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Dispenser Conversion Evaluationt. <br /> 2016 <br /> Distributor: Sales Person: P.O. # <br /> nry,M oF1Nt , <br /> Existing Dispenser <br /> MANUFACTURERiLeir2ct� <br /> SPECIFIC MODEL NUMBER <br /> NEW Dispenser <br /> MANUFACTURER <br /> SPECIFIC MODEL NUMBER <br /> Existing UDC Sump DISPENSER/ HYDRAULIC CABINET <br /> LENGTH -�' - <br /> Is it a Bravo UDC? ® or Make/Model /�/Mhd�i/4fti f✓ � ;-7. 2 <br /> Shallow pan or Deep Sump? ..-�r'lewGZGtc p <br /> Water splash lip opening(I.D.): Length Width / ;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 /> i Does conduit exist within 2" of the inner opening? 01/4' ( IF YES, IMAGES ARE REQUIRED) <br /> c: <br /> 12 Does conduit exist outside of the UDC water splash lip? /✓A (IF YES, IMAGES ARE REQUIRED) <br /> FOR ASSISTANCE, CALL 800-AT-BRAV0 <br /> FAX TO 323-888-4123 OR EMAIL TO YOUR SALES REPRESENTATIVE <br /> 12A <br /> BRAVOR WWW.SBRAVO.COM rpade. {pcc,IN1«,l �� I <br /> PROBLEM SOLVED <br /> 800-AT-BRAVOl., in USA 1e F 'u MEMBE0. <br />