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State of California
Department of Health Services
Water Treatment Device
Certificate Number
97-1291
Date Issued: June 10, 1997
TrademarlgModel Designation
GE Water by (;ulligan Filtration System FXRC
Manufacturer: Culligan International Company
Replacement Elements
None
The water treatment device(s) listed on this certificate have met the testing requirements pursuant to Section 116830of the
Health and Safety Code for the following health related contaminants:
Microbiological Contaminants
and Turbidity
Cysts (protozoan,
Turbi(li b,
Inorganic/Radiological
Contaminants
Lead
Organic Contaminants
None
RatedServiceCapacity:200 gallons RatedServiceFlow: 0.5 gpm
Donotuse where water ismicrobiologicallyunsafeor with water ofunknownquality,exceptthatsystemsclaimingcystreductionmaybe
usedonwater containingcysts.
ForPurchases Made In Iowa: This form nmst be signed and dated by the buyer and seller prior to the consunnnation of this
sale. This form should be retained on file by the seller for a nlininmm of two years.
BUYER: SELLER:
Name Name
Ad&ess Address
City State Zip City
Signature Date Signature
State Zip
Date
27
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