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Dispenser Conversion Evaluation Form <br />Distributor: <br />Sales Person: <br />Existing Dispenser <br />MANUFACTURER <br />SPECIFIC MODEL NUMBER <br />P.O. # <br />Existing UDC Sum DISPENSER / HYDRAULIC CABINET <br />LENGTH <br />Is it a Bravo UDC? 1:1 or Make/Model <br />Shallow pan or Deep Sump? <br />Water splash lip opening (I.D.): Length Width 110 WATER SPLASH LIP <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 />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? <br />:2: _ (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 />BRkV0 WWW.SBRAVO.COM made r - <br />PROBLEMSOLVED 800 -AT -BRAVO'"""'"' in USA '�MENC ?cm)'Pff <br />I 4r <br />D15? <br />N E W <br />D <br />MANUFACTURER <br />_bar <br />JLa <br />E ,5DE D5L <br />ZI <br />SPECIFIC MODEL NUNIBLER <br />Existing UDC Sum DISPENSER / HYDRAULIC CABINET <br />LENGTH <br />Is it a Bravo UDC? 1:1 or Make/Model <br />Shallow pan or Deep Sump? <br />Water splash lip opening (I.D.): Length Width 110 WATER SPLASH LIP <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 />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? <br />:2: _ (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 />BRkV0 WWW.SBRAVO.COM made r - <br />PROBLEMSOLVED 800 -AT -BRAVO'"""'"' in USA '�MENC ?cm)'Pff <br />