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Dispenser Conversion Evaluation Form <br />Distributor: Sales Person: P.O. # <br />Existing Dispenser <br />MANUFACTURER <br />SPECIFIC MODEL NUMBER <br />� mNEW onr <br />ps�e <br />1 <br />ECIFIC MODEL NUMBER <br />Existing UDC SumpbDIOSPENSERRAULIC CA <br />Is it a Bravo UDC? F� or Make/Model <br />Shallow pan or Deep Sump? L <br />Water splash lip opening (I.D.): Length 22 e Width_ ID <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 />1 <br />1; Does conduit exist within 2" of the inner opening? ( IF YES, IMAGES ARE REQUIRED ) <br />�Does conduit exist outside of the UDC water splash lip? (IF YES, IMAGES ARE REQUIRED ) <br />1 <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 �w.. made Cercrjfed (�P�'1 <br />•BRNO.�' � <br />800 -AT -BRAVO "'"" USA � �PROBLEM SOLVEO dam. In tSil:m�i's Lt„an,rse En!��pr;k' rvi L M B G R <br />