Forms

The documents on this page are available in Microsoft Word, Excel, and Adobe PDF formats. Get the free Adobe Acrobat reader.

Solid Waste Information System (SWIS) Data Entry Forms

• CalRecycle 37 (Fillable PDF) A form used by CalRecycle staff and LEAs to obtain a Solid Waste Information System (SWIS) number from CalRecycle or submit updates to the SWIS database.
• Minimum data required to obtain a site/SWIS number
• SWIS Portal Agreement (Fillable PDF) A form used by LEAs to authorize staff to submit inspections reports via the SWIS Agency Portal. The agreement will also add new staff to the LEA Directory and LEA Roundtable email list. 

Closed, Illegal and Abandoned (CIA) Disposal Sites Forms

• Closed, Illegal and Abandoned Site Prioritization—Defines CIA disposal site prioritization codes. Each CIA site must be identified by one of these codes.
• Declaration Form (Word), PDF version–A form to be used by CalRecycle staff to provide information on their personal knowledge of the facts regarding a particular circumstance. The declaration is testified to under the laws of the State of California and provided to CalRecycle.
• Gas Monitoring and Control System Plan Review (Draft)–A report template to be used when preparing a gas monitoring and control system plan.
• Notice and Order Template (Word), PDF version–A template to be used when a notice and order must be issued against a disposal site. To be completed and acted upon by CalRecycle or local enforcement agencies.
• Property Access Authorization FormWord download (Word), PDF version (CalRecycle 699)–An authorization form used by CalRecycle staff, their designated contractors, and representatives to gain access to investigate CIA sites.
  • Property Access Authorization Cover Letter (Word), PDF version–A CalRecycle letter used by staff, their designated contractors, and representatives, to request signature on an authorization form to gain access to investigate CIA sites.
• Request for Hearing Form (CalRecycle 218, revised September 2011)–A form to be completed by LEA staff, disposal site operators and/or owners or other interested parties to request a hearing before CalRecycle. The hearing can be requested for denial, suspension or revocation of a permit, administrative civil penalty, to challenge the terms and conditions of a permit, to appeal an enforcement order, to allege failure of the enforcement agency to act as required by law or regulation or to appeal the completeness review of a registration or standardized permit.
• Sampling Log—Tracks where and when a soil sample is taken, the sample ID number and a physical description of the soil.
• Site Assessment Form. (CalRecycle 881)–A form used by CalRecycle and LEA staff to assess CIA sites.
• Site Identification Form. (CalRecycle 880, revised January 2017)–A form used to collect data on CIA facilities. Used by LEAs and CalRecycle.
• Trench Log–A form for used to map trenches in field investigations conducted at CIA sites.

Closure Forms

• Final Closure Plan Completeness Review Checklist (CalRecycle 174)–A checklist to determine if submitted final closure and postclosure maintenance plans meet Title 27, Article 2 technical requirements and if the plans are adequate to produce a detailed cost estimate for disbursement of financial assurance funds.
• Final Closure Plan Qualitative Review Checklist (CalRecycle 177)–Intended for use by regulatory agency staff to assist in the review of final closure and postclosure maintenance plans to determine if the plans may be considered technically adequate.
• Solid Waste Facility Permit for Closed Sites (Word), (CalRecycle 214A, revised March 2010)
  • Recommended Procedures for Completion of Solid Waste Facility Permit for Closed Sites
• Preliminary Closure Plan Completeness Review Checklist (CalRecycle 176)–Intended for use by regulatory agency staff to assist in the review of preliminary closure and postclosure maintenance plans to determine if the plans may be considered complete.
• Preliminary Closure Plan Qualitative Review Checklist (CalRecycle 178)–Intended for use by regulatory agency staff to assist in the review of preliminary closure and postclosure maintenance plans to determine if the plans may be considered technically adequate.

Composting Site Visit Forms

• OCAP Pre-Evaluation Form (CIWMB 208)–A form to be completed by LEAs or CalRecycle staff prior to visiting a composting facility or operation.
• OCAP Site Visit Form (CIWMB 209)–A form to be completed by LEAs or CalRecycle staff during a visit to a composting facility or operation.

Enforcement Form

• Request for Hearing Form (CalRecycle 218, revised September 2011)–LEAs give this form to solid waste facility operators when they propose or issue a permit.

