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# DLA Official Forms

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Form Information
| Form Number:       | DLA2545                                                                                                                                                                                                                                                                       |
|--------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:        | Refrigerant Removal Verification Statement                                                                                                                                                                                                                                    |
| Form Version:      | Oct 2020                                                                                                                                                                                                                                                                      |
| Status:            | Active                                                                                                                                                                                                                                                                        |
| Functional Area:   | Disposition Services                                                                                                                                                                                                                                                          |
| Opr:               | Disposition Services                                                                                                                                                                                                                                                          |
| 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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