EPA Form 6700

- 05 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, Colle ction 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

1. Please provide the following informa tion about your Project/Farm

. Project /Farm Name

S treet address

C ity/Town

State Zip code

Phone Number

2. Please provide the following information for the c ontact person for facility operations

Name

Title

Email Address

P hone number

3. Please provide the c ontact a ddress (if d ifferent from Facility Address)

Street address City/Town

State
Zip code

Organic Waste Processing

4. 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)?

5. If organic waste is currently not accepted from offsite sources and processed in your anaerobic
digester, is your facility planning for or interested in re ceiving organic wastes from offsite?

Facility o peratin g status:

6. Please identify the status of your facility

a. Planning stage /Design stage/Permitting process

b. U nder constructionEPA Form 6700

- 05 c. Operational

d. Temporary shut

- down

e. Ceased o peration

f. Other

7. What is the targeted date for your co

- digestion system to be operational?

8. What date did your co

- digestion system become operational?

9. What date did your co

- digestion system temporarily shut

- down?

10. What is the targeted date for your co

- digestion system to re

- start operations?

11. What date did your co

- digestion system cease operations?

12. Please state the reason your co

- digestion system ceased operations.

On

- Farm Co

- Digestion Capacity

13. Taking into account the average volume of manure from your livestock processe d in your
anaerobic digestion system, please identify the available capacity to process other feedstocks

from offsite sources.

14. 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.

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

16. Does your farm accept and process food

- based feedstocks from off

- si te sources?

17. 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.

18. What was the total weight of food

- ba sed 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.

19. Does your farm accept and process food

- based feedstocks from off

- site sources?

20. What was t he 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.EPA Form 6700

- 05

21. 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

22. 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.

a. Beverage processing industry waste

b. Crop residues

c. Crude glycerine

d. De

- icing fluid

e. Fats, oils and greases (FOG)

f. Food processing industry waste

g. Food service waste, pre & post

- consumer
h. Fruit/vegetative wastes

i. Lab (or Pharma) wastes j. Litters

k. Manure from other farms

l. Mixed yard waste

m. Paper mill wastes

n. Rendering wastes

o. Retail food waste

p. Septa ge

q. Source

- separated commercial, institutional or residential organic wastes

r. Wastewater solids (sludge)

s. Other (please specify)

23. Are your tipping fees equal for all materials?

24. Which of the following ranges best represents your tipping fees for co

- digesting liquid

feedstocks?

a. N/A

– Facility does not process liquid feedstock.

b. Business Confidential/Prefer not to say

c. $0.00

- $0.05 per gallon

d. $0.06

- $0.10 per gallon

e. $0.11

- $0.20 per gallon

f. $0.21

- $0.50 per gallon

g. $0.51

- $1 per gallon

h. > $1 per gallon

25. Which of the following ranges best represents your tipping fees for co

- digesting solid

feedstocks?

a. N /A

– Facility does not process soli d feedstock.

b. Business Confidential/Prefer not to say

c. $0

- $10 per ton

d. $11

- $20 per tonEPA Form 6700

- 05 e. $21

- $30 per ton

f. $31

- $40 per ton

g. $41

- $50 per ton

h. $51

- $60 per ton

i. $61

- $70 per ton

j. $71 or more per ton

26. 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?

27. You indicated that you receive and co

- digest the feedstocks identified below in liquid form. The

feedstocks identif ied in your answer to question 2 2 above will be listed on this page. Which of
the following ranges best represents your tipping fee for these liquid feedstocks?

a. Prefer not to say

b. $0.00

- $0.05 per gallon

c. $0.06

- $0.10 per gallon

d. $0.11

- $0. 20 per gallon

e. $0.21

- $0.50 per gallon

f. $0.51

- $1 per gallon

g. > $1 per gallon

28. You indicated that you receive and co

- digest the feedstocks identified below in solid form. The

feedstocks identif ied in your answer to question 2 2 above will be listed on this page. Which of
the following ranges best represents your tipping fee for these solid feedstocks?