Equipment Loan Forms

• Equipment Loan Request Form (CalRecycle 640)–Used by local enforcement agencies when requesting to borrow equipment from CalRecycle for CalRecycle related field activities.
• Equipment Service Request Form (CalRecycle 720).

Inspection Report Forms

• CalRecycle no longer provides fillable pdf inspection report forms. Please use the SWIS Digital Inspection Program to submit inspection reports.
• Inspection Forms to Use for Activity Type–A listing used by LEAs and CalRecycle staff to determine which inspection form to use when inspecting a particular type of facility or activity.

Permit Finding Request Forms

• Conformance Finding Request Form, PDF–Usually submitted to CalRecycle’s Office of Local Assistance by Permitting staff. Also used by LEAs to request an early consultation.
• Financial Assurances Review Request (CalRecycle 217, revised January 2017)–Usually submitted to CalRecycle’s Financial Assurances Unit by Permitting staff. Also used by LEAs to request an early consultation. Please Note: If you are not able to access this form please contact Elizabeth Felix, CalRecycle Financial Assurances staff.

Permitting Forms

• 45-Day Owner/Operator Transfer Notice and 7-Day Owner/Operator Address Change Notice (CalRecycle 675, revised January 2016)–Form is used to identify a change of owner or operator of a solid waste facility. Completion of this form is not required by regulation, but it will provide CalRecycle and enforcement agency with the information required by PRC section 44005.
• Enforcement Agency Notification. (CalRecycle 169, revised March 2018)–This form will assist operators in meeting the requirements set for forth by Title 14 of the CCR, Section 18103.1: Any operator proposing to engage in solid waste handling pursuant to an EA notification shall notify the EA of its intent to operate in writing prior to commencing operations.
• Five-Year Permit Review Form (CIWMB 678)–A form for use by LEAs in conducting solid waste facility permit five-year reviews.
• Laundry List (Full Permit Application Checklist)–A checklist of application/permit submittal elements for solid waste facilities required to obtain a full permit from CalRecycle. Also known as the full permit Laundry List.
• Permit Reissuance Cover Page –This form is used to reissue a full solid waste facility permit when the 5-year permit review report concludes that there have not been any changes in design or operation since the permit was last issued (as directed by this guidance document).
• Registration Permit PDF version. (CIWMB 81)–A permit prepared by LEAs and submitted to CalRecycle to authorize operation of registration tier solid waste facilities.
• Registration Permit Application PDF version. (CIWMB 83)–An application form used by solid waste facility operators to apply for a registration permit.
• Report of Facility Information (RFI) Amendment Checklist (CalRecycle 216, revised March 2010)–A form used by LEAs to document their review an RFI for completeness
• Solid Waste Facility Permit–A template to be completed by LEAs and submitted to CalRecycle for CalRecycle concurrence in or objection to the issuance of the permit. This document specifies the operational parameters for the facility issued the permit.If you have questions about formatting the template please get in touch with your Permitting and Assistance point of contact.
  • Directions for Completion of Solid Waste Facility Permit
• Solid Waste Facility Permit for Closed Sites (Word), Fillable PDF. (CalRecycle 214A, revised March 2010)–A form to be completed by LEAs and submitted to CalRecycle for their concurrence in or objection to the issuance of a permit that reflects the closure of the facility.
  • Recommended Procedures for Completion of Solid Waste Facility Permit for Closed Sites
• Solid Waste Facility Permit Application (CalRecycle E-1-77, revised January 2016)–This form is completed by a solid waste facility operator and submitted to their EA to apply for a new solid waste facility permit, waste discharge permit, revision of a permit, exemption or waiver of a permit or permit review. It can also be used to submit documents to amend an application or to submit report of facility information amendments. A CalRecycle and Regional Water Quality Control Board form.
  • Directions for Completion of Form E-1-77 (Revised January 2016)
• Standardized Nonhazardous Ash Solid Waste Facility Permit (Word), Fillable PDF. (CIWMB 98)–A form to be completed by local enforcement agencies for the permitting of certain ash solid waste facilities.
• Standardized Permit Application (CalRecycle 92)–A form completed by certain California solid waste facility operators and submitted to LEAs prior to the beginning of operation of a facility or prior to making changes in operation of a facility.

Three-Part Test Form

• Voluntary Residual Percentage Reporting(CIWMB 607)–A form used by CDI facility operators to voluntarily report the residual putrescible waste received at their facility.

CIA Disposal Sites Home