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State of California
Department of Health Services
Water Treatment Device
Certificate Number
97-1291
Date Issued: June 10, 1997
Trademark/Model Designation Replacement Elements
GE Water by Culligan Filtration System FXRC None
Manufacturer:
Culligan International 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 Inorganic/Radiological
and Turbidity Contaminants
Cysts (protozoan) Lead
Turbidity
Organic Contaminants
None
Rated Service Capacity:
200 gallons
Rated Service Flow:
0.5 gpm
Do not use where water is microbiologically unsafe or with water of unknown quality, except that systems claiming cyst reduction may be
used on water containing cysts.
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