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 NameAddress AddressCity State Zip City State ZipSignature Date Signature Date
36
State of California Department of Public Health

Water Treatment Device

Certificate Number

05-1698

Date Issued: February 2,2010
Modified June 25, 2013

Trademark/Model Designation Replacement Elements
GE MWF MWF
PLWF
Manufacturer: General Electric Company
The water treatment device(s) listed on this certificate 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
Lead
Mercury
Organic Contaminants
Carbofuran
Endrin
p-Dichlorobenzene
Benzene
Atrazine
Lindane
Tetrachloroethylene
Toxaphene
2,4- D
Rated Service Capacity 300 gallons Rated Service Flow: 0.5 gallons per minute

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

(on some models)

(on some models)