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Dispenser Conversion Evaluation Form <br />Distributor: Sales Person: P.O. # <br />Existing Dispenser <br />MANUFACTURER <br />SPECIFIC MODEL NUMBER <br />NEW Dispenser <br />MANUFACTURER 61 1 1areo E SODS <br />SPECIFIC. I ODEL NUMBER <br />Existing UDC Sump <br />Is it a Bravo UDC? ❑ or Make/Model <br />Shallow pan or Deep Sump? <br />Water splash lip opening (I.D.): Length Z Width <br /># of eXisting Anchor Bolts for concrete pad / island: <br />Does the existing UDC have a water splash lip? _ <br />THE FOLLOWING APPLIES TO THE STATE OF CALIFORNIA ONLY <br />HYDRAULIC CABINET <br />I � <br />I 1 <br />I`_+1 <br />WATER SPLASH LIP <br />1 Does conduit exist within 2" of the inner opening? ( IF YES, IMAGES ARE REQUIRED ) <br />2 Does conduit exist outside of the UDC water splash lip? ( IF YES, IMAGES ARE REQUIRED ) <br />FOR ASSISTANCE, CALL 804 -AT -BRAVO <br />FAX TO 323-888-4123 OR EMAIL TO YOUR SALES REPRESENTATIVE <br />12A <br />BRAVO WWW.SBRAV�.C�M .... made Certified <br />WBE800-AT-BRAVO ""'� <br />PROBLEMSDLVF_❑ ».- in USA 1hmn�n's1lluinut�naajKiu MEMBER <br />