GE 200D8074P039 Certificate Number, Name Address City State Zip SignatureDate

	State of California
	Department of Health Services
	Water Treatment Device
	Certificate Number
	05 - 1698
	Date Issued: February 2, 2005
Trademark/Model Designation	Replacement Elements
MWF	MWF

Manufacturer: General Electric Company

The water treatment device(s) listed on this certi cate have met the testing requirements pursuant to Section

116830 of the Health and Safety Code for the following health related contaminants:

Microbiological Contaminants and Turbidity	Inorganic/Radiological Contaminants
Cysts	Asbestos
Turbidity	Lead
Organic Contaminants	Mercury
Alachlor
Atrazine
Benzene
Carbofuran
Lindane
Mercury
Toxaphene
1,4-dichlorobenzene
2,4-D

Rated Service Capacity: 300 galRated Service Flow: 0.5 gpm

Conditions of Certification:

Do not use where water is microbiologically unsafe or with water of unknown quality, except that systems certi ed for cyst reduction may be used on disinfected waters that may contain lterable cysts.

For Purchases Made In Iowa: This form must be signed and dated by the buyer and seller prior to the consummation of this sale. This form should be retained on file by the seller for a minimum of two years.

BUYER:

Name

Address

City State Zip

SignatureDate

SELLER:

Name

Address

City State Zip

SignatureDate

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