farm? (select all that apply)
 Continuous Stirred Tank Reactor
 High Rate Bioreactor
 Plug Flow
 Complete Mix
 Covered Lagoon
 Induced Blanket Reactor
 Hydraulic Self-Stir Reactors
 Hybrid
 Fixed Film
 Unknown
 Other (please specify)
Product End-Uses
 Please provide the average biogas production volume at your facility during calendar year 2015 in one of the units identified below.  
 SCFM
 SCFD
 SCFY
 Other

 Is the biogas produced at this facility used onsite, sold or flared?

 Please identify how the biogas produced in your digesters is used. It could be used onsite by the farm 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 farm/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 in the anaerobic digestion system at your farm?

 Do you flare the excess biogas?

 Do you have a gas purification system? 

 What type of gas purification system do you have?

 What is removed by your gas purification system? Check all that apply.
 Moisture
 Sulfur
 Siloxanes
 Carbon Dioxide
 Compressed Gas
 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, land applied as is with no dewatering or drying
 Yes, processed into animal bedding
 Yes, composted into a reusable or salable product
 Yes, processed into other salable products (e.g., flower pots)
 No, landfilled
 No, incinerated
 Other (please specify)

 If any digestate was disposed of in landfills or incinerated in 2015, please specify the amount in tons or gallons (if known).

 Is the de-watered/dried digestate further treated prior to land application?

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

 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?

 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)


