Grant Forms

This page contains forms that may be used by the California Department of Resources Recycling and Recovery's (CalRecycle) various grant programs. To find out what specific forms are required for your grant, please review the Procedures and Requirements for your specific grant program, or contact your CalRecycle grant manager if you have questions or need additional information.

General Grant Forms Farm and Ranch Cleanup Grants Household Hazardous Waste Grants Local Enforcement Agency Grants Solid Waste Disposal and Site Cleanup Grants Reuse Assistance Grants Tire Recycling, Cleanup, and Enforcement Grants Used Oil Recycling Grants

General Grant Forms

Title	Number	Adobe	Word/Excel
General Checklist of Business Permits, Licenses, and Filings	CalRecycle 669 (Rev. 9/12)	PDF, 669 KB	MS Word, 104 KB
Grant Payment Request	CalRecycle 87 (Rev. 9/12)	Fillable PDF, 525 KB	MS Word, 81 KB
Payee Data Record	STD. 204	Fillable PDF, 163 KB
Personnel Expenditure Summary	CalRecycle 165 (Rev. 2/10)	PDF, 538 KB	MS Word, 39 KB
Recycled-Content Certification for CalRecycle Grant Programs	CalRecycle 74G (Rev. 2/10)	PDF, 595 KB	MS Word, 58 KB
Reliable Contractor Declaration	CalRecycle 168 (Rev. 3/10)	PDF, 540 KB	MS Word, 50 KB
Travel Expense Log Form (Includes a sample completed form)	CalRecycle 246 (Rev. 11/10)	PDF, 624 KB	MS Excel, 34 KB

Farm and Ranch Cleanup

Title	Number	Adobe	Word/Excel
Expenditure Itemization	CalRecycle 224 (Rev. 5/10)	Fillable PDF, 534 KB	MS Word, 33 KB
Grant Report	CalRecycle 248 (New 2/10)	Fillable PDF, 600 KB	MS Word, 59 KB
Farm and Ranch Payment Request Checklist & Progress Report Form	CalRecycle 749 (New 8/12)	Fillable PDF, 555 KB	MS Word, 47 KB
Final Payment Request and Final Report Form	CalRecycle 750 (New 8/12)	Fillable PDF, 558 KB	MS Word, 56 KB

Farm and Ranch Cleanup Grants Home

Household Hazardous Waste

Title	Number	Adobe	Word/Excel
Expenditure Itemization Summary	CalRecycle 667 (Rev. 2/10)	PDF, 173 KB	MS Excel, 21 KB
Expenditure Itemization Summary (Sample)	CIWMB 667	PDF, 30 KB
Facility Construction/Expansion Evaluation	CIWMB 12 (Rev. 6/08)	PDF, 77 KB	MS Excel, 54 KB
Project Evaluation Data	CalRecycle 11 (Rev. 2/10)	Fillable PDF, 597 KB	MS Excel, 59 KB
Recycled-Content Certification	CalRecycle 74G-Oil (Rev. 7/10)	PDF, 548 KB	MS Word, 46 KB

Household Hazardous Waste Grants Home

Local Enforcement Agency

Title	Number	Adobe	Word/Excel
Grants Proposed Budget Report	CalRecycle 166a (Rev. 2/10)	PDF, 551 KB	MS Excel, 33 KB
Grant Final Budget Report	CalRecycle 166b (Rev. 2/10)	Fillable PDF, 604 KB	MS Excel, 59 KB

Local Enforcement Agency Grants Home

Reuse Assistance

Title	Number	Adobe	Word/Excel
Expenditure Itemization Summary	CIWMB 667-Reuse (New 2/08)	PDF, 14 KB	MS Excel, 34 KB

Reuse Assistance Grants Home

Solid Waste Disposal and Site Cleanup

Title	Number	Adobe	Word/Excel
Recycled-Content Certification	CalRecycle 74G-Cleanup (Rev. 2/10)	PDF, 574 KB	MS Word, 55 KB

