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0 <br />Dispenser Conversion Evaluation Form <br />Distributor: <br />Sales Person: <br />Existing Dispenser <br />MANUFACTURER <br />SPECIFIC MODEL NUMBER <br />P.O. # <br />Existing UDC Sump DISPENSER f HYDRAULIC CABINET <br />0 <br />Is it a Bravo UDC? or Make/Model <br />Shallow pan or Deep Sump? <br />Water splash lip opening (I.D.): Length_.. Z WidthP s <br />. . . . . . . . . . . <br />N LIP <br /># of existing Anchor Bolts for concrete pad island: 2 <br />Does the existing UDC have a water splash lip? <br />THE FOLLOWING APPLIES TO THE STATE OF CALIFORNIA ONLY <br />1 Does conduit exist within 2" of the inner opening? <br />i _ (IF YES, IMAGES ARE REQUIRED) <br />Does conduit exist outside of the <br />12 <br />e UDC water splash lip? <br />S --- i _ (IF YES, IMAGES ARE REQUIRED) <br />FOR ASSISTANCE, CALL 800 -AT -BRAVO <br />FAX TO 323-888-4123 OR EMAIL TO YOUR SALES REPRESENTATIVE <br />12A <br />WWW.SBRAVO.COM made 7-- -1 <br />• PROBLEM SOLVED 800 -AT -BRAVO in USA M E M B . ER <br />