GE 49-60456, 200D8074P009 manual Water Treatment Device, Certificate Number, Buyer, Seller

State of California

Department of Health Services

	Water Treatment Device
	Certificate Number
00 - 1434
	Date Issued: May 30, 2000
	Date Revised: February 9, 2001
GE Smart Water Filtration Systems - GWF06		GWF06
GE Smart Water Filtration Systems - GWF		GWF
Hotpoint Refrigerator Systems - HWF		HWF
General Electric Appliances

Cysts (protozoan)	Asbestos
Turbidity	Lead

Atrazine

Lindane

2,4-D

300 gallons* 0.5 gpm

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:			SELLER:
Name			Name
Address			Address
City	State	Zip	City	State	Zip
Signature		Date	Signature		Date

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