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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.
BUYER: SELLER:
Name Name
Address Address
City State Zip City State Zip
Signature Date Signature Date
36
State of California
Department of Public Health
Water Treatment Device
Certificate Number
Date Issued: February 2, 2010
Trademark/Model Designation
Replacement Elements
169805
-
GE MWF
MWF
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:
sotsebsAstsyC
Lead
Mercury
Atrazine
Benzene
Carbofuran
Endrin
Lindane
Tetrachloroethylene
Toxaphene
1,4-dichlorobenzene
2, 4-D
Microbiological Contaminants and Turbidity
Inorganic/Radiological Contaminants
Organic Contaminants
Do not use where water is microbiologically unsafe or with water of unknown quality, except that systems certified
for cyst reduction may be used on disinfected waters that may contain filterable cysts.
300 gal
Rated Service Capacity:
0.5 gpm
Rated Service Flow:
Conditions of Certification:
(on some models)
(on some models)
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