California Department of Resources Recycling and Recovery (CalRecycle)

Hazardous Waste & Universal Waste (U-Waste)

Forms

The following forms are available for local government program staff, operators of certified used oil recycling centers, and registered generators.

Grant Related Forms
Title Number Adobe Word/Excel
Reliable Contractor Declaration CIWMB 168 (Rev. 2/08) PDF, 537 KB MS Word, 72 KB
Travel Expense Log Form (Includes a sample completed form.) CIWMB 246 (Rev. 2/08) PDF, 28 KB MS Excel, 27 KB
Personnel Expenditure Summary CIWMB 165   MS Word, 41 KB
Expenditure Itemization Summary CIWMB 667 (Rev. 6/09) PDF, 558 KB MS Excel, 19 KB
Expenditure Itemization Summary (Sample) CIWMB 667 PDF, 30 KB  
Facility Construction/Expansion Evaluation Form (6/08) CIWMB 12 PDF, 77 KB MS Excel, 54 KB
Recycled Content Certification Form CIWMB 74G-Oil PDF, 22 KB MS Word, 71 KB
Payment Request Form CIWMB 87 PDF, 71 KB MS Word, 83 KB
Project Evaluation Data Form (6/08) CIWMB 11 PDF, 19 KB MS Excel, 66 KB
General Checklist of Business
Permits, Licenses, and Filings		 CIWMB 669 PDF, 278 KB MS Word, 188 KB
Used Oil Block Grant Annual Report Form (Rev. 6/09) CIWMB 644 PDF, 844 KB MS Word, 52 KB
Grant Self-Assessment Checklist CIWMB 641 PDF, 73 KB MS Word, 196 KB
Used Oil Collection Center Site Visit Forms
Title Number Adobe Word/Excel
Site Visit Checklist (English) (Rev. 7/08)                                        CIWMB 664 PDF, 52 KB MS Word, 53 KB
Site Visit Checklist (Spanish) (Rev. 7/08) CIWMB 664 PDF, 47 KB MS Word, 44 KB
Multiple Site Visit Checklist (Rev. 7/08) CIWMB 665 PDF, 92 KB  
Last updated: October 7, 2009
Used Oil & Household Hazardous Waste Program http://www.calrecycle.ca.gov/HomeHazWaste/
Contact: UsedOilHHW@calrecycle.ca.gov (916) 341-6457