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 MS Word, 101 KB
Grant Payment Request CalRecycle 87 (Rev. 8/13) Fillable PDF, 526 KB MS 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 MS Word, 39 KB
Reliable Contractor Declaration * CalRecycle 168 (Rev. 7/13) PDF, 532 KB MS Word, 56 KB
Travel Expense Log Form (Includes a sample completed form) CalRecycle 246 (Rev. 11/10) PDF, 624 KB MS Excel, 34 KB
* Unreliable Contractor List
Farm and Ranch Cleanup
Title Number Adobe Word/Excel
Expenditure Itemization CalRecycle 224 (Rev. 5/10) Fillable PDF, 534 KB MS 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, 558 KB MS 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, 555 KB MS Word, 47 KB
Grant Report CalRecycle 248 (2/10) Fillable PDF, 600 KB MS Word, 59 KB
Household Hazardous Waste
Title Number Adobe Word/Excel
Expenditure Itemization Summary CalRecycle 667 (Rev. 2/10) PDF, 173 KB MS Excel, 21 KB
Local Government Waste Tire Amnesty Grants
Title Number Adobe Word/Excel
Local Government Waste Tire Amnesty Grant Program
Expenditure Itemization Summary
CalRecycle 755 (12/12) PDF, 520 KB MS Excel, 45 KB
Local Government Waste Tire Amnesty Grant Program
Final Payment Request Checklist / Final Report Form
CalRecycle 754 (12/12) PDF, 568 KB MS Word, 56 KB
Local Government Waste Tire Amnesty Grant Program
Payment Request Checklist and Progress Report Form
CalRecycle 753 (12/12) PDF, 568 KB MS Word, 55 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 MS Excel, 32 KB
Progress Report/Payment Request
Local Government Waste Tire Cleanup Grant Program
CalRecycle 768 (Rev. 11/13) PDF, 570 KB MS Word, 57 KB
Property Access Authorization and Non-Responsibility Affidavit CalRecycle 741 (12/11) PDF, 23 KB MS 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 MS Excel, 49 KB
Expenditure Itemization Summary-TEA CalRecycle 736-EIS-TEA (Rev. 2/14) Not offered in PDF MS Excel, 52 KB
Progress Report
Waste Tire Enforcement
CalRecycle 737-PR-TEA (Rev. 10/13) PDF, 548 KB MS Word, 100 KB
TEA Personnel Expenditure Summary CalRecycle 767 (9/13) Not offered in PDF MS Excel, 93 KB
Recycled Fiber, Plastic, and Glass Grant Program
Title Number Adobe Word/Excel
Recycled Fiber, Plastic, and Glass (FPG) Certification Form CalRecycle 778 - FPG (Revised 6/14) PDF, 647 KB MS Word, 62 KB
Rubberized Pavement Grant Program
Title Number Adobe Word/Excel
Rubberized Pavement Certification CalRecycle 739-TRP (Rev. 8/13) PDF, 62 KB MS 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 MS 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 MS Word, 56 KB
Tire-Derived Product Grants
Title Number Adobe Word/Excel
Tire-Derived Product (TDP) Certification
(Use this form for all TDP13 grants and later)
CalRecycle 227 (Rev. 8/13) Fillable PDF, 88 KB MS Word, 69 KB
Tire-Derived Product (TDP) Certification
(Use this form for all TDP12 grants)
CalRecycle 227 (Rev. 10/12) Fillable PDF, 573 KB MS Word, 62 KB
Tire-Derived Product (TDP) Certification
(Use this form for all TDP11 grants)
CalRecycle 227 (Rev. 3/11) Fillable PDF, 542 KB MS Word, 68 KB
Tire Incentive Program
Title Number Adobe Word/Excel
Tire Incentive Program Certification CalRecycle 774 (New 2/14)  Fillable PDF, 785 KB MS Word, 82 KB
Used Oil Recycling
Title Number Adobe Word/Excel
Certified Center Multiple Site Visit Checklist CalRecycle 665 (Rev. 5/13) PDF, 599 KB MS Word, 97 KB
Certified Center Site Visit Checklist (English) * CalRecycle 664 (Rev. 5/13) PDF, 562 KB MS Word, 60 KB
Certified Center Site Visit Checklist (Spanish) * CalRecycle 664-Sp (Rev. 5/13) PDF, 562 KB MS Word, 63 KB
Expenditure Itemization Summary CalRecycle 667 (Rev. 2/13) PDF, 515 KB MS Excel, 31 KB
Used Oil Payment Program (OPP) Expenditure Worksheet (Optional) * CalRecycle 732 (1/11) PDF, 197 KB MS Excel, 42 KB
* Forms required for Used Oil Payment Program (OPP) reporting.
Last updated: March 28, 2014
Financial Assistance, http://www.calrecycle.ca.gov/Grants/
Contact: grants@calrecycle.ca.gov (916) 341-5062