State of California
Department of Health Services
Water Treatment Device
Certificate Number
06-1834
Date Issued: December 6, 2006
The water treatment
116830 of the Heait
< <
Micr ob iolo
Cysts
Turbidity;:
i! ii ii
OrR
_ursuant to Section
2, 4D
_ i ¸ _
c
Rated
o_C er tffication
Do not use where water is mnicrobiologic_lly _fe 6r with watcr 6f U_wn quality, except that systems certified for
cyst reduction may be used on disinfected waters that may contain filterable cysts.
For Purchases Made In Iowa: This form must be signed and dated bg the buger and seller prior to the consummation of this
sale. This form should be retained on file bg the seller for a minimum of two gears.
BUYER: SELLER:
Name Name
Address Address
Citg State Zip Citg
Signature Date Signature
42
State Zip
Date
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