California Department of Resources Recycling and Recovery (CalRecycle)

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
Title Number Adobe Word/Excel
General Checklist of Business Permits, Licenses, and Filings CalRecycle 669 (Rev. 5/13) PDF, 621 KB Word, 101 KB
Grant Payment Request CalRecycle 87 (Rev. 8/13) Fillable PDF, 526 KB Word, 83 KB
Payee Data Record STD. 204 Fillable PDF, 163 KB Not offered in Word/Excel
Personnel Expenditure Summary CalRecycle 165 (Rev. 2/10) PDF, 538 KB Word, 39 KB
Reliable Contractor Declaration * CalRecycle 168 (Rev. 7/13) PDF, 532 KB Word, 56 KB
Travel Expense Log Form (Includes a sample completed form) CalRecycle 246 (Rev. 2/15) Not offered in PDF Excel, 41 KB
* Unreliable Contractor List
Farm and Ranch Cleanup
Title Number Adobe Word/Excel
Expenditure Itemization CalRecycle 224 (Rev. 5/10) Not offered in PDF Word, 33 KB
Farm and Ranch Solid Waste Cleanup and Abatement Grant Program Final Payment Request and Final Report Form CalRecycle 750 (8/12) Fillable PDF, 215 KB Word, 56 KB
Farm and Ranch Solid Waste Cleanup and Abatement Grant Program Payment Request Checklist & Progress Report Form CalRecycle 749 (8/12) Fillable PDF, 196 KB Word, 47 KB
Grant Report CalRecycle 248 (2/10) Fillable PDF, 578 KB Word, 59 KB
Household Hazardous Waste
Title Number Adobe Word/Excel
Expenditure Itemization Summary CalRecycle 667 (Rev. 2/15) PDF, 1.4 MB Excel, 30 KB
Local Government Waste Tire Amnesty Grants
Title Number Adobe Word/Excel
Local Government Waste Tire Amnesty Grant Program
Expenditure Itemization Summary
CalRecycle 755 (Rev. 2/16) Not offered in PDF Excel, 43 KB
Local Government Waste Tire Amnesty Grant Program
Payment Request Checklist and Final Progress Report Form
CalRecycle 754 (Rev. 3/16) Not offered in PDF Word, 60 KB
Local Government Waste Tire Amnesty Grant Program
Payment Request Checklist and Progress Report Form
CalRecycle 753 (Rev. 3/16) Not offered in PDF Word, 54 KB
Local Government Waste Tire Amnesty,
Personnel Expenditure Summary, CalRecycle 771
CalRecycle 771 (New 1/14) PDF, 184 KB Not offered in Word/Excel
Local Government Waste Tire Cleanup Grants
Title Number Adobe Word/Excel
Local Government Waste Tire Cleanup Grant Program
Expenditure Itemization Summary
CalRecycle 745-EIS-TCU (Rev. 6/12) PDF, 516 KB Excel, 32 KB
Progress Report/Payment Request
Local Government Waste Tire Cleanup Grant Program
CalRecycle 768 (Rev. 11/13) PDF, 570 KB Word, 57 KB
Property Access Authorization and Non-Responsibility Affidavit CalRecycle 741 (12/11) PDF, 23 KB Word, 36 KB
Local Government Waste Tire Enforcement Grants
Title Number Adobe Word/Excel
CalRecycle Waste Tire Surveillance CalRecycle 229 (Rev. 7/12) Not offered in PDF Excel, 49 KB
Expenditure Itemization Summary-TEA CalRecycle 736-EIS-TEA (Rev. 2/14) Not offered in PDF Excel, 52 KB
Progress Report
Waste Tire Enforcement
CalRecycle 737-PR-TEA (Rev. 10/13) Not offered in PDF Word, 100 KB
TEA Personnel Expenditure Summary CalRecycle 767 (9/13) Not offered in PDF Excel, 93 KB
Organics Grant Program
Title Number Adobe Word/Excel
Expenditure Itemization Summary CalRecycle 777 (New 1/15) Not offered in PDF MS Excel, 32 KB
Feedstock Certification CalRecycle 778-GHG (Revised 6/15) Fillable PDF, 746 KB Word, 87 KB
Recycled Fiber, Plastic, and Glass Grant Program
Title Number Adobe Word/Excel
Expenditure Itemization Summary CalRecycle 777 (New 1/15) Not offered in PDF Excel, 32 KB
Feedstock Certification CalRecycle 778-GHG (Revised 6/15) Fillable PDF, 746 KB Word, 87 KB
Rubberized Pavement Grant Program
Title Number Adobe Word/Excel
Rubberized Pavement Certification CalRecycle 739-TRP (Rev. 8/13) PDF, 62 KB Word, 59 KB
Rubberized Pavement Payment Calculation Summary
(Use this form for all TRP3 grants and later)
CalRecycle 748 (2/13) Not offered in PDF Excel, 218 KB
Tire-Derived Aggregate Grants
Title Number Adobe Word/Excel
Tire Derived Aggregate (TDA) Certification CalRecycle 740-TDA (Rev. 8/13) Fillable PDF, 61 KB Word, 56 KB
Tire-Derived Product Grants
Title Number Adobe Word/Excel
Tire-Derived Product (TDP) Certification
(Use this form for all TDP14 and later grants)
CalRecycle 227 (Rev. 10/14) Fillable PDF, 50 KB Word, 69 KB
Tire-Derived Product (TDP) Certification
(Use this form for all TDP13 grants)
CalRecycle 227 (Rev. 8/13) Fillable PDF, 88 KB Word, 69 KB
Tire-Derived Product (TDP) Certification
(Use this form for all TDP12 grants)
CalRecycle 227 (Rev. 10/12) Fillable PDF, 573 KB Word, 62 KB
Tire-Derived Product (TDP) Certification
(Use this form for all TDP11 grants)
CalRecycle 227 (Rev. 3/11) Fillable PDF, 542 KB Word, 68 KB
Tire Incentive Program
Title Number Adobe Word/Excel
Tire Incentive Program Certification
(Use this form for all TIP2 grants)
CalRecycle 774 (Rev. 12/15) Fillable PDF, 608 KB Word, 77 KB
Tire Incentive Program Certification
(Use this form for all TIP1 grants)
CalRecycle 774 (Rev. 2/14) Fillable PDF, 785 KB Word, 82 KB
Used Oil Recycling
Title Number Adobe Word/Excel
Collection Center Basics to Customize Handout New 6/15 Not offered in PDF Word, 82 KB
Certified Center Site Visit Checklist * (Manual) CalRecycle 664 (Rev. 5/15) PDF, 562 KB Word, 60 KB
Certified Center Auto-Fill Site Visit Checklist (System Generated)*
Expenditure Itemization Summary CalRecycle 667 (Rev. 2/15) PDF, 1.4 MB Excel, 30 KB
Payee Data Record  STD. 204  Fillable PDF, 105 KB Not offered in Word/Excel
Used Oil Payment Program (OPP) Expenditure Worksheet (Optional) * CalRecycle 732 (1/11) PDF, 197 KB Excel, 42 KB
* Forms required for Used Oil Payment Program (OPP) reporting.
Last updated: May 3, 2016
Financial Assistance, http://www.calrecycle.ca.gov/Funding/
Contact: grants@calrecycle.ca.gov (916) 341-5062