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# DLA Official Forms

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| Form Number:  DLA2545                                                                                                                                                                                                                                                                             |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:  Refrigerant Removal Verification Statement                                                                                                                                                                                                                                           |
| Form Version:  Oct 2020                                                                                                                                                                                                                                                                           |
| Status:  Active                                                                                                                                                                                                                                                                                   |
| Functional Area:  Disposition                                                                                                                                                                                                                                                                     |
| Opr:  Disposition                                                                                                                                                                                                                                                                                 |
| Safeguards:  None                                                                                                                                                                                                                                                                                 |
| Electronic:  Yes                                                                                                                                                                                                                                                                                  |
| Form Link:  Documents/FormsSite/forms/DL2545.pdf                                                                                                                                                                                                                                                  |
| Type:  Prescribed                                                                                                                                                                                                                                                                                 |
| Prescribed:  40 CFR 82.156(f)(2) and DoDM 4160.21-V4                                                                                                                                                                                                                                              |
| Description:  THIS FORM REPLACES DRMS FORM 2016 DATED JUNE 2011, WHICH IS OBSOLETE.  This form is used to document removal of refrigerant for items listed.                                                                                                                                       |
| Records Retention:  4160.4 Property Accountability.  Inventories of property on-hand, disposal transaction registers, resolution listings and similar materials used to research and provide overall accountability status of property.  Temporary.  Cutoff at end of CY.  Destroy after 3 years. |
| Form Audience:                                                                                                                                                                                                                                                                                    |

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