State of California
Department of Health Services
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| Water Treatment Device |
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| 00 - 1434 |
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| Date Issued: May 30, 2000 |
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| Date Revised: February 9, 2001 |
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| GE Smart Water Filtration Systems - GWF06 | GWF06 |
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| GE Smart Water Filtration Systems - GWF | GWF |
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| Hotpoint Refrigerator Systems - HWF | HWF |
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| General Electric Appliances |
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Cysts (protozoan) | Asbestos |
Turbidity | Lead |
Atrazine
Lindane
300 gallons* | 0.5 gpm |
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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.
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| SELLER: |
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Name |
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Address |
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| Address |
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City | State | Zip |
| City | State | Zip |
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Signature |
| Date |
| Signature |
| Date |
30