Solid Waste Disposal and Site Cleanup Grants Home

Tire Recycling, Cleanup, and Enforcement

Title	Number	Adobe	Word/Excel
Expenditure Itemization Summary Local Government Waste Tire Amnesty	CalRecycle 755 (New 12/12)	PDF, 520 KB	MS Excel, 45 KB
Payment Request Checklist / Progress Report Form Local Government Waste Tire Amnesty	CalRecycle 753 (New 12/12)	PDF, 568 KB	MS Word, 55 KB
Final Payment Request Checklist / Final Report Form Local Government Waste Tire Amnesty	CalRecycle 754 (New 12/12)	PDF, 568 KB	MS Word, 56 KB
CalRecycle Waste Tire Surveillance	CalRecycle 229 (Rev. 7/12)	Not offered in PDF	MS Excel, 49 KB
Expenditure Itemization Summary Local Government Waste Tire Cleanup	CalRecycle 745-EIS-TCU (Rev. 6/12)	PDF, 516 KB	MS Excel, 32 KB
Expenditure Itemization Summary Waste Tire Enforcement	CalRecycle 736-EIS-TEA (Rev. 5/12)	Not offered in PDF	MS Excel, 39 KB
Progress Report Waste Tire Enforcement	CalRecycle 737-PR-TEA (Rev. 10/12)	PDF, 547 KB	MS Word, 99 KB
Property Access Authorization and Non-Responsibility Affidavit	CalRecycle 741 (New 12/11)	PDF, 23 KB	MS Word, 36 KB
Rubberized Pavement Payment Calculation Summary (Use this form for all Pavements grants awarded in FY 2012/13 and later	CalRecycle 748 (New 2/13)	Not offered in PDF	MS Excel, 218 KB
Rubberized Asphalt Concrete (RAC) Certification (Use this form for all RAC grants awarded in FY 2010/11)	CalRecycle 727-RAC (New 11/10)	PDF, 555 KB	MS Word, 59 KB
Rubberized Pavement Certification (Use this form for all Pavement grants awarded)	CalRecycle 739-TRP (New 9/11)	PDF, 60 KB	MS Word, 59 KB
Tire-Derived Aggregate (TDA) Certification (Use this form for all TDA grants awarded)	CalRecycle 740-TDA (New 9/11)	Fillable PDF, 45 KB	MS Word, 63 KB
Tire-Derived Product (TDP) Certification (Use this form for all TDP grants awarded in FY 2009/10)	CalRecycle 227 (Rev. 2/10)	Fillable PDF, 534 KB	MS Word, 61 KB
Tire-Derived Product (TDP) Certification (Use this form for all TDP grants awarded in FY 2010/11 and FY2011/12)	CalRecycle 227 (Rev. 3/11)	Fillable PDF, 542 KB	MS Word, 68 KB
Tire-Derived Product (TDP) Certification (Use this form for all TDP grants awarded in FY 2012/13 and later)	CalRecycle 227 (Rev. 10/12)	Fillable PDF, 573 KB	MS Word, 62 KB

Tire Recycling, Cleanup, and Enforcement Grants Home

Used Oil Recycling

Title	Number	Adobe	Word/Excel
Expenditure Itemization Summary	CalRecycle 667 (Rev. 2/10)	PDF, 173 KB	MS Excel, 21 KB
Recycled-Content Certification	CalRecycle 74G-Oil (Rev. 7/10)	PDF, 548 KB	MS Word, 46 KB
Site Visit Checklist (English) *	CalRecycle 664 (Rev. 3/10)	PDF, 586 KB	MS Word, 54 KB
Site Visit Checklist (Spanish) *	CalRecycle 664-Sp (Rev. 3/10)	PDF, 596 KB	MS Word, 59 KB
Site Visit Checklist (Multiple Sites) *	CalRecycle 665 (Rev. 3/10)	PDF, 628 KB	MS Word, 90 KB
Used Oil Block Grant Annual Report	CalRecycle 644 (Rev. 7/10)	PDF, 839 KB	MS Word, 174 KB
Used Oil Payment Program (OPP) Expenditure Worksheet (Optional) *	CalRecycle 732 (New 01/11)	PDF, 197 KB	MS Excel, 42 KB

* Forms required for Used Oil Payment Program (OPP) reporting.

Used Oil Recycling Grants Home