a. Prefer not to say

b. $0

- $10 per ton

c. $11

- $20 per ton

d. $21

- $30 per ton

e. $31

- $40 per ton

f. $41

- $50 per ton

g. $51

- $60 per ton

h. $61

- $70 per ton

i. $71 or more per ton

29. Please identify the sources of the feedstocks that are received and processed in the co

- digestion
system at your facility. Check all that apply.

a. Airports

b. Biodiesel production

c. Corporate complexes

d. Farmers Markets

e. Food/Beverage Processors

f. Fruit/Vegetable FarmsEPA Form 6700

- 05 g. Grocery Stores/Supermarkets

h. Healthcare

i. Hospitality

j. Industrial

k. Laboratories/Pharmaceutical Companies

l. Other Livestock Farms

m. Municipal/Residential

n. Prisons

o. Restaurants and Food Service

p. Retail Stores

q. Schools

r. Sports and Entertainment Venues

s. Wastewater Treatment Plants

t. Other (please specify)

30. 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.

31. Please identify the fo llowing specifications for your digester.

a. Temperature range

b. Wet or dry

c. Batch or continuous

d. Number of stages

32. How would you describe the anaerobic digestion system at your farm? (select all that apply)

a. Continuous Stirred Tank Reactor

b. High Rate Bioreactor

c. Plug Flow

d. Complete Mix

e. Covered Lagoon

f. Induced Blanket Reactor

g. Hydraulic Self

- Stir Reactors

h. Hybrid

i. Fixed Film

j. Unknown

k. Other (please specify)

Product End

- Uses

33. Please provide the average biogas production volume at your facility during calendar year 2015

in one of the units identified below.

a. SCFM

b. SCFD

c. SCFYEPA Form 6700

- 05 d. Other

34. Is the biogas produc ed at this facility used onsite, sold or flared ?

35. Please identify how the biogas produced in your digesters is used. It could be used onsite by the

farm or offsite by a purchase r. Check all that apply.

a. Produce mechanical power

b. Produce heat and electricity (CHP)

c. Produce electricity (including net metering)

d. Produce electricity (sold to grid)

e. Fuel boilers and furnaces to heat digesters

f. Fuel boilers and furnaces to heat other sp aces

g. Compressed to vehicle fuels: used for farm /personal vehicles

h. Compressed to vehicle fuels: sold to customers

i. Renewable natural gas (processed in order to inject to pipeline)
j. Other (please specify)

36. Are you able to utilize all of the biogas produced in the anaerobic digestion system at your farm?

37. Do you flare the excess biogas?

38. Do you have a gas purification system?

39. What type of gas purification system do you have?

40. What is removed by your gas purification system? Check all that apply.

a. Mo isture

b. Sulfur

c. Siloxanes

d. Carbon Dioxide

e. Compressed Gas

f. Other (please specify)

41. Do you beneficially re

- use the solid digestate you produce? (Select all that apply)

a. Yes, de

- watered/dried and land applied

b. Yes, land applied as is with no dewatering or drying

c. Y es, processed into animal bedding

d. Yes, composted into a reusable or salable product

e. Yes, processed into other salable products (e.g., flower pots)

f. No, landfilled

g. No, incinerated

h. Other (please specify)EPA Form 6700

- 05

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

43. Is the de

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

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

45. How do you manage the liqui d digestate you produce? Check all that apply.

a. Beneficially reused as fertilizer via land application

b. Recirculated through digester

c. Discharged to a wastewater treatment plant

d. Other (please specify)

46. Is the liquid digestate further treated prior to land app lication?

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

48. Do you recover nutrients from your digestate?

a. No

b. Yes, phosphorous recovery by chemical precipitation (e.g., struvite)

c. Yes, a mmonia r ecovery

d. Other (please specify)