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CONVERSION ORDER FORM <br /> REQUIRED INFORMATION <br /> PLEASE PRINT CLEARLY - FILL ❑UT THE SECTIONS BELOW <br /> DISTRIBUTOR: SALES PERSON: P.O. # <br /> Cj - /L7�Z, -- qd-7 J <br /> ExiSTINWOLD DISPENSER <br /> MANUFACTURER aft6le%o <br /> SERIES / MAKE <br /> MODEL NUMBERW <br /> THIS INFORMATION IS NEEDED TO DETERMINE NUMBER OF OFFSETS, IF ANY <br /> UDC Sump <br /> a <br /> 21—B RAVO BOX? OR MANUFADTURER LICNOTH <br /> SHALLOW PAN OR DEEP SUMP - :�-✓"'(�l..C.'wl <br /> WATER SPLASH OPENING: LENGTH ^k 1, WIDTH <br /> /Y <br /> OF ANCHOR BOLTS: LENGTH WIDTH �( 7/ <br /> WArzRap <br /> DOES THE LDDC HAVE A WATERCPLABH LIP? "KI YES ❑ ND <br /> THIS INFORMATION DEFINES THE UDC SUMP OPENING AND DETERMINES FRAME DIMENSIONS <br /> NEW/REPLACEMENT DISPENSER <br /> MANUFACTURER 00,1214PrO <br /> SERIES / MAKE 1w"V147V V I.-- <br /> MODEL NUMBER <br /> THIS INFORMATION CONFIRMS COMPLETE PIPING OFFSET PROFILE, DISPENSER-SPECIFIC <br /> WATER SPLASH RUNOFF PROFILE, AND ACCURATE ANCHOR POINT LOCATIONS <br /> FAX WITH C O NV- B Z ❑ ❑ ❑ ORDER <br /> PHONE: 323-888-4133 FAX: 323-888-4123 <br /> YEIj� <br /> S. BRAVO SYSTEMS, INC - 2929 Vail Avenue - Commerce - CA - 90040 <br /> sraTUds Fax: 323/888-4123 - E-mail: info@sbravo.com - www.sbravo.com Conn-B2000OrdeT Form <br />