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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 <br />Dispenser <br />MANUFACTURER 6 ;) 6reo E SCVS DSL <br />SPECIFIC. MODEL 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___ -2-2— <br /># <br />2-2— <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.' LENGTH 4= <br />I I A <br />I I L <br />I � I <br />WATER SPLASH LIP -6. <br />Does conduit exist within 2" of the inner opening? _ ( IF YES, IMAGES ARE REQUIRED ) <br />c: <br />2; Does conduit exist outside of the UDC water splash lip? ( 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 />Ring IN <br />(DBPAVO www.SBRAvo.COM4'=made�A" <br />'1�P�/ <br />800-AT-BRAVO <br />PROBLEM SOLVED am I. in USA MCMBEa <br />