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Dispenser Conversion Evaluation Form <br /> Distributor: Sales Person: P.O. # <br /> MAY231� 206 <br /> Existing Dispenser <br /> MANUFACTURER ee o <br /> SPECIFIC MODEL NUMBERdy���� � <br /> NEW Dispenser <br /> MANUFACTURER _ GicFsYcU <br /> SPECIFIC MODEL NUMBER ,Co �vc� ,�J 1' <br /> • ■ [::I <br /> Existing UDC Sump <br /> Is it a Bravo UDC? 0 or Make/Model Shallow pan or Deep Sump? S -*0 a0wWater splash lip opening (I.D.): Length, +"' Width a* ;PP <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 /> 17 Does conduit exist within 2" of the inner opening? o0W (IF YES, IMAGES ARE REQUIRED) <br /> cra <br /> i <br /> 12; Does conduit exist outside of the UDC water splash lip? OW (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 /> _l BRAVO WWW.SBRAVO.COM made ` � 5i" - <br /> PROBLEMBOLVED 800-AT-BRAVO 4■II�.. in USA ��a'^'^�b���-+ F�n�nia " EMBER <br />