Drms Online Form PDF Details

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QuestionAnswer
Form NameDrms Online Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesDTID, drms form 2016, drmo form 2016, 2016

Form Preview Example

REFRIGERANT REMOVAL VERIFICATION STATEMENT

(Prescribing Authority: 40 CFR 82.156.(f)(2) & DoD 4160.21-M)

THE REFRIGERANT HAS BEEN EVACUATED FROM THIS ITEM(S), IN COMPLIANCE WITH THE CLEAN AIR ACT AMENDMENTS OF 1990, SECTION 608, AND U.S. EPA REGULATIONS AT 40 CFR 82.156.

NAME

(Required by regulation) (Person/Technician evacuating the refrigeranT)

ADDRESS

(Required by regulation) (Service Organization or Company)

CITY

(Required by regulation)

STATE

ZIP CODE

DATE REFRIGERANT REMOVED

(Required by regulation)

SIGNATURE OF PERSON TURNING-IN APPLIANCE(s) / EQUIPMENT

(Required by regulation)

GENERATOR/DRMO

(Add information to match the STATEMENT to the equipment to demonstrate compliance during regulatory inspections)

ITEM DESCRIPTION or NOUN NAME/SERIAL NO.

TURN-IN DOCUMENT NO. (DTID)

NOTE: Retain copy of certificate for 3 years with the DTID from the date of receipt

DRMS FORM 2016, APR 2004 (EF)

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