Document MMVEYwwYepm7w3LOpz2ZpvG0x

NATIONAL SANITATION FOUNDATION MATERIAL FORMULATION CONFIDENTIAL REPORT Document Regional Regional Control Code SW00146-001 Office 04 Company Number 24300 Issue Date 11/30/89 Representative MDF * * * DO NOT DUPLICATE Standard CBl Code *** Numbcr_5J>- l. -PROGRAM PARTICIPANT JACUZZI BROTHERS DIVISION MR. JEFF ROUSSEL 12401 INTERSTATE-30 P0 BOX 8903 LITTLE ROCK, AR 72219-8903 Plant At: LITTLE ROCK, AR II. MODEL(S) Equipment Model Number(s) ST27 & ST33 Description of Equipment SAND FILTERS III. PART(S) Description of Part(s) DRAIN BUSHING & FILL PLUG Part :Numbe:r(s) Fabricated by JACUZZI BROTHERS Surface Are^qf Part(sP(sq. in.) !dnjtact Area Part is (X| Pool Water =*G<mtact Temperature (Range) Part(a) Exposed to 32-104 "F (sq- in.) 72219-8903 IV. SUPPLIER |r, i# BasicsMaterial SujSlieig$ B.F. GOODRICH Material Type Comp let e Fo rmu la t SRVC/CLEAR 411; |S:7407-0G9 ,,GEONh l IB ^Natural ( ) gJrecolored: ( ] !35ee Form V. IMPOSITION OF FORMULATION AND 3ERTINENT.J3ATA ~ USE REVERSE SIDE. liSPBe Completed By Basic Matetrial/Pigment/Supplier. ||||f *** NOTE: 21 CFR citation or otKl;r"16SUmentation required. *** VI. CERTIFICATION It is herein certified that this material is intended for the specific end use application. It is further certified that the information provided is accurate and complete and, that I, and the company I represent, know of no reason this material should not be used in pool/spa/hot tub water contact. Company BASIC && Signature Title Address_______________ _______ Telephone 2/0 ~~ Date MATERIAL SUPPLIER / c/f C,/S<? FAX %/L - A Mir* - AC 0 C C fry* #4* Seal Ln the BLUE envelope provided. Insert in an outer envelope and MAIL TO: Toxicological Services National Sanitation Foundation P.O. Box 1468 Ann Arbor, MI 48106 Page (1) 21537002 BFG14891