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Drinking Water Treatment Device Information Form
*Population Centre:
*Source of Information:
Device
*Name
*Model Number
Other ID
Manufacturer
*Name
Address
*(Location-city & state/province)
Telephone :	Fax :	Email :	Website :
Distributor
Name
Address
Telephone :	Fax :	Email :	Website :
Certification
*ANSI/NSF Standard(s)	NSF-
*Other Standard
Certification Organization
*Name
Address
*(Location-city & state/province)
Telephone :	Fax :	Email :	Website :
*Performance Claims: ?

*Essential Data