Form CalRecycle757 "Quality Incentive Payment Claim Form" - California

What Is Form CalRecycle757?

This is a legal form that was released by the California Department of Resources Recycling and Recovery - a government authority operating within California. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on February 1, 2018;
  • The latest edition provided by the California Department of Resources Recycling and Recovery;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CalRecycle757 by clicking the link below or browse more documents and templates provided by the California Department of Resources Recycling and Recovery.

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Download Form CalRecycle757 "Quality Incentive Payment Claim Form" - California

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State of California • Environmental Protection Agency
Department of Resources Recycling and Recovery
CalRecycle 757 (Rev. 2/18)
DOR 56
Division of Recycling
801 K Street, MS 17-24 • Sacramento, California 95814
Phone 916/323-5778 • Fax 916/445-0645 • TDD 916/324-2555
Website www.calrecycle.ca.gov
QUALITY INCENTIVE PAYMENT CLAIM FORM
Application for the month of:
Year:
Certification Number:
Facility Name:
Facility Address:
Contact Person:
Telephone Number:
Payment Information:
Information must match the mailing address on the Payee Data Record (STD 204)
Payee’s Name:
Payee’s Address:
Color Sorted Glass:
FLINT
AMBER
GREEN
Redemption Weight
(Tenth of Tons)
To be eligible to submit Quality Incentive Payment Claim Form CalRecycle 757, (previously known as DOR 56),
the sorting facility must have a Division approved methodology to attribute beverage container materials to the
types of programs from which they were received.
The Division shall pay a Quality Incentive Payment for Glass which is collected by curbside programs or dropoff and
collection programs, color sorted and substantially free of contamination.
To be eligible for payment, a Quality Incentive Payment Claim Form CalRecycle 757, (previously known as DOR 56),
must be submitted to the Division, no later than the first day of the second month following the reporting month.
Applications postmarked after this date or incomplete applications may be denied payment.
I certify under penalty of perjury that the facts presented herein are true and correct to the best of my knowledge.
Signature and Title of Authorized Representative
Date
State of California • Environmental Protection Agency
Department of Resources Recycling and Recovery
CalRecycle 757 (Rev. 2/18)
DOR 56
Division of Recycling
801 K Street, MS 17-24 • Sacramento, California 95814
Phone 916/323-5778 • Fax 916/445-0645 • TDD 916/324-2555
Website www.calrecycle.ca.gov
QUALITY INCENTIVE PAYMENT CLAIM FORM
Application for the month of:
Year:
Certification Number:
Facility Name:
Facility Address:
Contact Person:
Telephone Number:
Payment Information:
Information must match the mailing address on the Payee Data Record (STD 204)
Payee’s Name:
Payee’s Address:
Color Sorted Glass:
FLINT
AMBER
GREEN
Redemption Weight
(Tenth of Tons)
To be eligible to submit Quality Incentive Payment Claim Form CalRecycle 757, (previously known as DOR 56),
the sorting facility must have a Division approved methodology to attribute beverage container materials to the
types of programs from which they were received.
The Division shall pay a Quality Incentive Payment for Glass which is collected by curbside programs or dropoff and
collection programs, color sorted and substantially free of contamination.
To be eligible for payment, a Quality Incentive Payment Claim Form CalRecycle 757, (previously known as DOR 56),
must be submitted to the Division, no later than the first day of the second month following the reporting month.
Applications postmarked after this date or incomplete applications may be denied payment.
I certify under penalty of perjury that the facts presented herein are true and correct to the best of my knowledge.
Signature and Title of Authorized Representative
Date