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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 />MANUFACTURERS G1 1 r -c® L soc)s 1JS� <br />SPEGIFI ; 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 3 Width I �' <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 />C CABINET <br />tENGIh <br />1;= 2 <br />WATER SPLASH LIP <br />r_'= , <br />,1 <br />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 800 -AT -BRAVO <br />FAX TO 323-888-4123 OR EMAIL TO YOUR SALES REPRESENTATIVE <br />12A <br />B14AVO <br />WVWV.SBRAVO.COM made C eTcfjled�■,PROBLEMSOL800-AT-BRAVO in USA ��,�� ��r='' <br />