Biodiesel Survey Form
Name:
Mr/Ms/Dr   First Name   Last Name
Title:
Organization:
Agency:
Address1:
Address2:
City: ST: ZIP:
Phone:
Email:

1. Does your facility use biodiesel?

Yes | No

2. Reasons your facility uses biodiesel. (Check all that apply)

Satisfy Executive Order
Energy Policy Act
Farm Bill
Agency Direction
Environment
Safety Issues
Reduce wear and tear on vehicle
Other

3. Types of Biodiesel being used. (Check all that apply)

B100
B50
B20
B5
Other

4. Estimated Annual Volume of each type. (In Gallons)

B100
B50
B20
B5
Other

5. What applications are you using Biodiesel for? (Check all that apply)

Trucks
Aircraft Support Equipment
Stationary Generators
Boilers/heating
Other

6. Approximate number of people in your organization.

7. Approximate number of vehicles that use biodiesel.

8. Where do you purchase your biodiesel from?

Source 1.
Source 2.
Source 3.

9. How do you purchase biodiesel? (Check all that apply)

Contract
Credit Card
Other

10. How much do you pay for biodiesel? (Per gallon)

Average
High
Low

11. Have you encountered problems from biodiesel usage? (If yes, please explain)

Yes | No

12. Do you have a biodiesel success story you would like to share?

Yes | No


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